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Objective: Transcranial magnetic stimulation is an emerging treatment of treatment-resistant depression. Current protocols rely on daily treatments. This study was designed to determine whether the time period over which treatment is delivered is an important factor in efficacy. Method: Sixteen adult patients with treatment-resistant major depression were randomly assigned to one of the two treatment groups, both of which received 2 weeks of treatment. One group received daily treatment (10 treatments, on business days). The other group received three treatments in week one, and two treatments in week two (five treatments, on spaced business days). Mood was rated using the Hamilton Depression Rating Scale (HDRS) and a self-rated visual analogue scale. Response was defined as a 50% reduction in HDRS rating, and remission was defined as achieving an HDRS score of 8 or less. The groups were compared throughout the 2-week study period. Results: At entry, there were no demographic differences between the groups. Multivariate tests showed a significant main effect for time (Pillai trace = 0.76, F(4,56) = 8.56, p < 0.001, power = 0.99) reflecting the improvement in both measures of depression during treatment. There was no significant difference between the groups overall (Pillai trace = 0.25, F(2,13) = 2.12, p = 0.16, power = 0.36). Additionally, there was no significant interaction between time and treatment group (Pillai trace = 0.18, F(4,56) = 1.35, p = 0.26, power = 0.39) indicating that the significant improvement in depression over time was similar for both treatment groups. There were no significant differences in response and remission rates between the groups. Conclusion: The time period of treatment appeared to be an important outcome factor. This suggests that less than daily transcranial magnetic stimulation treatment may be a useful clinical alternative. [ABSTRACT FROM AUTHOR]

Less than half of those suffering major depressive episodes achieve remission with the first antidepressant provided and one-third of all patients suffering depression have a chronic condition. Clinical experience indicates that a substantial proportion of patients suffer treatment-resistant depression (TRD). Our aim is to explore the literature reporting the drug treatment of TRD, and to present such information as would be of interest to clinical psychiatrists. Literature searches were conducted using PubMed and entering the words antidepressant, augmentation, combined antidepressants, treatment resistant depression and the names of individual antidepressant medications. Most authors recommended that TRD should be first approached by reassessing the diagnosis, adding psychotherapy and attending to psychosocial factors. Details of the following pharmacological options were identified: (i) augmentation of the currently employed antidepressant with a medication which is not an antidepressant; (ii) change of antidepressant; and (iii) addition of a second antidepressant to the current antidepressant, or commencement of a combination of two antidepressants. When monotherapy provided at the maximum manufacturer-recommended doses for 3−4 weeks has failed to provide remission in depression, the diagnosis should be confirmed, psychotherapy added and psychosocial factors should receive attention. In the sustained absence of remission, a better outcome may be obtained by augmenting the antidepressant, changing from a single-action to a double- or multiple-action drug, or by combining antidepressants. [ABSTRACT FROM AUTHOR]

Examines the influence of cosmetic surgery on the mental state of a person. Factor causing the immobile face of the patient; Motor retardation on the major depressive episode of the face; Effect of benzodiazepine on the speech of the patient.