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Effect of rTMS on Treatment-Resistant Depression

JAMA Psychiatry; ePub 2018 Jun 27; Yesavage, et al

In a recent randomized clinical trial to determine the efficacy of repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant major depression (TRMD), 164 US veterans with depression showed an overall remission rate of 39%, with no significant difference between the active and sham groups. Patients with comorbid posttraumatic stress disorder (PTSD) showed the least improvement. Participants were randomized to either left prefrontal rTMS treatment (10 Hz, 120% motor threshold, 4,000 pulses/session) or to sham (control) rTMS treatment for up to 30 treatment sessions. Total participants had a mean (SD) age of 55.2 (12.4) years, 132 (80.5%) were men, and 126 (76.8%) were of white race. Of these, 81 were randomized to receive active rTMS and 83 to receive sham. Researchers found:

  • For the primary analysis of remission, there was no significant effect of treatment.
  • At the end of the acute treatment phase, 33 of 81 (40.7%) of those in the active treatment group achieved remission of depressive symptoms compared with 31 of 83 (37.4%) of those in the sham treatment group.
  • Overall, 64 of 164 (39.0%) of the participants achieved remission.


Yesavage JA, Fairchild JK, Mi Z, et al, for the VA Cooperative Studies Program Study Team. [Published online ahead of print June 27, 2018]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2018.1483.