Effects of bupropion and repetitive transcranial magnetic stimulation (rTMS) on sexual function, depression severity and cognitive performance in individuals with major depressive disorder – results from a double-blind, sham-controlled randomized intervention

BACKGROUND: Although repetitive transcranial magnetic stimulation (rTMS) is recognized as an effective therapeutic option for major depressive disorder (MDD), little research is available regarding its effectiveness with respect to sexual dysfunction in patients with MDD. The objective of this intervention study was therefore to examine the effectiveness of adjuvant rTMS to a standard treatment with bupropion for individuals with MDD and sexual dysfunction. METHODS: A total of 40 inpatients (mean age: 32.0 years; 21 females) diagnosed with MDD according to DSM-5 criteria, suffering from sexual dysfunction, and treated with standard medication of bupropion, were randomly assigned either to an active rTMS intervention or to a sham rTMS condition (each condition: ten sessions across three consecutive weeks). Gender-specific self-rated sexual function was assessed at baseline, at the fifth, and tenth sessions (study end). At baseline and at study end, experts rated participants' depression intensity (Hamilton Depression Rating Scale; HDRS), and participants completed the Montreal Cognitive Assessment (MoCA), a cognitive screener designed to detect mild cognitive impairment and early dementia. RESULTS: Female sexual function improved over time, but more so in the active rTMS condition than in the sham condition. Male sexual dysfunction decreased over time, irrespective of the study condition. Depression severity decreased over time, irrespective of the study condition. Cognitive functions improved over time, but more so in the active rTMS condition. CONCLUSION: Compared to a sham condition, adjuvant active rTMS to standard antidepressant medication with bupropion improved sexual function and cognitive performance among a sample of females with MDD. For depression and male sexual dysfunction, improvements were unrelated to adjuvant active rTMS. rTMS should be considered with respect to sexual function in females with major depressive disorder.