title: Cognitive-emotional reactivation during deep transcranial magnetic stimulation over the prefrontal cortex of depressive patients affects antidepressant outcome.
abstract: BACKGROUND
  Transcranial magnetic stimulation (TMS) enables non-surgical activation of specific brain areas. TMS over the prefrontal cortex (PFC) is emerging as a significant tool that can augment or replace non/partially effective antidepressant medications. Deep TMS (DTMS) utilizes newly developed coils that enable effective stimulation of deeper cortical layers involved in the pathophysiology of depression.
  
  
  OBJECTIVE
  We aimed to assess the H1-DTMS coil as an add-on to antidepressants in treating patients with major depression. We also intended to evaluate whether the antidepressant outcome of DTMS treatment is affected by a cognitive-emotional procedure performed during stimulation.
  
  
  METHODS
  57 patients were enrolled in the study that included 4 weeks of daily 20 Hz stimulation sessions and additional 4 weekly sessions as a short maintenance phase. Two subgroups of patients received either positive or negative cognitive-emotional reactivation along with the stimulation sessions.
  
  
  RESULTS
  21 of 46 patients (46%) who received at least 10 stimulation sessions achieved response (improvement of ≥ 50% in the Hamilton Depression Rating Scale (HDRS)) and 13 of them (28%) achieved remission (HDRS-24 ≤ 10) by the end of the daily treatment phase. Improvements were smaller in the negatively reactivated group and Beck Depression Inventory scores were not significantly improved in this group.
  
  
  CONCLUSIONS
  DTMS over the PFC proved to be safe and effective in augmenting antidepressant medications. Negative cognitive-emotional reactivation can disrupt the therapeutic effect of DTMS. A large sham controlled study is required to further establish the effectiveness of DTMS as an augmentation treatment and the role of cognitive reactivation during stimulation.
authors.affiliation: Dept. of Psychiatry, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Moshe
authors.initials: M
authors.lastname: Isserles
authors.forename: Oded
authors.initials: O
authors.lastname: Rosenberg
authors.forename: Pinchas
authors.initials: P
authors.lastname: Dannon
authors.forename: Yechiel
authors.initials: Y
authors.lastname: Levkovitz
authors.forename: Moshe
authors.initials: M
authors.lastname: Kotler
authors.forename: Frederic
authors.initials: F
authors.lastname: Deutsch
authors.forename: Bernard
authors.initials: B
authors.lastname: Lerer
authors.forename: Abraham
authors.initials: A
authors.lastname: Zangen
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003071:Cognition; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents