ABSTRACT
The antidepressant effects of repetitive transcranial magnetic stimulation (rTMS) that have been demonstrated in recent studies could be related to its ability to modulate cortical excitability. Yet, the relationship between stimulus location and frequency and treatment outcome has not been established. The aim of the present study was to compare efficacy of rTMS in various configurations and clomipramine treatment in patients with major depression (MD) and to evaluate the relationship between clinical outcome and changes in cortical excitability. Fifty-nine MD patients were randomized to receive (1) left (n = 12) or right (n = 12) 3 Hz rTMS with placebo medication; (2) left (n = 10) or right (n = 9) 10 Hz rTMS with placebo medication; (3) active medication (clomipramine) with sham rTMS (n = 16). Both 3 Hz and 10 Hz rTMS were administered to the prefrontal cortex by a circular coil at an intensity of 110% and 100% of the resting motor threshold (rMT) respectively. Measurements of cortical excitability were performed prior to and 24 h after completion of 2 wk of daily rTMS or pharmacological treatments. These included the rMT, silent period threshold (SPT), inter-threshold difference (ITD), MEP/M-wave amplitude ratio and silent period duration (SPD). Severity of depression was blindly assessed by the Hamilton Depression Rating Scale (HDRS). The best improvement scores were seen in patients who received left 3 Hz rTMS. The 10 Hz rTMS treatment was less tolerated resulting in a significantly higher dropout rate. A significant increase of the MEP/M wave amplitude ratio accompanied by a shortening of the SPD was evidenced in patients who showed marked clinical improvement (reduction in HDRS by 50% or more) following left rTMS regardless of stimulation frequency. Our results suggest that 3 Hz left rTMS has a higher therapeutic efficacy and tolerability in patients with MD. The enhancement of cortical excitability may be related to the antidepressant action of rTMS.
Subject(s)
Antidepressive Agents/therapeutic use , Cerebral Cortex , Clomipramine/therapeutic use , Depressive Disorder, Major/therapy , Transcranial Magnetic Stimulation , Aged , Analysis of Variance , Cerebral Cortex/pathology , Cerebral Cortex/physiopathology , Cerebral Cortex/radiation effects , Depressive Disorder, Major/pathology , Depressive Disorder, Major/physiopathology , Dose-Response Relationship, Radiation , Double-Blind Method , Female , Functional Laterality , Humans , Male , Middle Aged , Time Factors , Treatment OutcomeABSTRACT
Antipsychotic agents are the mainstay of treatment for schizophrenia. However, almost 50% of schizophrenia patients exhibit non-compliance with antipsychotic drug therapy. This in turn may account for high relapse rate, reduced quality of life and increased burden on society. Identification of factors that may mediate adherence to treatment is therefore a primary clinical challenge. This paper reviews the literature regarding medication adherence among schizophrenia patients, with an emphasis on four groups of mediating factors: illness-related, patient-related, treatment-related and environmental-related factors. In addition, we describe a modified health-belief model that may facilitate better understanding of empirical findings. Therapeutic interventions to encourage better treatment compliance are discussed.