Low frequency rTMS, inhibits the antidepressive effect of ECT. A pilot study

OBJECTIVE Low frequency rTMS of the prefrontal cortex have been shown to have a statistically and clinically significant antidepressant effect. The present pilot study was carried out to investigate if right prefrontal low frequency rTMS as an add-on to ECT accelerates the antidepressant effect and reduces cognitive side effects. METHODS In this randomized, 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. 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 antidepressant effect of ECT.