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Transcranial magnetic stimulation accelerates the antidepressant effect of amitriptyline in severe depression: a double-blind placebo-controlled study.
Biol Psychiatry. 2005 Jan 15; 57(2):162-6.BP

Abstract

BACKGROUND

Transcranial magnetic stimulation (TMS) is a noninvasive method to stimulate the cortex, and the treatment of depression is one of its potential therapeutic applications. Three recent meta analyses strongly suggest its benefits in the treatment of depression. The present study investigates whether repetitive TMS (rTMS) accelerates the onset of action and increases the therapeutic effects of amitriptyline.

METHODS

Forty-six outpatients meeting DSM-IV criteria for nonpsychotic depressive episode were randomly assigned to receive rTMS (n = 22) or sham repetitive TMS (sham) (n = 24) during 4 weeks over dorsolateral prefrontal cortex (DLPFC) in this double-blind controlled trial. All patients were concomitantly taking amitriptyline (mean dose 110 mg/d). The rTMS group received 20 sessions (5 sections per week) of 5 Hz rTMS (120% of motor threshold and 1250 pulses per session). Sham stimulation followed the same schedule, however, using a sham coil. The efficacy variables were the Hamilton Depression Rating Scale-17 items (HAM-D/17), the Montgomery-Asberg Depression Rating Scale (MADRS), a Visual Analogue Scale (VAS), and the Clinical Global Impression (CGI). Tolerability was assessed by clinical examination and a safety screening of TMS side effects.

RESULTS

Repetitive TMS had a significantly faster response to amitriptyline. There was a significant decrease in HAM-D/17 scores, already after the first week of treatment (p < .001 compared with baseline and p < .001 compared with sham). The decrease in HAM-D/17 scores in the rTMS group was significantly superior compared with the sham group throughout the study (p < .001 at fourth week).

CONCLUSIONS

Repetitive TMS at 5 Hz accelerated the onset of action and augmented the response to amitriptyline.

Authors+Show Affiliations

Institute of Psychiatry, University of São Paulo, Faculty of Medicine, São Paulo-SP, Brazil. drumi@usp.brNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15652875

Citation

Rumi, Demetrio Ortega, et al. "Transcranial Magnetic Stimulation Accelerates the Antidepressant Effect of Amitriptyline in Severe Depression: a Double-blind Placebo-controlled Study." Biological Psychiatry, vol. 57, no. 2, 2005, pp. 162-6.
Rumi DO, Gattaz WF, Rigonatti SP, et al. Transcranial magnetic stimulation accelerates the antidepressant effect of amitriptyline in severe depression: a double-blind placebo-controlled study. Biol Psychiatry. 2005;57(2):162-6.
Rumi, D. O., Gattaz, W. F., Rigonatti, S. P., Rosa, M. A., Fregni, F., Rosa, M. O., Mansur, C., Myczkowski, M. L., Moreno, R. A., & Marcolin, M. A. (2005). Transcranial magnetic stimulation accelerates the antidepressant effect of amitriptyline in severe depression: a double-blind placebo-controlled study. Biological Psychiatry, 57(2), 162-6.
Rumi DO, et al. Transcranial Magnetic Stimulation Accelerates the Antidepressant Effect of Amitriptyline in Severe Depression: a Double-blind Placebo-controlled Study. Biol Psychiatry. 2005 Jan 15;57(2):162-6. PubMed PMID: 15652875.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transcranial magnetic stimulation accelerates the antidepressant effect of amitriptyline in severe depression: a double-blind placebo-controlled study. AU - Rumi,Demetrio Ortega, AU - Gattaz,Wagner F, AU - Rigonatti,Sergio Paulo, AU - Rosa,Moacyr Alexandro, AU - Fregni,Felipe, AU - Rosa,Marina Odebrecht, AU - Mansur,Carlos, AU - Myczkowski,Martin Luiz, AU - Moreno,Ricardo Alberto, AU - Marcolin,Marco Antonio, PY - 2004/06/01/received PY - 2004/10/18/revised PY - 2004/10/27/accepted PY - 2005/1/18/pubmed PY - 2005/5/21/medline PY - 2005/1/18/entrez SP - 162 EP - 6 JF - Biological psychiatry JO - Biol Psychiatry VL - 57 IS - 2 N2 - BACKGROUND: Transcranial magnetic stimulation (TMS) is a noninvasive method to stimulate the cortex, and the treatment of depression is one of its potential therapeutic applications. Three recent meta analyses strongly suggest its benefits in the treatment of depression. The present study investigates whether repetitive TMS (rTMS) accelerates the onset of action and increases the therapeutic effects of amitriptyline. METHODS: Forty-six outpatients meeting DSM-IV criteria for nonpsychotic depressive episode were randomly assigned to receive rTMS (n = 22) or sham repetitive TMS (sham) (n = 24) during 4 weeks over dorsolateral prefrontal cortex (DLPFC) in this double-blind controlled trial. All patients were concomitantly taking amitriptyline (mean dose 110 mg/d). The rTMS group received 20 sessions (5 sections per week) of 5 Hz rTMS (120% of motor threshold and 1250 pulses per session). Sham stimulation followed the same schedule, however, using a sham coil. The efficacy variables were the Hamilton Depression Rating Scale-17 items (HAM-D/17), the Montgomery-Asberg Depression Rating Scale (MADRS), a Visual Analogue Scale (VAS), and the Clinical Global Impression (CGI). Tolerability was assessed by clinical examination and a safety screening of TMS side effects. RESULTS: Repetitive TMS had a significantly faster response to amitriptyline. There was a significant decrease in HAM-D/17 scores, already after the first week of treatment (p < .001 compared with baseline and p < .001 compared with sham). The decrease in HAM-D/17 scores in the rTMS group was significantly superior compared with the sham group throughout the study (p < .001 at fourth week). CONCLUSIONS: Repetitive TMS at 5 Hz accelerated the onset of action and augmented the response to amitriptyline. SN - 0006-3223 UR - https://www.unboundmedicine.com/medline/citation/15652875/Transcranial_magnetic_stimulation_accelerates_the_antidepressant_effect_of_amitriptyline_in_severe_depression:_a_double_blind_placebo_controlled_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0006-3223(04)01109-6 DB - PRIME DP - Unbound Medicine ER -