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Transcranial magnetic stimulation helpful in psychiatric disorders

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Pooled data from multiple studies indicate that repetitive transcranial magnetic stimulation (rTMS) is useful for depression, auditory verbal hallucinations, and possibly for negative symptoms of schizophrenia as well, according to Dutch researchers.

Dr. Christina W. Slotema of Parnassia Bavo Psychiatric Institute, the Hague, and colleagues say in a March 9th online paper in the Journal of Clinical Psychiatry that although rTMS is safe, its efficacy in various psychiatric disorders has been unclear.

Their meta-analysis included 34 studies of depression, 7 studies of patients with auditory verbal hallucinations, 7 studies of schizophrenics with negative symptoms, and 3 studies of subjects with obsessive-compulsive disorder – all randomized trials of rTMS versus sham therapy.

An additional 6 studies compared rTMS with electroconvulsive therapy for depression. Electroconvulsive therapy gave significantly superior results.

However, rTMS (n = 751) was significantly better than sham therapy (n = 632) for depression, and it was better as monotherapy than as an adjunct to antidepressant medication.

rTMS (n = 105) was also significantly more effective than sham therapy (n = 84) for auditory verbal hallucinations.

In schizophrenic patients with negative symptoms, however, treated subjects (n = 74) showed only a trend toward improvement compared to those who received sham therapy (n = 74). Moreover, 24% of the intervention group had side effects compared with 0% in the placebo group. rTMS had no significant effect in patients with obsessive-compulsive disorder.

Side effects were transient and mild overall, and the researchers conclude that “rTMS deserves a place in the standard toolbox of psychiatric treatment methods.”

They add that although rTMS can’t replace electroconvulsive therapy for depression, “there may be subgroups in which rTMS can replace antidepressant medication.”

J Clin Psychiatry 2010.