title: Intensive HF-rTMS treatment in refractory medication-resistant unipolar depressed patients.
abstract: BACKGROUND
  Major depression is a worldwide severe mental health problem. Unfortunately, not all depressed patients respond to pharmacotherapy or psychotherapy, even when adhering to treatment guidelines. Even though current guidelines do not in particular advocate repetitive Transcranial Magnetic Stimulation (rTMS) in refractory treatment resistant depression (TRD), using more intensive stimulation parameters might hold promise as a valuable alternative.
  
  
  OBJECTIVE
  Consequently, in this randomized sham-controlled crossover study, we wanted to evaluate clinical outcome of intensive HF-rTMS treatment in TRD when applied to the left dorsolateral prefrontal cortex (DLPFC).
  
  
  METHODS
  After a 2-week antidepressant washout, 20 unipolar TRD patients, at least stage III, received 20 sham-controlled high-frequency (HF)-rTMS sessions, in a crossover design. Five daily suprathreshold HF-rTMS sessions were spread over four successive days delivering in total 31,200 stimuli.
  
  
  RESULTS
  Overall, the procedure resulted in immediate statistical significant decreases in depressive symptoms regardless of order/type of stimulation (real/sham), suggesting possible placebo responses. On the other hand, albeit only 35% (7/20) of the patients showed a 50% reduction of their initial Hamilton Depression rating score at the end of the two-week procedure, all these patients showed a prompt clinical response after real HF-rTMS treatment, not after sham. Furthermore, a shorter duration of the current depressive episode was a predictor for beneficial clinical outcome. Unresponsiveness to former ECT could be indicative for negative clinical outcome in these kinds of patients.
  
  
  CONCLUSIONS
  Single center setup with relatively small sample size and no follow-up.
  
  
  CONCLUSIONS
  Our findings indicate that intensive HF-rTMS treatment might have the potential to result in fast clinical response when confronted with a refractory TRD patient.
authors.affiliation: Department of Psychiatry and Medical Psychology, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium; University Hospital (UZBrussel), Department of Psychiatry, Brussels, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium. Electronic address: cbaeken@hotmail.com.
authors.forename: Chris
authors.initials: C
authors.lastname: Baeken
authors.affiliation: Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium.
authors.forename: Marie-Anne
authors.initials: MA
authors.lastname: Vanderhasselt
authors.affiliation: Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Remue
authors.affiliation: University Hospital (UZBrussel), Department of Psychiatry, Brussels, Belgium.
authors.forename: Sarah
authors.initials: S
authors.lastname: Herremans
authors.affiliation: University Hospital (UZBrussel), Department of Psychiatry, Brussels, Belgium.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Vanderbruggen
authors.affiliation: University Hospital (UZBrussel), Department of Psychiatry, Brussels, Belgium.
authors.forename: Dieter
authors.initials: D
authors.lastname: Zeeuws
authors.affiliation: University Hospital (UZBrussel), Department of Psychiatry, Brussels, Belgium.
authors.forename: Liesbeth
authors.initials: L
authors.lastname: Santermans
authors.affiliation: Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium.
authors.forename: Rudi
authors.initials: R
authors.lastname: De Raedt
mesh_terms: D000328:Adult; D018592:Cross-Over Studies; D061218:Depressive Disorder, Treatment-Resistant / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017397:Prefrontal Cortex; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome
keywords: HF-rTMS; Intensive; Left DLPFC; Medication-resistance; Refractory major depression