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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EDaily left prefrontal repetitive transcranial magnetic stimulation (TMS) demonstrated therapeutic effects in patients with major depressive disorder (MDD), according to a recent study. There has been some controversy regarding the reliability of previous sham studies that have investigated TMS, but the current study was designed with that potential flaw in mind, and the sham control was formatted to closely emulate the somatosensory experience of active treatment, including the sound of the device during administration and the pulsing sensation to the scalp.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EMood Disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EDaily left prefrontal repetitive transcranial magnetic stimulation (TMS) demonstrated therapeutic effects in patients with major depressive disorder (MDD), according to a recent study by George and colleagues. TMS is a brain intervention that alters activity within specific regions of the brain using electrical current. There has been some controversy regarding the reliability of previous sham studies that have investigated TMS, because some feel that sham TMS controls do not adequately mimic active TMS treatment. Thus, the concern was that controls were too obvious to investigators and study participants. The current study was designed with that potential flaw in mind, and the sham control was formatted to closely emulate the somatosensory experience of active treatment, including the sound of the device during administration and the pulsing sensation to the scalp.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThis prospective, multicenter, randomized, active sham-controlled (1:1 randomization) trial included 190 patients with unipolar nonpsychotic MDD who were free of antidepressant, antipsychotic, and anticonvulsant medication for at least 2 weeks prior to baseline evaluation. Patients received active repetitive TMS (n=92) to the left prefrontal cortex (10-Hz pulses for 4 seconds with 26-second intervals between pulses for a total of 37.5 minutes per session; total of 3000 pulses per session) using a figure-eight solid-core coil or sham TMS (n=98), which consisted of a similar coil with a metal insert that blocked the magnetic field and scalp electrodes that simulated the active TMS sensation. Treatment was standardized at 120% magnetic field intensity relative to the individual patient\u0027s resting motor threshold. Patients received 3 weeks of daily weekday treatment during the fixed-dose phase, followed by 3 additional weeks of blinded treatment for improvers. The two groups were well matched at baseline with regard to demographics and clinical characteristics. Of the 190 intent-to-treat patients, 154 completed and 120 were fully adherent.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe primary outcome was remission rate for the two treatment arms using logistical regression and controlling for age, treatment resistance, study site, and duration of the current depressive episode. Secondary outcomes included response rates, as determined by Hamilton Scale for Depression (HAM-D), Montgomery-Asberg Depression Rating Scale (MADRS), Clinical Global Impression Severity of Illness Scale (CGI-S), and Inventory of Depressive Symptoms-Self Report (IDS). Investigators also evaluated spontaneous adverse events that were related to repetitive TMS to assess for safety.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EPatients who received active TMS treatment demonstrated a significant treatment effect compared with control (OR, 4.2; 95% CI, 1.32 to 13.24; p=0.02). Fourteen percent of patients in the TMS arm remitted versus 5% in the sham arm. The number that was needed to treat was 12. Patients who underwent TMS demonstrated significant improvement in MADRS (p=0.01), CGI-S (p=0.01), and IDS (p=0.001) scores compared with sham control (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11273\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11273\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11273\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003ESecondary Outcome Measures: Improvements from Baseline to End of Phase 1.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-7\u0022\u003EIIt is important to note that site differences were found during the course of this study. In fact, most remitters (83%) and patients who were found to be less treatment-resistant (66.4%) originated at two of the four study sites. While site and resistance status did not appear to influence primary study results, interpretation of these variables did impact regression estimates.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EThere was no significant difference in spontaneous adverse events according to treatment arm. Five patients who were receiving TMS withdrew from study participation due to adverse events (one because of syncope after 14 treatments and four because of pain or headaches after initial treatment). No seizures or suicides were documented. The most common adverse events that were reported were headache, discomfort at stimulation site, and insomnia for both groups.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EOverall, TMS was associated with more favorable outcomes compared with sham control. Daily left prefrontal TMS therapy was shown to have significantly greater antidepressant effects and was well tolerated in patients with unipolar depression. Safety profiles were similar between the two groups.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2010 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section ref-list\u0022 id=\u0022ref-list-1\u0022\u003E\u003Ch2 class=\u0022\u0022\u003ECitation\u003C\/h2\u003E\u003Col class=\u0022cit-list ref-use-labels\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label ref-label-empty\u0022\u003E\u003C\/span\u003E\n            \u003Cdiv class=\u0022cit ref-cit ref-journal no-rev-xref\u0022 id=\u0022cit-10.4.19.1\u0022 data-doi=\u002210.1001\/archgenpsychiatry.2010.46\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EGeorge\u003C\/span\u003E  \u003Cspan class=\u0022cit-name-given-names\u0022\u003EMS\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-etal\u0022\u003Eet al\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003EArch Gen Psychiatry\u003C\/abbr\u003E \n               \u003Cspan class=\u0022cit-pub-date\u0022\u003E2010\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E67\u003C\/span\u003E(\u003Cspan class=\u0022cit-issue\u0022\u003E5\u003C\/span\u003E):\u003Cspan class=\u0022cit-fpage\u0022\u003E507\u003C\/span\u003E\u2013\u003Cspan class=\u0022cit-lpage\u0022\u003E516\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003Ca href=\u0022{openurl}?query=rft.jtitle%253DArchives%2Bof%2BGeneral%2BPsychiatry%26rft.stitle%253DArch%2BGen%2BPsychiatry%26rft.issn%253D0003-990X%26rft.aulast%253DGeorge%26rft.auinit1%253DM.%2BS.%26rft.volume%253D67%26rft.issue%253D5%26rft.spage%253D507%26rft.epage%253D516%26rft.atitle%253DDaily%2BLeft%2BPrefrontal%2BTranscranial%2BMagnetic%2BStimulation%2BTherapy%2Bfor%2BMajor%2BDepressive%2BDisorder%253A%2BA%2BSham-Controlled%2BRandomized%2BTrial%26rft_id%253Dinfo%253Adoi%252F10.1001%252Farchgenpsychiatry.2010.46%26rft_id%253Dinfo%253Apmid%252F20439832%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url\u0022\u003E\u003Cspan\u003EOpenUrl\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=10.1001\/archgenpsychiatry.2010.46\u0026amp;link_type=DOI\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref\u0022\u003E\u003Cspan\u003ECrossRef\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=20439832\u0026amp;link_type=MED\u0026amp;atom=%2Fspmdc%2F10%2F4%2F19.atom\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-medline\u0022\u003E\u003Cspan\u003EMedline\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=000277261200009\u0026amp;link_type=ISI\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-newisilink cit-ref-sprinkles-webofscience\u0022\u003E\u003Cspan\u003EWeb of Science\u003C\/span\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003C\/li\u003E\u003C\/ol\u003E\u003C\/div\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/10\/4\/19.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzms21\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzms21\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}