5 Hz Repetitive transcranial magnetic stimulation to left prefrontal cortex for major depression

• Published in: Journal of affective disorders 2015-11, Vol.186, p.13-17
• Main Authors: Philip, Noah S, Carpenter, S. Louisa, Ridout, Samuel J, Sanchez, George, Albright, Sarah E, Tyrka, Audrey R, Price, Lawrence H, Carpenter, Linda L
• Format: Article
• Language: English
• Subjects: Psychiatry
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2014.12.024

Abstract Background Repetitive transcranial magnetic stimulation (rTMS) to left prefrontal cortex at 10 Hz is the most commonly utilized protocol for major depressive disorder (MDD). Published data suggests that left sided 5 Hz rTMS may be efficacious and well tolerated. Objective We analyzed outcomes in a naturalistic cohort of MDD patients who could not tolerate 10 Hz rTMS and were routinely switched to 5 Hz. We hypothesized that the efficacy of 5 Hz rTMS would be equivalent to 10 Hz. Methods Records were reviewed for patients ( n =98) who received 15 or more acute rTMS treatments. The sample was split based upon the frequency (10 or 5 Hz) at which the majority of treatments were delivered. The Inventory of Depressive Symptoms (IDS-SR) and 9-Item Patient Health Questionnaire (PHQ-9) were used to evaluate outcomes. Results Baseline IDS-SR was higher in the 5 Hz ( n =27) than in the 10 Hz ( n =71) group ( p .1). Statistical power was sufficient to detect small group differences ( d =.26). Limitations Open-label data in a naturalistic setting. Conclusion Outcomes associated with 5 Hz rTMS did not differ from 10 Hz, despite higher baseline depressive symptom severity and anxiety in 5 Hz patients. 5 Hz stimulation may be an alternative treatment option for patients unable to tolerate 10 Hz rTMS.