Effectiveness of rTMS With Double-Cone-Coil in Patients With Major Depression
Condition: Depression
MeSH terms: Depression; Depressive Disorder
Study type: Interventional

Summary: 
      Repetitive Transcranial Magnetic Stimulation (rTMS) is used to modulate the neuronal
      excitability in patients with depression. In the present study the investigators will examine
      whether medial frontal rTMS using a double-cone-coil proves to be superior to conventional
      high-frequency-rTMS applied to the left-sided prefrontal cortex with a butterfly-coil.
    

Detailed description: 
      Depression is a common mental disorder that presents with depressed mood, loss of interest,
      feelings of guilt or low self-worth, disturbed sleep or appetite, low energy levels and poor
      concentration. These problems can become chronic or recurrent and lead to substantial
      impairments in an individual's ability to take care of his or her everyday's
      responsibilities, at its worst, depression can lead to suicide. Depression can be reliably
      diagnosed in primary care. Antidepressant medications and brief, structured forms of
      psychotherapy are effective for 60-80% of those affected and can be delivered in primary
      care.

      In patients with depression the cerebral metabolism is deranged in some specific areas such
      as hypoexcitability in frontal cortical areas. High-frequency rTMS of the dorsolateral
      prefrontal cortex (DLPFC) has been investigated for the treatment of hypoexcitability
      disorders. Mild antidepressant effects of rTMS applied to the left sided dorsolateral
      prefrontal cortex (DLPFC) using a standard butterfly coil can possibly be increased by a
      different stimulation protocol over the medial frontal cortex using a double-cone-coil. First
      hints to effectiveness of this treatment arise from case reports and therefore need
      replication and comparability to conventional stimulation protocols. In the present study the
      investigators will examine whether medial frontal rTMS using a double-cone-coil proves to be
      more effective to conventional high-frequency-rTMS applied to the left-sided prefrontal
      cortex with a butterfly-coil.
    

Intervention name(s): Medial Frontal rTMS Double-Cone-Coil; Left DLPFC Butterfly Coil; Placebo Stimulation
Intervention type(s): Device; Device; Device
Intervention description(s): High frequency rTMS ( Alpine Biomed Mag Pro Option) applied over medial superior frontal cortex (supplementary motor cortex) (Brodmann area 6/8),Double-Cone-water-cooled-Coil (2000 Stimuli of 10 Hz each session), 110% motor threshold.; High frequency rTMS ( Alpine Biomed Mag Pro Option): 2000 stimuli of 10 Hz over the left DLPFC (each session), Butterfly-water-cooled-Coil, 110% motor threshold.; Sham Stimulation (conventional butterfly-coil, angled 45°): left DLPFC continuous rTMS, 10 Hz, 2000 Stimuli each session, 110% motor threshold
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Depression; Transcranial magnetic stimulation; rTMS; DLPFC; medial frontal cortex; anterior cingulate complex