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Clinicians have hoped that repetitive transcranial magnetic stimulation (rTMS) could replace ECT for some depressed patients, but effectiveness data have been variable. In this manufacturer-sponsored, blinded study, 301 medication-free, depressed patients who had failed an average of 1.6 antidepressant trials were randomized to rTMS or sham rTMS for 6 weeks. Case patients received fast rTMS (10 pulses/second, 3000 pulses/session, at 120% of motor threshold) over the left dorsolateral prefrontal cortex. Compared with control patients, case patients had lower mean symptom severity on the Montgomery-Asberg Depression Rating Scale (MADRS); the difference was small but significant.
At 4 and 6 weeks, mean MADRS scores were similar between groups. …