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Academic Journal
HIGH VS. LOW FREQUENCY
| Title: |
A Symptom-Specific Analysis of the Effect of High-Frequency Left or Low-Frequency Right Transcranial Magnetic Stimulation over the Dorsolateral Prefrontal Cortex in Major Depression
| | Date: | 2010 | | Author(s): |
Rossini D, Lucca A Magri L, Malaguti A, Smeraldi E, Colombo C, Zanardi R
| | Source: | Neuropsychobiology | | Abstract: |
Background: We have investigated the efficacy of high-frequency left (HFL) versus low-frequency right (LFR) repetitive
transcranial magnetic stimulation (rTMS) in depression, focusing on specific symptoms as possible predictors of outcome for these two different types of stimulation. Method: Seventy-four outpatients with a major depressive episode treated with an adequate antidepressant dosage for at least 4 weeks were included in our study and randomly assigned to two different groups: HFL or LFR
rTMS. The Hamilton Rating Scale for Depression (HAM-D) items were pooled into 6 factors to evaluate specific symptoms as possible predictors of response. Results: Twenty-one out of 32 patients (65.6%) and 24 out of 42 patients (57.1%) were responders in the HFL and LFR groups, respectively. No significant difference in response rate was observed. Considering the whole sample, we found an inverse correlation between activity and HAMD score reduction and a significant positive relation between somatic anxiety and outcome. An inverse correlation between psychic anxiety and HAM-D score reduction emerged considering the HFL group. In the LFR group, there was a sig- nificant negative relationship between baseline activity and the outcome. Conclusion: These findings support the hypothesis that LFR rTMS could be as effective as HFL rTMS and more suitable for patients with a higher anxiety degree, particularly in bipolar patients.
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| | Title: |
A RANDOMIZED TRIAL OF THE ANTI-DEPRESSANT EFFECTS OF LOW- AND HIGH-FREQUENCY TRANSCRANIAL MAGNETIC STIMULATION IN TREATMENT-RESISTANT DEPRESSION
| | Date: | 2010 | | Author(s): |
Paul B. Fitzgerald PB, Hoy K, Daskalakis ZJ, Kulkami J
| | Source: | DEPRESSION AND ANXIETY | | Abstract: |
Background: The majority of studies investigating the effectiveness of repetitive transcranial magnetic stimulation (rTMS) as a treatment formajor depression have focused on high-frequency rTMS to the left prefrontal cortex (HFL-rTMS). In addition, low-frequency right prefrontal rTMS (LFR-rTMS) has also been shown to have antidepressant properties. To date only a small number of studies have directly compared the efficacy of these two approaches. Methods: The aim of this study, therefore, was to investigate further whether LFR-rTMS is as effective as HFLrTMS in the treatment ofmajor depression. Twenty-seven patients were randomized to one of two treatment arms (HFL-rTMS or LFR-rTMS) for 3 weeks with a possible 1-week extension. Non-responders were offered the opportunity of crossing over to the other treatment type. Stimulation parameters for HFL-rTMS were 30 stimulation trains of 5 s duration at 100% of the resting motor threshold (RMT); for LFR-rTMS, stimulation was applied in four trains of 180s duration (30s intertrain interval) at 110% of the RMT. Stimulation was provided 5-week days per week. Results: There were significant improvements seen from baseline to end point irrespective of group and on all clinical outcome measures. In addition, there was no deterioration in any of the measures used to assess cognitive change, and significant improvements were seen on measures of immediate verbal memory and verbal fluency. Conclusions: HFL-rTMS and LFR-rTMS appear to be equally efficacious in treating major depression. This study adds to the growing literature supporting LFR-rTMS as an additional viable method of rTMS delivery in the treatment of depression.
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| | Title: |
Repetitive Transcranial Magnetic Stimulation for Treatment of Medication-Resistant Depression in Older Adults
| | Date: | 2010 | | Author(s): |
Milev R, Abraham G, Hasey G, Cabaj JL
| | Source: | Journal of ECT | | Abstract: |
The antidepressant effects of repetitive transcranial magnetic stimulation (rTMS) are well documented, but studies to date have produced heterogeneous results in late-life depression.
Objective: To address this matter, we evaluated the efficacy of both high- and low-frequency rTMS delivered to the prefrontal cortex of older adults with treatment-resistant major depression.
Methods: Forty-nine older adults (69 T 6.7 years) with treatmentrefractory major depressive disorders underwent a series of rTMS treatments as an adjuvant to pharmacotherapy. Patients received highfrequency rTMS delivered to the left dorsolateral prefrontal cortex, lowfrequency stimulation to the right dorsolateral prefrontal cortex, or a combination thereof, at 80Y110% of the motor threshold.
Results: There was a modest, but statistically significant, mean reduction (24.7%) in Hamilton Depression Rating Scale (HDRS) scores from baseline to the end of treatment. Nine patients were classified as responders (50% HDRS reduction), and 4 patients reached remission status (final HDRS score G8). Similar improvements in HDRS scores were observed for high- and low-frequency rTMS. Treatment was generally well tolerated, and no serious adverse effects were reported.
Conclusions: The findings support the contention that in older adults with treatment-refractory depression, rTMS can be an effective treatment alternative for some patients.
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