The response time and executive function of patients with first-episode depression with repetitive transcranial magnetic stimulation combined paroxetine treatment

Objective To study the response time of repetitive transcranial magnetic stimulation (rTMS) combined with paroxetine in treating first-episode depression and its effects on executive function. Methods Forty-six patients aged 18 to 45 yrs meeting the Dignostic and Statistical Manual of Mental Disorders Fourth Edition criteria for first-episode depression randomly received rTMS (n=25)or sham rTMS(n=21) on the left dorsolateral prefrontal cortex (DLPFC) for 4 weeks．All patients were concomitantly taking paroxetine (20-40 mg/d).The rTMS treatment was 20 sessions (5 sections per week) of 10 Hz（80% motor threshold and 800 pulse per session) and sham stimulation followed the same schedule, however, using a sham coil without any magnetic field. The Hamilton Depression Rating Scale-24 items (HAMD) and Wisconsin Card Sorting Test (WCST) was used to assess efficacy. Results There were no differences on HAMD score and WCST parameters at baseline between the two groups. After the treatment，the rTMS group ［（31.82±5.93）,（23.82±4.05）,（17.95±6.82）,（12.55±3.14）］ showed a significantly faster reduction than the sham group ［（37.00±8.43）,（27.95±6.87）,（22.11±5.23）,（16.47±4.03）］(P＜0.05) on HAMD scores from 1st to 4th week .The response and remission rates were significantly higher in the rTMS group after the stimulation period （95%，73% vs. 63%，37%, P=0.016, P=0.009), but not at the endpoint．Not only in the rTMS group but in the sham group (P 0.05) on WCST parameters between two groups． Conclusion The 10 Hz rTMS may have augmentative effects on paroxetine treatment in patients with first-episode depression without advert effects on the executive function. Key words: Paroxetine; Depressive disorder; Transcranial magnetic stimulation; Onset of action; Executive function