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Low-frequency rTMS inhibits the anti-depressive effect of ECT. A pilot study

Published online by Cambridge University Press:  27 July 2020

Poul Erik Buchholtz Open the ORCID record for Poul Erik Buchholtz [Opens in a new window] ,
Mahmoud Ashkanian ,
Simon Hjerrild ,
Line Kirstine Hauptmann ,
Torben Albert Devantier ,
Paulina Jensen ,
Sanne Wissing ,
Mette Viller Thorgaard ,
Laerke Bjerager  and
Julie Lund
...Show all authors
Poul Erik Buchholtz*
Affiliation:
Department for Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
Mahmoud Ashkanian
Affiliation:
Department for Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
Simon Hjerrild
Affiliation:
Department for Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
Line Kirstine Hauptmann
Affiliation:
Department for Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
Torben Albert Devantier
Affiliation:
Department for Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
Paulina Jensen
Affiliation:
Department for Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
Sanne Wissing
Affiliation:
Department for Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
Mette Viller Thorgaard
Affiliation:
Department for Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
Laerke Bjerager
Affiliation:
Department for Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
Julie Lund
Affiliation:
Department for Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
Anja Johnsen Alrø
Affiliation:
Department for Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
Maria Simonsen Speed
Affiliation:
Department for Affective Disorders, Aarhus University Hospital, Aarhus, Denmark Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
Rene Børge Korsgaard Brund
Affiliation:
Department for Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
Poul Videbech
Affiliation:
Center for Neuropsychiatric Depression Research, Mental Health Center Glostrup, Copenhagen, Denmark
*
Author for correspondence: Poul Erik Buchholtz, Email: poulhans@rm.dk
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Abstract

Objective:

Low-frequency repetitive transcranial magnetic stimulation (rTMS) of the prefrontal cortex has been shown to have a statistically and clinically significant anti-depressant effect. The present pilot study was carried out to investigate if right prefrontal low-frequency rTMS as an add-on to electroconvulsive therapy (ECT) accelerates the anti-depressant effect and reduces cognitive side effects.

Methods:

In this randomised, controlled, double-blind study, thirty-five patients with major depression were allocated to ECT+placebo or ECT+low-frequency right prefrontal rTMS. The severity of depression was evaluated during the course using the Hamilton scale for depression (the 17-item as well as the 6-item scale) and the major depression inventory (MDI). Furthermore, neuropsychological assessment of cognitive function was carried out.

Results:

The study revealed no significant difference between the two groups for any of the outcomes, but with a visible trend to lower scores for MDI after treatment in the placebo group. The negative impact of ECT on neurocognitive functions was short-lived, and scores on logical memory were significantly improved compared to baseline 4 weeks after last treatment. The ECT-rTMS group revealed generally less impairment of cognitive functions than the ECT-placebo group.

Conclusion:

The addition of low-frequency rTMS as an add-on to ECT treatment did not result in an accelerated response. On the contrary, the results suggest that low-frequency rTMS could inhibit the anti-depressant effect of ECT.

Keywords

low-frequency transcranial magnetic stimulation (rTMS)electroconvulsive therapy (ECT)depressionrandomised trial
Type
Original Article
Information
Acta Neuropsychiatrica , Volume 32 , Issue 6 , December 2020 , pp. 328 - 338
Copyright
© Scandinavian College of Neuropsychopharmacology 2020

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