Background
In Egypt, major depressive disorder (MDD) is the most common mental disorder. Its prevalence is about 2.7% among other mental disorders. There is a significant effect of MDD on the quality of life (QOL) of the affected. Anxiety, a common co-occurring symptom in depression, affects as many as 90% of all patients with depression. Repetitive transcranial magnetic stimulation (rTMS) has become a clinically approved, recognized, and acceptable therapeutic intervention for treatment-resistant depression.
Patients and Methods
We recruited 51 patients diagnosed with moderate to severe MDD in this double-blinded sham-controlled trial. Age range was from 18 to 60 years. Patients were randomly assigned (1:1:1) to three study groups [10-Hz rTMS, intermittent theta-burst stimulation (iTBS), or sham]. Sessions were conducted by applying 10-Hz rTMS, iTBS, or sham to the left dorsolateral prefrontal cortex with a schedule of five successive daily sessions a week for 4–6 weeks. Sessions were delivered through a figure-of-eight coil connected to the Neurosoft rTMS system. The outcome measures were the change in anxiety and QOL scores between baseline and after interventions as measured by Hamilton Anxiety Rating Scale and QOL scale, respectively.
Results
The improvement of anxiety symptoms was measured by the change in scores of the Hamilton Anxiety Rating Scale between baseline and after 4 weeks of intervention. There were significant differences between active groups (10-Hz rTMS and iTBS) versus sham group with a highly statistically significant difference favoring 10-Hz rTMS (11.6±5.9; 48.9%) over sham (2.2±2.7; 8.4%) (P<0.001), also, there was a significant difference favoring iTBS (13.2±5.32; 54.3%) over sham (2.2±2.75; 8.4%) (P<0.001). Regarding QOL, the 10-Hz rTMS group showed a mean of improvement of 20±11.4 points on the scale (54.9%) in comparison with 2.2±2.33 (5.8%) in the sham group (P<0.001). Further, iTBS showed a change of 20.7±9.55 (63.18%) versus 2.2±2.34 (5.8%) in the sham group (P<0.001).
Conclusions
Both conventional 10-Hz rTMS and iTBS are efficacious and tolerable not only in the management of treatment resistant MDD but also in improving comorbid anxiety and QOL.