Rapid symptom improvement in major depressive disorder using accelerated repetitive transcranial magnetic stimulation
Soo-Jeong Kim 1, 2, Sang Joon Son 3, Mi Jang 4, Byung-Hoon Kim 1, 2, Seok Joo Hong 3, Lina Seo 3, Sun-Woo Choi 2, Jeong-Ho Seok 1, 2*, Jai Sung Noh 3
1Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, 63gil 20 Eonju-ro, Gangnam-gu, Seoul 06229, Republic of Korea, 2Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea, 3Department of Psychiatry, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do 16499, Republic of Korea, 4Department of Mental Health Services, National Center for Mental Health, 127, Yongmasan-ro, Gwangjin-gu, Seoul 04933, Republic of Korea
Received: January 28, 2020; Revised: February 28, 2020; Accepted: March 11, 2020; Published online: March 11, 2020.
© The Korean College of Neuropsychopharmacology. All rights reserved.

Abstract
Abstract
Objectives: Repetitive transcranial magnetic stimulation (rTMS) has contributed to increase in the remission rate for patients with major depressive disorder (MDD). However, current rTMS treatment is practically inconvenient because it requires daily treatment sessions for several weeks. Accelerated rTMS treatment is as efficient and safe for MDD patients as conventional rTMS.
Methods: Fifty-one patients with MDD participated in this study; they were randomized into accelerated rTMS (21), conventional rTMS (22), and sham-treatment (8) groups. The accelerated and conventional rTMS groups received 15 sessions for 3 days and 3 weeks, respectively. The sham-treatment group received 15 sham rTMS sessions for 3 days. Primary outcome was assessed using self-report and clinician-rated Korean Quick Inventory of Depressive Symptomatology (KQIDS-SR and KQIDS-C, respectively). Adverse effects were monitored using the Frequency, Intensity, and Burden of Side Effects Rating scale. Changes in depressive symptoms were compared among the three groups using mixed model analyses.
Results: For the KQIDS-SR score, there was a significant main effect of “time” (F3,47=11.05, p<0.001), but no effect of “group” (F2,47=2.04, p=0.142), and a trend-level interaction effect of “group×time” (F6,47=2.26, p=0.053). Improvement in depressive symptoms, based on the KQIDS-SR score 3 weeks after treatment, was more prominent in the accelerated rTMS group than in the sham-treatment group (p=0.011). Tolerability was comparable among the three groups.
Conclusions: The accelerated rTMS treatment group showed rapid improvement of depressive symptoms compared with the sham-treatment and conventional rTMS treatment groups. Therefore, accelerated rTMS treatment could be a viable option for MDD, with improved accessibility.
Keywords: repetitive transcranial magnetic stimulation, major depressive disorder, effectiveness, safety, rapid improvement, accessibility


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