TY - JOUR AU - McLoughlin, D AU - Mogg, A AU - Eranti, S AU - Pluck, G AU - Purvis, R J2 - Health Technology Assessment JO - Health Technology Assessment TI - The clinical effectiveness and cost of repetitive transcranial magnetic stimulation versus electroconvulsive therapy in severe depression: a multicentre pragmatic randomised controlled trial and economic analysis PY - 2007 VL - 11 IS - 24 DO - 10.3310/hta11240 DA - 2007/07/02 UR - http//journalslibrary.nihr.ac.uk/hta/hta11240 AB - OBJECTIVE To investigate if repetitive transcranial magnetic stimulation (rTMS) was as effective as electroconvulsive therapy (ECT) in treating major depressive episodes and to perform a cost-effectiveness analysis.DESIGN A single-blind pragmatic multicentre randomised controlled trial (RCT) with 6 months of follow-up to test equivalence of rTMS with ECT.SETTING The South London and Maudsley NHS Trust and Pembury Hospital in the Invicta Mental Health Trust in Kent.PARTICIPANTS Right-handed adult patients referred for ECT for treatment of a major depressive episode (DSM-IV) were assessed. During the 2.5-year trial period, 260 patients were referred for ECT, of whom 46 entered the trial. The main reason for not entering the trial was not consenting to ECT while being formally treated under the UK Mental Health Act 1983.INTERVENTIONS Patients were randomised to receive a 15-day course of rTMS of the left dorsolateral prefrontal cortex (n = 24) or a course of ECT (n = 22).MAIN OUTCOME MEASURES Patients were assessed before randomisation, at end of treatment and at the 6-month follow-up. Primary outcome measures were the 17-item Hamilton Rating Scale for Depression (HRSD) and proportion of remitters (defined as HRSD score