title: Priming stimulation enhances the effectiveness of low-frequency right prefrontal cortex transcranial magnetic stimulation in major depression.
abstract: OBJECTIVE
  Low-frequency, right-sided repetitive transcranial magnetic stimulation (rTMS) to the prefrontal cortex has been shown to have antidepressant effects. Recent research has suggested that preceding low-frequency rTMS with a period of low-intensity, 6-Hz stimulation ("priming") enhances the physiological effects of low-frequency stimulation. The aim of this study was to investigate whether priming stimulation would enhance therapeutic response to low-frequency rTMS in patients with depression.
  
  
  METHODS
  The study consisted of a 2-arm, double-blind, randomized, controlled trial in 60 patients with treatment-resistant depression. Right 1-Hz rTMS was provided in one continuous, 15-minute train to all subjects. The priming stimulation (twenty 5-second, 6-Hz trains) or an equivalent, sham preceded 1-Hz stimulation. The primary outcome variable was the score on the Montgomery-Asberg Depression Rating Scale (MADRS).
  
  
  RESULTS
  There was a significant overall reduction in MADRS scores across the 4 weeks of the study and a significantly greater reduction in MADRS scores in the active-priming group compared with the sham-priming group.
  
  
  CONCLUSIONS
  Low-intensity, high-frequency priming stimulation appears to enhance the response to low-frequency, right-sided rTMS treatment in patients with treatment-resistant depression.
authors.affiliation: Alfred Psychiatry Research Centre, The Alfred and Monash University Department of Psychological Medicine, Melbourne, Victoria, Australia. paul.fitzgerald@med.monash.edu.au
authors.forename: Paul B
authors.initials: PB
authors.lastname: Fitzgerald
authors.forename: Kate
authors.initials: K
authors.lastname: Hoy
authors.forename: Susan
authors.initials: S
authors.lastname: McQueen
authors.forename: Sally
authors.initials: S
authors.lastname: Herring
authors.forename: Rebecca
authors.initials: R
authors.lastname: Segrave
authors.forename: Greg
authors.initials: G
authors.lastname: Been
authors.forename: Jayashri
authors.initials: J
authors.lastname: Kulkarni
authors.forename: Zafiris J
authors.initials: ZJ
authors.lastname: Daskalakis
mesh_terms: D000328:Adult; D000368:Aged; D003865:Major Depressive Disorder / Q000628:therapy*; D004311:Double-Blind Method; D004351:Drug Resistance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017397:Prefrontal Cortex / Q000503:physiopathology*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome