title: Ultra-high-frequency left prefrontal transcranial magnetic stimulation as augmentation in severely ill patients with depression: a naturalistic sham-controlled, double-blind, randomized trial.
abstract: OBJECTIVE
  Repetitive transcranial magnetic stimulation (rTMS) is supposed to be not as effective in severe depression as it is in medium depression. We evaluated the treatment response to an ultra-high-frequency (UHF; 30 Hz) approach, which was used to maximize the rTMS efficacy in severely ill patients.
  
  
  METHODS
  43 severely depressed patients were included in the randomized, double-blind study and received either rTMS with 30 Hz over the left dorsolateral prefrontal cortex or sham condition for 3 weeks as an add-on therapy to stable antidepressant medication. Hamilton Depression Rating Scale (HDRS) and cognitive performance were evaluated before and after the intervention.
  
  
  RESULTS
  In the active UHF group, the HRDS score was reduced by about 7.2, whereas the sham condition showed a smaller reduction of the HDRS score with 3.9. However, lithium as a covariant was responsible for the outcome difference, not the group of stimulation. No adverse events were reported. Comparing the differences of both groups in the pre- and post-study performance in a trail-making test, a group effect for the UHF group that was not influenced by the lithium intake was observed.
  
  
  CONCLUSIONS
  A 30-Hz left prefrontal rTMS in severely depressed patients was safe and no adverse events occurred. Due to a strong effect of lithium as a covariate, we could not demonstrate favorable antidepressant effects of the UHF stimulation compared to sham. However, we found an improvement of processing speed performance in the UHF group, which covaried with improvement of psychomotor retardation.
authors.affiliation: Department of Psychiatry and Psychotherapy, Kreisklinikum Siegen GmbH, Siegen, Germany.
authors.forename: Heiko
authors.initials: H
authors.lastname: Ullrich
authors.forename: Laura
authors.initials: L
authors.lastname: Kranaster
authors.forename: Erich
authors.initials: E
authors.lastname: Sigges
authors.forename: Jürgen
authors.initials: J
authors.lastname: Andrich
authors.forename: Alexander
authors.initials: A
authors.lastname: Sartorius
mesh_terms: D000368:Aged; D001703:Biophysics; D003072:Cognition Disorders / Q000209:etiology / Q000628:therapy; D015331:Cohort Studies; D003863:Depression / Q000150:complications / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D017397:Prefrontal Cortex / Q000502:physiology*; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome