BRAIN STIMULATION: Basic, Translational, and Clinical Research in Neuromodulation
Volume 2, Issue 1 , Pages 14-21 , January 2009

Controversy: Repetitive transcranial magnetic stimulation or transcranial direct current stimulation shows efficacy in treating psychiatric diseases (depression, mania, schizophrenia, obsessive-complusive disorder, panic, posttraumatic stress disorder)

  • Mark S. George, MD

      Affiliations

    • Brain Stimulation Laboratory, Psychiatry Department, Medical University of South Carolina, Charleston, South Carolina
    • Corresponding Author InformationCorrespondence and reprint requests: Dr. Mark George, Brain Stimulation Laboratory, Department of Psychiatry, Medical University of South Carolina, 502 N, IOP, 67 President St, Charleston, SC 29425.
    • ,
  • Frank Padberg, MD

      Affiliations

    • Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University Munich, Munich, Germany
    • ,
  • Thomas E. Schlaepfer, MD

      Affiliations

    • Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
    • Departments of Psychiatry and Mental Health, The Johns Hopkins University, Baltimore, Maryland
    • ,
  • John P. O'Reardon, MD

      Affiliations

    • Neuromodulation Treatment & Research Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
    • ,
  • Paul B. Fitzgerald, MBBS, MPM, PhD, FRANZCP

      Affiliations

    • Alfred Psychiatry Research Centre, The Alfred and Monash University School of Psychology, Psychiatry and Psychological Medicine, Victoria, Australia
    • ,
  • Ziad H. Nahas, MD

      Affiliations

    • Brain Stimulation Laboratory, Psychiatry Department, Medical University of South Carolina, Charleston, South Carolina
    • ,
  • Marco A. Marcolin, MD

      Affiliations

    • Neuromodulation Research Lab, Psychiatry Department, University of São Paulo, SP, Brazil

Received 6 June 2008 ,Accepted 6 June 2008.

References 

  1. George MS, Belmaker RH. TMS in clinical psychiatry. Washington, DC: American Psychiatric Press; 2006;
  2. George MS, Nahas Z, Borckardt JJ, et al. Brain stimulation for the treatment of psychiatric disorders. Curr Opin Psychiatry. 2007;20(3):250–254discussion 247–249
  3. George MS, Bohning DE, Li X, et al. Neuroimaging of rTMS effects on the brain. In:  Marcolin M,  Padberg F editor. Transcranial brain stimulation in mental disorders. Berlin: Karger; 2007;
  4. George MS, Nahas Z, Kozel FA, et al. Mechanisms and state of the art of transcranial magnetic stimulation. J ECT. 2002;18(4):170–181
  5. Li X, Nahas Z, Kozel FA, et al. Acute left prefrontal transcranial magnetic stimulation in depressed patients is associated with immediately increased activity in prefrontal cortical as well as subcortical regions. Biol Psychiatry. 2004;55(9):882–890
  6. Li X, Teneback CC, Nahas Z, et al. Interleaved transcranial magnetic stimulation/functional MRI confirms that lamotrigine inhibits cortical excitability in healthy young men. Neuropsychopharmacology. 2004;29(7):1395–1407
  7. Antal A, Nitsche MA, Paulus W. Transcranial direct current stimulation and the visual cortex. Brain Res Bull. 2006;68(6):459–463
  8. Higgins ES, George MS. The neuroscience of clinical psychiatry: the pathophysiology of behavior and mental illness. Baltimore: Lippincott, Williams & Wilkins; 2007;
  9. Ridding MC, Rothwell JC. Is there a future for therapeutic use of transcranial magnetic stimulation?. Nat Rev Neurosci. 2007;8(7):559–567
  10. Sackeim HA, Prudic J, Nobler MS, et al. Effects of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. Brain Stimulation. 2008;1(2):71–83
  11. Prudic J, Olfson M, Marcus SC, Fuller RB, Sackeim HA. Effectiveness of electroconvulsive therapy in community settings. [comment] Biol Psychiatry. 2004;55(3):301–312
  12. Sackeim HA, Prudic J, Devanand DP, et al. A prospective, randomized, double-blind comparison of bilateral and right unilateral electroconvulsive therapy at different stimulus intensities. Arch Gen Psychiatry. 2000;57(5):425–434
  13. Sackeim HA, Haskett RF, Mulsant BH, et al. Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial. JAMA. 2001;285(10):1299–1307
  14. Grisaru N, Yarovslavsky U, Abarbanel J, Lamberg T, Belmaker RH. Transcranial magnetic stimulation in depression and schizophrenia. Eur Neuropsychopharmacology. 1994;4:287–288
  15. Hoflich G, Kasper S, Hufnagel A, Ruhmann S, Moller HJ. Application of transcranial magnetic stimulation in treatment of drug-resistant major depression—a report of two cases. Hum Psychopharmacol. 1993;8:361–365
  16. Kolbinger HM, Hoflich G, Hufnagel A, Moller HJ, Kasper S. Transcranial magnetic stimulation (TMS) in the treatment of major depression—a pilot study. Hum Psychopharmacol. 1995;10:305–310
  17. George MS, Wassermann EM, Williams WA, et al. Daily repetitive transcranial magnetic stimulation (rTMS) improves mood in depression. Neuroreport. 1995;6(14):1853–1856
  18. George MS, Wassermann EM. Rapid-rate transcranial magnetic stimulation and ECT. Convuls Ther. 1994;10(4):251–254discussion 255–258
  19. Sackeim HA, Prudic J, Devanand DP, et al. Effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. N Engl J Med. 1993;328:839–846
  20. George MS. Why would you ever want to? Toward understanding the antidepressant effect of prefrontal rTMS. Hum Psychopharmacol. 1998;15(5):307–313
  21. Nobler MS, Sackeim HA, Prohovnik I, et al. Regional cerebral blood flow in mood disorders, III: treatment and clinical response. Arch Gen Psychiatry. 1994;51:884–897
  22. Nobler MS, Oquendo MA, Kegeles LS, et al. Decreased regional brain metabolism after ECT. Am J Psychiatry. 2001;158:305–308
  23. Bench CJ, Friston KJ, Brown RG, Frackowiak RSJ, Dolan RJ. Regional cerebral blood flow in depression measured by positron emission tomography: the relationship with clinical dimensions. Psychol Med. 1993;23:579–590
  24. Dolan RJ, Bench CJ, Brown RG, et al. Regional cerebral blood flow abnormalities in depressed patients with cognitive impairment. J Neurol Neurosurg Psych. 1992;55:768–773
  25. Bench CJ, Friston KJ, Brown RG, et al. The anatomy of melancholia—focal abnormalities of cerebral blood flow in major depression. Psychol Med. 1992;22:607–615
  26. Sackeim HA, Long J, Luber B, et al. Physical properties and quantification of the ECT stimulus: I, basic principles. Convuls Ther. 1994;10(2):93–123
  27. Nobler MS, Sackeim H. Mechanisms of action of electroconvulsive therapy. Psychiatric Ann. 1998;28:23–29
  28. Rubin E, Sackeim H, Nobler MS, Moeller JR. Brain imaging studies of antidepressant treatments. Psychiatric Ann. 1998;24:653–658
  29. Alexander GE, DeLong MR, Strick PL. Parallel organization of functionally segregated circuits linking basal ganglia and cortex. Annu Rev Neurosci. 1986;9:357–381
  30. George MS, Wassermann EM, Post RM. Transcranial magnetic stimulation: a neuropsychiatric tool for the 21st century. J Neuropsychiatry Clin Neurosci. 1996;8(4):373–382
  31. George MS, Avery D, Nahas Z, et al. rTMS studies of mood and emotion. Electroencephalogr Clin Neurophysiol Suppl. 1999;51:304–314
  32. George MS, Lisanby SH, Sackeim HA. Transcranial magnetic stimulation: applications in neuropsychiatry. Arch Gen Psychiatry. 1999;56(4):300–311
  33. Padberg F, Zwanzger P, Thoma H, et al. Repetitive transcranial magnetic stimulation (rTMS) in pharmacotherapy-refractory major depression: comparative study of fast, slow and sham rTMS. Psychiatry Res. 1999;88:163–171
  34. George MS, Wassermann EM, Kimbrell TA, et al. Mood improvement following daily left prefrontal repetitive transcranial magnetic stimulation in patients with depression: a placebo-controlled crossover trial. Am J Psychiatry. 1997;154(12):1752–1756
  35. George MS, Nahas Z, Molloy M, et al. A controlled trial of daily left prefrontal cortex TMS for treating depression. Biol Psychiatry. 2000;48(10):962–970
  36. Berman RM, Narasimhan M, Sanacora G, et al. A randomized clinical trial of repetitive transcranial magnetic stimulation in the treatment of major depression. Biol Psychiatry. 2000;47:332–337
  37. Padberg F, Zwanzger P, Keck ME, et al. Repetitive transcranial magnetic stimulation (rTMS) in major depression: relation between efficacy and stimulation intensity. Neuropsychopharmacology. 2002;27:638–645
  38. Pascual-Leone A, Rubio B, Pallardo F, Catala MD. Rapid-rate transcranial magnetic stimulation of left dorsolateral prefrontal cortex in drug-resistant depression. [comments] Lancet. 1996;348(9022):233–237
  39. Gershon AA, Dannon PN, Grunhaus L. Transcranial magnetic stimulation in the treatment of depression. Am J Psychiatry. 2003;160:835–845
  40. Kozel FA, George MS. Meta-analysis of left prefrontal repetitive transcranial magnetic stimulation (rTMS) to treat depression. J Psychiatric Pract. 2002;8:270–275
  41. Holtzheimer PE, Russo J, Avery D. A meta-analysis of repetitive transcranial magnetic stimulation in the treatment of depression. Psychopharmacol Bull. 2001;35:149–169
  42. Burt T, Lisanby SH, Sackeim HA. Neuropsychiatric applications of transcranial magnetic stimulation. Int J Neuropsychopharmacol. 2002;5(1):73–103
  43. Martin JL, Barbanoj MJ, Schlaepfer TE, et al. Transcranial magnetic stimulation for treating depression. Cochrane Database Syst Rev. 2002;(2):CD003493
  44. Herrmann LL, Ebmeier KP. Factors modifying the efficacy of transcranial magnetic stimulation in the treatment of depression: a review. J Clin Psychiatry. 2006;67(12):1870–1876
  45. Fitzgerald PB, Brown TL, Marston NAU, et al. Transcranial magnetic stimulation in the treatment of depression: a double-blind placebo controlled trial. Arch Gen Psychiatry. 2003;60:1002–1008
  46. Rossini D, Lucca A, Zanardi R, Magri L, Smeraldi E. Transcranial magnetic stimulation in treatment-resistant patients: a double-blind, placebo-controlled trial. Psychiatry Res. 2005;137:1–10
  47. O'Reardon JP, Solvason HB, Janicak PG, et al. Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial. Biol Psychiatry. 2007;62(11):1208–1216
  48. Avery DH, Isenberg KE, Sampson SM, et al. Transcranial magnetic stimulation in the acute treatment of major depressive disorder: clinical response in an open-label extension trial. J Clin Psychiatry. 2008;69(3):441–451
  49. Fitzgerald PB, Benitez J, de Castella A, et al. A randomized, controlled trial of sequential bilateral repetitive transcranial magnetic stimulation for treatment-resistant depression. Am J Psychiatry. 2006;163(1):88–94
  50. Fitzgerald PB, Hoy K, McQueen S, et al. Priming stimulation enhances the effectiveness of low-frequency right prefrontal cortex transcranial magnetic stimulation in major depression. J Clin Psychopharmacol. 2008;28(1):52–58
  51. Fitzgerald PB, Huntsman S, Gunewardene R, Kulkarni J, Daskalakis ZJ. A randomized trial of low frequency right prefrontal cortex transcranial magnetic stimulation as augmentation in treatment resistant major depression. Int J Neuropharmacol. 2006;9:655–666
  52. Lisanby SH, Gutman D, Luber B, Schroeder C, Sackeim HA, Sham TMS. intracerebral measurement of the induced electrical field and the induction of motor-evoked potentials. Biol Psychiatry. 2001;49(5):460–463
  53. Loo CK, Taylor JL, Gandevia SC, et al. Transcranial magnetic stimulation (TMS) in controlled treatment studies: are some “sham” forms active?. Biol Psychiatry. 2000;47:325–331
  54. Borckardt J, Walker J, Branham RK, et al. Development and evaluation of a portable sham tms system. Brain Stimulation. 2008;1(1):52–59
  55. Arana AB, Borckardt JJ, Ricci R, et al. Electrical Stimulation as a sham control for rTMS: does it truly mimic the cutaneous sensation and pain of active prefrontal rTMS?. Brain Stimulation. 2008;1(1):4–51
  56. Li X, Nahas Z, Anderson B, Kozel FA, George MS. Can left prefrontal rTMS be used as a maintenance treatment for bipolar depression?. Depress Anxiety. 2004;20(2):98–100
  57. Fitzgerald PB, Benitez J, de Castella AR, et al. Naturalistic study of the use of transcranial magnetic stimulation in the treatment of depressive relapse. Austr N Z J Psychiatry. 2006;40(9):764–768
  58. O'Reardon JP, Blumner KH, Peshek AD, Pradilla RR, Pimiento PC. Long-term maintenance therapy for major depressive disorder with rTMS. J Clin Psychiatry. 2005;66(12):1524–1528
  59. Schule C, Zwanzger P, Baghai T, et al. Effects of antidepressant pharmacotherapy after repetitive transcranial magnetic stimulation in major depression: an open followup study. J Psychiatr Res. 2003;37:145–153
  60. Herwig U, Fallgatter AJ, Hoppner J, et al. Antidepressant effects of augmentative transcranial magnetic stimulation: randomised multicentre trial. Br J Psychiatry. 2007;191:441–448
  61. George MS, Speer AM, Molloy M, et al. Low frequency daily left prefrontal rTMS improves mood in bipolar depression—a placebo-controlled case report. Hum Psychopharmacol. 1998;13(4):271–275
  62. Nahas Z, Kozel FA, Li X, Anderson B, George MS. Left prefrontal transcranial magnetic stimulation (TMS) treatment of depression in bipolar affective disorder: a pilot study of acute safety and efficacy. Bipolar Disord. 2003;5(1):40–47
  63. Figiel GS, Epstein C, McDonald WM, et al. The use of rapid rate transcranial magnetic stimulation (rTMS) in refractory depressed patients. J Neuropsychiatry Clin Neuro. 1998;10:20–25
  64. Kozel FA, Nahas Z, deBrux C, et al. How coil-cortex distance relates to age, motor threshold, and antidepressant response to repetitive transcranial magnetic stimulation. J Neuropsychiatry Clin Neurosci. 2000;12(3):376–384
  65. McConnell KA, Nahas Z, Shastri A, et al. The transcranial magnetic stimulation motor threshold depends on the distance from coil to underlying cortex: a replication in healthy adults comparing two methods of assessing the distance to cortex. Biol Psychiatry. 2001;49(5):454–459
  66. Nahas Z, Teneback CC, Kozel A, et al. Brain effects of TMS delivered over prefrontal cortex in depressed adults: role of stimulation frequency and coil-cortex distance. J Neuropsychiatry Clin Neurosci. 2001;13(4):459–470
  67. Mosimann UP, Marre SC, Werlen S, et al. Antidepressant effects of repetitive transcranial magnetic stimulation in the elderly: correlation between effect size and coil-cortex distance. Arch Gen Psychiatry. 2002;59:560–561
  68. Nahas Z, Li X, Kozel FA, et al. Safety and benefits of distance-adjusted prefrontal transcranial magnetic stimulation in depressed patients 55-75 years of age: a pilot study. Depress Anxiety. 2004;19(4):249–256
  69. Jorge RE, Moser DJ, Action L, Robinson RG. Treatment of vascular depression using repetitive transcranial magnetic stimulation. Arch Gen Psychiatry. 2008;65(3):268–276
  70. Herwig U, Padberg F, Unger J, et al. Transcranial magnetic stimulation in therapy studies: examination of the reliability of “standard” coil positioning by neuronavigation. Biol Psychiatry. 2001;50(1):58–61
  71. Herwig U, Satrapi P, Schonfeldt-Lecuona C. Using the international 10-20 EEG system for positioning of transcranial magnetic stimulation. Brain Topogr. 2003;16(2):95–99
  72. Fregni F, Boggio PS, Nitsche MA, et al. Treatment of major depression with transcranial direct current stimulation. Bipolar Disord. 2006;8(2):203–204
  73. Boggio PS, Rigonatti SP, Ribeiro RB, et al. A randomized, double-blind clinical trial on the efficacy of cortical direct current stimulation for the treatment of major depression. Int J Neuropsychopharmacol. 2008;11(2):249–254
  74. Gruber NP, Dilsaver SC, Shoaib AM, Swann AC. ECT in mixed affective states: a case series. J ECT. 2000;16(2):183–188
  75. Devanand DP, Polanco P, Cruz R, et al. The efficacy of ECT in mixed affective states. J ECT. 2000;16(1):32–37
  76. Hill MA, Courvoisie H, Dawkins K, Nofal P, Thomas B. ECT for the treatment of intractable mania in two prepubertal male children. Convuls Ther. 1997;13(2):74–82
  77. Miller MC. ECT and mania. [letter; comment] Am J Psychiatry. 1995;152(4):654
  78. Shaldivin A, Kaptsan A, Belmaker RH, Einat H, Grisaru N. Transcranial magnetic stimulation in an amphetamine hyperactivity model of mania. Bipolar Disord. 2001;3(1):30–34
  79. Belmaker RH, Grisaru N. Does TMS have bipolar efficacy in both depression and mania?. Biol Psychiatry. 1998;43:755
  80. Belmaker RH, Einat H, Levkovitz Y, Segal M, Grisaru N. TMS effects in animal models of depression and mania. In:  George MS,  Belmaker RH editor. Transcranial magnetic stimulation in neuropsychiatry. Washington, DC: American Psychiatric Press; 2000;p. 99–114
  81. Nedjat S, Folkerts HW. Induction of a reversible state of hypomania by rapid-rate transcranial magnetic stimulation over the left prefrontal lobe. J ECT. 1999;15:166–168
  82. Grisaru N, Chudakov B, Yaroslavsky Y, Belmaker RH. TMS in mnia: a controlled study. Am J Psych. 1998;155(11):1608–1610
  83. Kaptsan A, Yaroslavsky Y, Applebaum J, Belmaker RH, Grisaru N. Right prefrontal TMS versus sham treatment of mania: a controlled study. Bipolar Disord. 2003;5(1):36–39
  84. Baxter LR. Brain imaging as a tool in establishing a theory of brain pathology in obsessive compulsive disorder. J Clin Psychiatry. 1990;51(s):22–25
  85. Baxter LR, Schwartz JM, Guze BH, Bergman K, Szuba MP. PET imaging in obsessive compulsive disorder with and without depression. J Clin Psychiatry. 1990;51:61–69
  86. Rauch SL, Jenike MA, Alpert N, et al. PET study of OCD during symptom provocation. APA New Res Abstracts. 1993;133:NR293
  87. Greenberg BD, George MS, Martin JD, et al. Effect of prefrontal repetitive transcranial magnetic stimulation in obsessive-compulsive disorder: a preliminary study. Am J Psychiatry. 1997;154(6):867–869
  88. Alonso P, Pujol J, Cardoner N, et al. Right prefrontal repetitive transcranial magnetic stimulation in obsessive-compulsive disorder: a double-blind, placebo-controlled study. Am J Psychiatry. 2001;158(7):1143–1145
  89. Mantovani A, Lisanby SH, Pieraccini F, et al. Repetitive transcranial magnetic stimulation (rTMS) in the treatment of obsessive-compulsive disorder (OCD) and Tourette's syndrome (TS). Int J Neuropsychopharmacol. 2006;9(1):95–100
  90. McCann UD, Kimbrell TA, Morgan CM, et al. Repetitive transcranial magnetic stimulation for posttraumatic stress disorder. [letter] Arch Gen Psychiatry. 1998;55:276–279
  91. Grisaru N, Amir M, Cohen H, Kaplan Z. Effect of transcranial magnetic stimulation in posttraumatic stress disorder: a preliminary study. Biol Psychiatry. 1998;44:52–55
  92. Zhang W, Davidson JR. Post-traumatic stress disorder: an evaluation of existing pharmacotherapies and new strategies. Expert Opin Pharmacother. 2007;8(12):1861–1870
  93. Zwanzger P, Minov C, Ella R, et al. Transcranial magnetic stimulation for panic. Am J Psych. 2002;159:315–316
  94. Mantovani A, Lisanby SH, Pieraccini F, et al. Repetitive transcranial magnetic stimulation (rTMS) in the treatment of panic disorder (PD) with comorbid major depression. J Affect Disord. 2007;102(1-3):277–280
  95. Prasko J, Záleský R, Bares M, et al. The effect of repetitive transcranial magnetic stimulation (rTMS) added on to serotonin reuptake inhibitors in patients with panic disorder: a randomized, double blind sham controlled study. Neuro Endocrinol Lett. 2007;1:33–38
  96. Hoffman RE, Gueorguieva R, Hawkins KA, et al. Temporoparietal transcranial magnetic stimulation for auditory hallucinations: safety, efficacy and moderators in a fifty patient sample. Biol Psychiatry. 2005;58(2):97–104
  97. Hoffman RE, Cavus I. Slow transcranial magnetic stimulation, long-term depotentiation, and brain hyperexcitability disorders review. Am J Psychiatry. 2002;159(7):1093–1102
  98. Hoffman RE, Boutros NN, Hu S, et al. Transcranial magnetic stimulation and auditory hallucinations in schizophrenia. Lancet. 2000;355(9209):1073–1075
  99. Hoffman RE, Boutros NN, Berman RM, et al. Transcranial magnetic stimulation of left temporoparietal cortex in three patients reporting hallucinated “voices”. Biol Psychiatry. 1999;46:130–132
  100. Hoffman R, Boutros N, Berman R, Krystal J, Charney D. Transcranial magnetic stimulation and hallucinated 'voices'. Biol Psychiatry. 1998;43:93s-310
  101. Aleman A, Sommer IE, Kahn RS. Efficacy of slow repetitive transcranial magnetic stimulation in the treatment of resistant auditory hallucinations in schizophrenia: a meta-analysis. J Clin Psychiatry. 2007;68(3):416–421
  102. Fitzgerald PB, Benitez J, Daskalakis JZ, De Castella A, Kulkarni J. The treatment of recurring auditory hallucinations in schizophrenia with rTMS. World J Biol Psychiatry. 2006;7(2):119–122
  103. Jin Y, Potkin SG, Kemp AS, et al. Therapeutic effects of individualized alpha frequency transcranial magnetic stimulation (alphaTMS) on the negative symptoms of schizophrenia. Schizophr Bull. 2006;32(3):556–561
  104. Rollnik JD, Huber TJ, Mogk H, et al. High frequency repetitive transcranial magnetic stimulation (rTMS) of the dorsolateral prefrontal cortex in schizophrenic patients. NeuroReport. 2000;11(18):4013–4015
  105. Nahas Z, McConnell K, Collins S, et al. Could left prefrontal rTMS modify negative symptoms and attention in schizophrenia?. Biol Psychiatry. 1999;45:37S–120S
  106. Geller SG, Grisaru N, Abarnabel JM, Lemberg T, Belmaker RH. Slow magnetic stimulation of prefrontal cortex in depression and schizophrenia. Prog Neuro-Psychopharmacol Biol Psychiatry. 1997;21:105–110
  107. Schneider AL, Schneider TL, Stark H. Repetitive transcranial magnetic stimulation (rTMS) as an augmentation treatment for the negative symptoms of schizophrenia: a 4-week randomized placebo controlled study. Brain Stimulation. 2008;1(2):106–111

PII: S1935-861X(08)00037-5

doi: 10.1016/j.brs.2008.06.001

BRAIN STIMULATION: Basic, Translational, and Clinical Research in Neuromodulation
Volume 2, Issue 1 , Pages 14-21 , January 2009

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