Electroconvulsive therapy (ECT) is a form of treatment for depression that is administered over a period of days and weeks. Individuals with chronic and severe depression, and those who do not respond well to medication or traditional treatments, may benefit from this type of approach. However, the more exposure a client has to ECT, the higher the risk of cognitive impairment. Repetitive transcranial magnetic stimulation (rTMS) is another type of treatment that involves stimulating certain regions of the brain to improve synapsis plasticity. This technique is also administered over days and weeks and has been shown to be effective at reducing the symptoms and severity of depression. Unlike ECT, existing research has shown that this treatment does not cognitively impair clients. But there is not enough research to determine whether the frequency and duration of treatment influences overall effectiveness.
To address this void in research, Cherrie Galletly of the Adelaide Clinic at Ramsay Health Care Mental Health Services in South Australia recently conducted a study comparing daily rTMS to nondaily rTMS. Galletly enrolled 77 participants with major depression into the study, many of whom had co-occurring mental health problems such as abuse issues, posttraumatic stress, and substance misuse. The participants were placed either in the daily rTMS condition where they received treatment 5 days every week for 4 weeks or in the nondaily condition where they received only three rTMS sessions a week for 6 weeks.
Galletly chose this sampling of participants because she wanted her test subjects to mimic real-life clinical situations, in which a large number of depressed individuals also have other mental health problems. Additionally, the participants were selected only if they had been resistant to other forms of treatment, including medication. Galletly found that after 4 weeks, the group with daily treatment had better outcomes than the nondaily group. However, when Galletly examined both groups at 6 weeks, their responses were equally good. These results suggest that the overall number of rTMS sessions influences outcome rather than the duration of treatment. Galletly said that the results indicate that “the efficacy of rTMS is related to the number of treatments given and that spacing the treatments neither improves nor reduces efficacy.”
Galletly, C., Gill, S., Clarke, P., Burton, C., Fitzgerald, P. B. (2012). A randomized trial comparing repetitive transcranial magnetic stimulation given 3 days/week and 5 days/week for the treatment of major depression: Is efficacy related to the duration of treatment or the number of treatments? Psychological Medicine, 42.5, 981-988.
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