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RMT is central to therapeutic TMS. Routine clinical checks may reveal changes and some research has reported changes. It is unclear whether long-term preservation TMS treatment produces accumulative/permanent change in RMT of clinical concern. Our aim was to examine RMT records of participants in preservation TMS for any evidence of possible accumulative/permanent RMT change. The records were accessed of 30 females and 10 males who had received preservation TMS for from 24 to 57 (male) and 60 (female) months. Generalized estimating equations were used to explore trajectories of RMT over time for the overall sample and by age and gender. Some individual records displayed occasional sharp (up or down) spikes, frequently followed by a degree of rectification. The records of the three highest (mean 75.8) and lowest (mean 36.1) RMT scores were free of large variations. There were no significant changes in RMT over time for the total group, or by gender or age. For this group of 40 patients receiving long term TMS, there were no significant changes in the RMT. [ABSTRACT FROM AUTHOR]

Over the last quarter century, transcranial magnetic stimulation (TMS) has been researched and applied in clinical practice in the treatment of major depressive disorder (MDD). More than 100 placebo-controlled studies and 20 meta-analyses have shown this treatment to be effective in treatment resistant depression (TRD). This revolutionary modality uses electromagnetism to therapeutically impact brain cortex; it causes few side effects. TMS corrects abnormalities in brain connectivity, and such corrections correlate with changes in mood. TMS is complimentary and not a replacement for electroconvulsive therapy (ECT), a comprehensive service will provide both techniques. The efficacy of TMS is expected to increase with new stimulation protocols. Currently used as a second line treatment, TMS is likely to become a first line option. Currently, expertise is limited to those working in particular clinics – there is a need/call for training to be more widely available. [ABSTRACT FROM AUTHOR]

Transcranial magnetic stimulation (TMS) is a safe and effective treat- ment of resistant major depressive disorder (MDD). However, MDD is a chronic disorder and relapse is common. The leading method of managing those cases of MDD who respond to TMS, but continue to relapse, is to provide maintenance TMS – short courses of 5 treatments over 2.5 days, repeat at monthly (or greater) intervals. The strategy is to increase the interval between treatment clusters and for patients to be discharged when they have been able to remain well for a couple of months. However, patients and doctors are both frequently apprehensive about increasing the between cluster interval, and patients tend to remain in treatment programs for long periods. We present a protocol and instrument to assist in moving from treatment to discharge, which we have found helpful. [ABSTRACT FROM AUTHOR]

Background: Tiredness is used in some characterizations of major depressive disorder (MDD). Transcranial magnetic stimulation (TMS) lowers all symptoms of MDD. Objective: To explore whether, 1) a visual analogue scale (VAS) for tiredness is a valid and reliable measure of a feature of MDD, and 2) TMS treatment reduces subjective tiredness occurring in MDD. Method: A naturalistic study of treatment with 10 Hz TMS. Completed pre- and post-treatment: HAMD-6, a visual analogue scale (VAS-6), the Clinical Global Impression - Severity (CGI-S) and a 'VAS-tiredness'. Two groups received TMS. Acute course: N=52 participants suffering acute MDD, received 20 treatment courses (total courses 86). Relapse prevention (RP) course: N=26 participants suffering chronic relapsing MDD received scheduled episodic courses over 3 days; (total courses 266). VAS-tiredness scores were compared with the standardized tool results. Results: There were significant medium to large correlations between pre- and post-treatment VAS-tiredness and the standard depression measures (HAMD-6 .406 to .447, VAS-6 .446 to .525, CGI-S .348 to .407; all p<.001). TMS treatment produced a significant reduction in VAS tiredness in both (Acute course and RP) groups (main effect: F(1,350)=147.3, p<.001, η2=.30). The two groups displayed difference in the pre-treatment VAStiredness with the Acute group having higher scores pre-treatment. Post-treatment tiredness scores were similar. Conclusion: VAS-tiredness is a valid measure of a feature of MDD. VAS-tiredness provides potentially useful information and complements standard mood tools. TMS treatment can reduce tiredness in MDD. [ABSTRACT FROM AUTHOR]

Background: Transcranial Magnetic Stimulation (TMS) is effective in major depressive episodes (MDE). However, MDE may follow a chronic, relapsing course, and some individuals may not satisfactorily respond to a first course of TMS. Objective: To investigate the outcome of second courses of TMS. Method: A naturalistic investigation--we prospectively studied 30 MDE in-patients and routinely collected information, including pre- and post-treatment with Six-item Hamilton Depression Rating Scale (HAMD6), a six-item Visual Analogue Scale (VAS6) and the Clinical Global Impression-Severity (CGI-S). Two categories of patients were considered: i) those who had remitted with a first course, but relapsed, and ii) those who had not remitted with the first course. Results: Thirty individuals received a second TMS course. The mean time to the second course was 27.5 weeks. Based on the HAMD6, 26 (87%) achieved remission after the first course, and 22 (73%) achieved remission after the second course. Furthermore, based on the HAMD6 results, of the four patients who did not achieve remission with a first course, three (75%) did so with a second course. Conclusion: In MDE, a second course of TMS is likely to help those who remitted to a first course and then relapsed, as well as those who did not achieve remission with a first course. [ABSTRACT FROM AUTHOR]

Background: Various TMS protocols have been described, none is appropriate in all circumstances. Objective: To describe the response of a person with acute MDD treated with TMS who was only available for treatment on 3 consecutive days per week. Method: 5 treatment sessions were provided over 3 days – this was provided 4 times, separated by no-treatment periods of 4 days. HAMD6, CSI-S and VAS for depression were completed on the first and last day of each 3-day treatment series. Results: Remarkable improvement; the HAMD6 fell from 12 (severe depression) to 0, the CGI-S fell from 5 (Markedly ill) to 1 (Normal, not mentally ill) and the VAS fell by 98%. There was clear improvement during the last 3 treatment series, as well as during all 3 no-treatment periods. Conclusion: Should these findings be replicated, an additional, useful protocol may be established. [ABSTRACT FROM AUTHOR]

Background: The predominant, current western view is that all suicide is the result of mental disorder. This view is much too narrow and does not admit extensive information regarding the social, economic, and forensic factors (among many others) which may contribute to completed suicide. A consequence of this narrow view is that prevention strategies mainly focus on the detection and treatment of mental disorder. A preferred approach is to place greater emphasis on public health approaches to suicide prevention. Objective: To develop and suggest a body of information which may be useful in a public health approach to suicide. Conclusion: It is suggested that the following be available to the general public: i) suicide is a fact of life which should be minimised, ii) suicide has many different triggers, iii) most people who take their lives are able to make decisions, and iv) increased public discussion and understanding of suicide is desirable. Five pieces of information that may be useful to those contemplating suicide include: i) don't murder the part of you that wants to live, ii) suicide actions may leave you alive but disabled, iii) suicide hurts other people, iv) suicidal impulses do pass if you hold on, and v) suicide is a waste. [ABSTRACT FROM AUTHOR]

Background. Over the last century, the claim has been made that suicide is always, or almost always, the result of mental disorder. Aim. To explore the beliefs of famous English speaking poets regarding the triggers of suicide. Method. Poetry libraries were explored for poetry giving information regarding the attitude of writers to the triggers of suicide. This material was analysed and categorized. Results. Fifteen poems (separate poets) were identified and examined. The triggers of suicide included mental disorder and socioeconomic stressors (acute and chronic). In a minority of cases (four), categorization could not be made. Conclusions. Poets describe the triggers of suicide as including not only mental disorder, but also socioeconomic (acute and chronic) factors. [ABSTRACT FROM AUTHOR]

Background . For the last 200 years Western medicine has insisted that all suicide is triggered by mental disorder. Aim. To locate ancient reports of suicide in which the triggers (non - mental disorder) are clearly stated, and to discover whether these triggers still have that role today. Method . We selected cases in which the triggers were compatible with those considered by Plato to constitute acceptable reasons for suicide: Loss of a lover, Loss of a child, Loss of choic e of spouse (forced marriage), Loss of liberty (and revenge), Shame – own actions, Shame – actions of others, Shame – loss in battle, Guilt, and Physical pain. Ancient and current cases were sought. Findings. In all categories we identified at least one an cient and two recent cases. Conclusion. We demonstrated that millennia ago, and at the present time, various non - mental disorder events had and have the capacity to trigger suicide. If we are to prevent suicide, our culture must discourage this response an d strongly recommend other response options, to those who suffer such experiences. [ABSTRACT FROM AUTHOR]

Current medical theory states that all, or almost all, suicide is the result of mental disorder. The aim was to explore the work of Marcus Aurelius, to understand the view of suicide that was held when Stoics philosophy was at its apogee. Appropriate literature was examined. Marcus Aurelius (a leading Stoic philosopher and successful Roman Emperor) wrote that adverse circumstances, in particular, being unable to live in accordance with one's beliefs, was sufficient justification for suicide. His work is an important link in the history of suicide. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to better understand the triggers of suicide, particularly among the ancient Greek and Persian soldiers and commanders. Method: 'Herodotus: The Histories' is a history of the rulers and soldiery who participated in the Greco-Persian wars (492-449 BCE). A new translation (2013) of this manuscript was studied. Accounts of suicide were collected and collated, with descriptions of circumstances, methods, and probable triggers. Results: Nine accounts of suicide were identified. Eight of these were named individuals (4 Greeks and 4 Persians); of whom, seven were male. Only one (not the female) appeared to act in response to a mental disorder. Other triggers of suicide included guilt, avoidance of dishonour/punishment and altruism. Cutting/ stabbing was the most common method; others included hanging, jumping, poison, and burning (the single female). Conclusion: While soldiers at a time of war do not reflect the general community, they are nevertheless members of their society. Thus, this evidence demonstrates that suicide triggered by burdensome circumstances (in addition to mental disorder) was known to the Greek and Persian people more than two millennia ago. [ABSTRACT FROM AUTHOR]

Background. In the West, beginning in the early 19th century, the belief was published that suicide was always, or almost always, the result of a mental disorder (a medical problem). This belief became established wisdom when psychological autopsies commenced in mid-20th century. However, should this belief be inaccurate, our suicide prevention strategies, which are currently medically orientated, need to change. Aim. To argue the case that metal disorder is not always, or almost always, the cause of suicide, and that suicide may be triggered by a host of other factors. Method. The scientific basis of psychological autopsies and the practice of medicalization were explored. The opinions of non-medical experts were explored, including philosophers, historians, sociologists, economists and ethicists, among others. Epidemiology of rates in different countries and gender differences were examined for evidence. Conclusion. Suicide is not exclusively a medical problem. While suicide is more common in people who have a mental disorder than people without a mental disorder, mental disorder is not a necessary condition. Thus, open discussions about the nature and causes of suicide are required, with a view to involving experts from a range of fields, and the general community, in developing and funding suitable prevention strategies. [ABSTRACT FROM AUTHOR]

This study sought to explore whether using the structure of the International Classification of Functioning Disability and Health (ICF) for the thematic coding of coroners' reports would provide insights into the array and relative importance of different influential factors in Indigenous and non-Indigenous suicide. A total of 411 coroners' reports from the Northern Territory, Australia, were thematically analyzed according to an adapted ICF structure, using a process established by consensus across authors. Categorized statements were tallied and represented graphically. The ICF structure provided a meaningful way of categorizing factors. Key factors associated with suicide across both Indigenous and non-Indigenous cases comprised the following in order of frequency of identification by coroners. Environmental Factors, namely (a) alcohol and drug abuse, categorized under Products and technology and (b) conflict and relationship breakdown, categorized under Support and relationships. The other major factors were within the category Body functions and structures, namely (c) mental illness and mental health concerns, categorized under Mental functions. Substantial differences were evident between factors for Indigenous and non-Indigenous cases. An array of factors was associated with completed suicide, with considerable variability across populations. There were indications of the relative importance of environmental factors. Implications are noted for suicide prevention and the uti lity of the ICF in psychiatry and the study of suicide. [ABSTRACT FROM AUTHOR]