Chat with us, powered by LiveChat -Explore yourreactions to use of the repetitive transcranial magnetic stimulation and deep brain stimulation modalities, discussed in this unit. Are you in favor of or opposed to these modalities? Provide a rationale. ? This modalities have been used to treat some psychiatric diseases with great results, put examples of patients or diseases for what it can be useful, and what considerations need to be taken into account. -There has been a recent increased interest in do-it-yourself brain stimulation as a means of improving cognitive ability (Lumosity). Explain your opinion regarding do-it-yourself brain stimulation. Your post will be checked in Turnitin for plagiarism. Responses should be a minimum of 350 words, scholarly written, APA formatted, and referenced. A minimum of 3 references are required (other than your text). *Attached is some related information that may be useful. Repetitivetranscranialmagneticstimulationtreatspostpartumdepression.pdf Theemerginguseofbrainstimulationtreatmentsforpsychiatricdisorders.pdf transcranialstimulationDEEPBRAINSTIMULATION.docx Funding for supporting inves Reprint requ School of Medi South Euclid Av 1935-861X/10/$ doi:10.1016/ Brain Stimulation (2010) 3, 36?41 Repetitive transcranial magnetic stimulation treats postpartum depression Keith S. Garcia,a Patricia Flynn,a Katherine J. Pierce,a Marty Caudlea aDepartment of Psychiatry, Washington University School of Medicine, St. Louis Missouri Background Postpartum depression (PPD) is a prevalent illness, affecting 10-15% of new mothers. PPD is the most common complication of childbirth and is a significant public health concern. It is known to adversely impact maternal-infant bonding, childrearing practices, and can lead to suicide and infanticide. The current treatment approaches to PPD are suboptimal. Many mothers are reluctant to take medication because of concerns about side effects or exposure of their newborn infant through breastfeeding. The specific aims of this study were to (1) examine acute treatment effectiveness, (2) examine response durability, and (3) assess an effect of repetitive transcranial magnetic stimulation (rTMS) on maternal bonding. Methods Nine antidepressant-free women with PPD were given 20 rTMS treatments over 4 weeks (10 Hz, 120% motor threshold, left dorsolateral prefrontal cortex). Multiple characteristics were assessed at baseline and throughout treatment. Duration of effect was assessed at 30 days, 3 months and 6 months posttreatment. Results Friedman?s tests were conducted on Hamilton Rating Scale for Depression-24 item (HRSD-24), Edinburgh Postnatal Depression Scale (EPDS), Inventory of Depressive Symptomatology-Self-Report (IDS-SR) and Clinical Global Impressions-Severity (CGI-S) scores to compare performances at four time points (baseline, end of Week 2, end of Week 4, and 180-day follow-up). Overall, these results revealed a significant reduction in depressive symptoms by the end of Week 2 of treatment. Analyses yielded a medium effect size (r 5 0.68) on the primary outcome variable (HRSD-24). Of note, all nine patients remained in treatment for the complete 4 weeks, did not miss any treatment sessions and eight participants achieved remission of symptoms, defined as a HRSD , 10 and a CGI-S 5 1. Analysis of follow-up data indicated robustness of the rTMS treatment over time. At 6-month follow-up, of the eight women that remitted, seven remained in remission without further psychiatric intervention, including the addition of medication and one was lost to follow-up. Results also indicated a significant improvement in bonding. the project was awarded by the B.J.C. Townley fund tigator-initiated protocols. ests: Katherine J. Pierce, PhD, Washington University cine, Department of Psychiatry, Campus Box 8134, 660 e., St. Louis, MO 63110. E-mail address: [emailprotected] Submitted March 10, 2009; revised April 11, 2009. Accepted for publication June 1, 2009. -see front matter ? 2010 Elsevier Inc. All rights reserved. s.2009.06.001 mailto:[emailprotected] rTMS treats PPD 37 Conclusions Our results demonstrate promising results for the use of rTMS in the treatment of PPD. Further randomized, sham-controlled studies need to be completed. ? 2010 Elsevier Inc. All rights reserved. Keywords repetitive transcranial magnetic stimulation; postpartum depression; transcranial magnetic stimulation Postpartum depression (PPD) is reported to occur in 10-15% of delivering women.1,2 It is the most common complication of childbirth and is a significant public health concern.3,4 PPD disrupts maternal homeostasis and has an insidious impact on the lives of families by affecting maternal-infant bonding, breastfeeding, child-rearing prac- tices, and overall child well-being.5-8 Furthermore, PPD has been shown to place children at significant risk of impaired cognitive and emotional development.7 Unfortunately, PPD is associated with both maternal suicide and infanticide.9,10 Treatment options for PPD are currently limited to psychotherapy, pharmacotherapy, and electroconvulsive therapy (ECT). Studies have found psychotherapeutic inter- ventions to be an accepted intervention for PPD. Treatment in the form of individual therapy, peer support, and/or group therapy has been found to be helpful in alleviating the anxiety, irritability, and feelings of detachment experienced by women who have PPD. 11-13 Specifically, interpersonal psychotherapy (IPT) is a proven, effective treatment for mild-to-moderate PPD and an alternative to pharmaco- therapy, especially for women who are breastfeeding. However, IPT may not be the treatment of choice for women who have moderate-to-severe symptoms and/or have a history of severe depression in the past, or have had previous reproductive-related depressive disorders. 14 In addition, only limited information regarding the durability of IPT exists and it has been shown that its beneficial effects may be time limited.15 Physicians generally prefer pharmacotherapy to treat women with PPD.16 However, patient acceptance of the use of psychotropic medication for the treatment of PPD is limited by maternal concerns regarding infant exposure through breastfeeding and the unknown future effects of such exposure.17,18 As a consequence of the perceived risk of breastfeeding while on medication, as well as other concerns, such as the potential impact of medication side effects on late night child care, a significant number of women report that they would not consider using psycho- tropic medication to treat their PPD.19 The end result is that many women choose to expose their infant to the adverse effects of PPD rather than receive treatment. ECT has been the primary device-based therapy for treating unremitting major depression for over 6 decades, and is perhaps the most broadly effective treatment for major depression. 20 Although there are no systematic trials of ECT in PPD, case literature supports its effectiveness in postpartum psychiatric states.21 ECT, however, has well-documented adverse effects, including headache, muscle pain, and memory deficits.22-24 In addition, recovery time from each ECT treatment may take several hours, which can limit the ability of a new mother to care for her infant. Repetitive transcranial magnetic stimulation (rTMS) is a recently US Food and Drug Administration-approved depression therapy,25,26 which uses briefly pulsed, powerful magnetic fields to induce focused electrical currents in the brain, depolarizing neurons. Recent meta-analyses have shown that rTMS is superior to sham conditions in the treatment of patients with major depressive disorder (MDD).27-29 Unlike psychotherapeutic interventions, patients receiving rTMS respond rapidly, often within 2-4 weeks, and the response can be sustained.30 Repetitive TMS is unique compared with other somatic depression therapies because there are no systemic side effects that would interfere with child care and no risk of exposure to the infant through breast- feeding. Thus, the use of rTMS for the treatment of PPD would address many of the short comings of medication. We have completed an open-label rTMS treatment trial (pilot) of unmedicated mothers with PPD in an attempt to estimate the utility of rTMS in this population. Outcome measures included investigator-administered, as well as self-reported, measures of depression, and response dura- bility was monitored for 6 months. In addition, we examined the effects of rTMS on maternal bonding. Methods Human Research Protections protocol approval was obtained from the Washington University School of Medicine Human Research Protections Office before enrolling subjects. Informed consent was obtained during an appointment with the principal investigator before performing any protocol procedures. Patients Recruitment material was displayed in more than 50 obstetrics/gynecology offices and in local businesses frequented by women in a large metropolitan Midwestern community. Physicians in the community were encouraged to make referrals to the study through marketing methods, including presentations by the study nurse coordinator and principal investigator and mailings that informed them about inclusion requirements. 38 Garcia et al The entrance criteria included women with clinically diagnosed PPD, age 18-50 years old, who had experienced an uncomplicated pregnancy and delivery that resulted in a healthy, single infant. A score greater than nine points on the Edinburgh Postnatal Depression scale (EPDS),31,32 as well as documentation of meeting DSM-IV-TR criteria for a major depressive episode (completed by study psychi- atrist/principal investigator, K.S.G.) was required for entry. Patients with a history of psychosis or bipolar disorder were excluded from participation. A total of 39 women were screened by telephone. Of these, 27 women did not meet the inclusion criteria or were unable to participate because of other issues (two were calling for their daughters; two preferred medication; two had child care issues; two had a history of drug or ethyl alcohol dependence; one had transportation issues; three had a time commitment; one had a multiparous birth; one had an adopted infant; two were teenaged; one stated medical reasons; three were bipolar and on medication; seven gave no reason [three of whom were scheduled for in-person informational appointments but did not show up]). Inter- views were conducted for the remaining women and resulted in 12 signed informed consents. After the signing of the consent form, the principal investigator (K.S.G.) performed a protocol-specific interview that involved a discussion of the participant?s options for treatment, as stated in the consent form. Three participants consented and then withdrew their consent after the initial interview with the principal investi- gator. One woman was returning to work full time and was Table 1 Demographic characteristics of nine PPD patients Characteristic Race 89% White 11% Indian Marital status 67% Married 33% Single Employment status 67% Employed Breastfeeding status 50% Breastfeeding Age (y) 34.11 (6.05) Level of education 16.89 (2.47) EPDS baseline score 18.22 (4.52) HRSD-24 baseline score 22.67 (6.44) IDS-SR baseline score 41.22 (11.69) PPD 5 postpartum depression; EPDS 5 Edinburgh Postnatal Depression Scale; HDRS-24 5 Hamilton Rating Scale of Depression-24-point scale; IDS- SR 5 Inventory of Depressive Symptomatology-Self-Report; SD 5 standard deviation. Data are given as mean (SD). not sure her job would allow the time off for treatment. The other two women preferred the option of returning to their primary care physician for medication therapy. Nine women who completed the selection process were enrolled. Baseline characteristics for the participants are summarized in Table 1. Participants were 30 days to 1-year postpartum. Fifty percent of our study?s subjects were breastfeeding, which reflected a section of the PPD population known to be unwilling to expose their infants to antidepressant medica- tions. 17,18 Before treatment, participants were queried as to their primary reason for choosing rTMS. The predominant response was ??I was concerned about medication side effects.?? Eight of the nine participants had a previous history of major depressive disorder, and two of the eight with a postpartum onset. Of these eight, four received successful pharmacologic intervention, two were intolerant of medication side effects, and two were not treated. Partic- ipants were antidepressant-free at study entry and other than one participant taking seven 2-mg doses of diazepam over the course of the 4 weeks of treatment for Meniere- related vertigo, no psychotropic or central nervous system medications were consumed. Study design This study was an open-label, single-arm 4-week pilot of the use of high-frequency, high-intensity, left dorsolateral prefrontal cortex (DLPFC) rTMS for the treatment of PPD. Repetitive TMS treatment Twenty rTMS treatments (10 Hz applied at 120% of the motor threshold for 4 seconds of stimulation and 26 seconds off for a total of 75 trains or 3000 pulses) (Neuro- netics Model 2100 CRS TMS System, Neuronetics, Inc., Malvern, PA) were delivered five times per week over the left DLPFC. Motor threshold testing was performed weekly by the principal investigator to modify dosing if required. Treatment was administered by an rTMS-experienced registered nurse or physician assistant. Clinical ratings/measures Assessment of depressive symptoms included a clinical interview, Edinburgh Postnatal Depression Scale (EPDS),31,32 Hamilton Rating Scale of Depression-24 (HRSD-24),33 Inventory of Depressive Symptomatology- Self Report (IDS-SR),34 and Clinical Global Impressions- Severity (CGI-S)35 that occurred weekly throughout treatment and at 1-, 3- and 6-months posttreatment. In addition, a measure of bonding was administered before and immedi- ately after the 4 weeks of treatment (Postpartum Bonding Questionnaire [PBQ]). 36,37 The PBQ consists of 25 items Table 2 Friedman?s test results for baseline, week 2, week 4, and 6-month follow-up scores for clinical outcome measures (n 5 7) Mean/SD Mean/SD Mean/SD Mean/SD c2 Significance Scale Baseline score 2-wk score 4-wk score 6-mo score value level (P) HRSD-24 23.43 (6.00) 9.00 (3.70) 2.14 (3.19) 2.00 (3.32) 19.50 , .0005 IDS-SR 42.43 (11.89) 20.71 (7.48) 7.29 (6.42) 4.29 (5.25) 19.97 , .0005 EPDS 18.29 (4.68) 9.14 (2.12) 3.43 (3.21) 2.71 (2.43) 19.35 , .0005 CGI-S 4.00 (0.00) 2.57 (0.79) 1.14 (0.38) 1.29 (0.49) 19.82 , .0005 HDRS-24 5 Hamilton Rating Scale of Depression-24-point scale; IDS-SR 5 Inventory of Depressive Symptomatology-Self-Report; EPDS 5 Edinburgh Postnatal Depression Scale; CGI-S 5 Clinical Global Impressions-Severity; SD 5 standard deviation. Data are given as mean (SD). rTMS treats PPD 39 rated on a scale of 0-5. The PBQ has 25 statements, each fol- lowed by six responses ranging from ??always?? to ??never.?? Positive responses, such as ??I enjoy playing with my baby,?? are scored from zero (always) to 5 (never). Negative responses, such as ??I am afraid of my baby,?? are scored from 5 (always) to zero (never). The sum of scores for all the 25 items is calcu- lated, with a high score indicating pathology. Statistical analysis The primary outcome measure for the study was the HRSD-24.33 Secondary outcome variables included the EPDS,31,32 IDS-SR (self-report),34 and CGI-S.35 Treatment response was defined as a . 50% reduction in HRSD-24 scores from baseline. Remission was defined as a HRSD- 24 , 10 and a CGI-S 5 1. Friedman?s tests were conducted on HRSD-24, EPDS, IDS-SR, and CGI-S scores to compare depressive symp- tomatology at four time points (baseline, end of treatment Week 2, end of treatment Week 4, and 180-day follow-up). Friedman?s test was chosen because the assumption of normality could not be verified and the sample size was small. In the presence of a significant overall test, post hoc comparisons were performed by using the Wilcoxon signed-ranks test. The critical alpha level was adjusted by using Bonferroni?s correction to take into account the potential for increased Type I error (critical alpha 5 .008). Effect size (r) was calculated by completing a Wilcoxon signed-ranks test comparing baseline to the end of Week 0 5 10 15 20 25 HDRS-24 Means Across Study Figure 1 Hamilton Rating Scale of Depression-24 items (HRSD-24) means across study duration. 4 HDRS-24 scores (a priori analysis point). The resulting Z score was then entered into the following formula: where r 5 Z/ON. Wilcoxon signed-ranks test was used to examine changes in mother-infant bonding from pretreatment to posttreatment as measured by the PBQ. 36,37 Results The results of the Friedman?s tests indicated that there was a significant improvement in depressive symptomatology (Table 2). Post hoc analyses (i.e., Wilcoxon signed-ranks test) with adjustment of the two-tailed level to .008 to accommodate increased Type I error indicated that the significant decrease in symptoms occurred at the end of the second week of treatment (HRSD-24 baseline Md 5 23.00, Week 2 Md 5 10.00, P 5 .008; EPDS baseline Md 5 19.00, Week 2 Md 5 9.00, P 5 .008; IDS-SR baseline Md 5 45.00, Week 2 Md 5 21.00, P 5 .008). A Wilcoxon signed-ranks test comparing baseline with the end of week 4 HDRS-24 scores (a priori analysis point) yielded a medium effect size (r 5 0.68). Of note, all nine patients remained in treatment for the complete 4 weeks and did not miss any treatment sessions. Eight participants achieved remission of symptoms, defined as a HRSD , 10 and a CGI-S 5 1. Analysis of follow-up data indicated robustness of the rTMS treatment over time (Figures 1-3). At 6-month follow-up, of the eight who remitted, seven re- mained in remission at the 6-month follow-up without further psychiatric intervention, including the addition of 0 5 10 15 20 25 30 35 40 45 IDS-SR Means Across Study Figure 2 Inventory of Depressive Symptomatology-Self-Report (IDS-SR) means across study duration. 0 2 4 6 8 10 12 14 16 18 20 EPDS Means Across Study Figure 3 Edinburgh Postnatal Depression Scale (EPDS) means across study duration. 40 Garcia et al medication, and one was lost to follow-up. In addition, a Wilcoxon signed-ranks test was conducted to evaluate the impact of the intervention on women?s bonding with their infants (as measured by the PBQ). 36,37 There was a statistically significant improvement in bonding scores from pretreatment (Md 5 20.00) to posttreatment (Md 5 7.00, P 5 .010) assessment. Repetitive TMS was safe and well tolerated. A patient satisfaction questionnaire given at the end of treatment indicated that eight of nine preferred rTMS to medication, but only six of nine believed it was convenient. Minor adverse events included headache, treatment site pain (both of which were relieved with pretreatment over-the-counter analgesics), and facial stimulation (which resolved with magnetic repositioning). There were no drop outs because of adverse events and there were no observed serious adverse events. Discussion This is the first open-label rTMS pilot group study of PPD to address the question of the use of rTMS as a treatment for PPD (three previous case studies existed).38-40 Treat- ment response was rapid, robust, and durable suggesting that rTMS could be used as a treatment bridge that would allow mothers with PPD to remain medication free until a time when they are no longer breastfeeding and the use of medication maintenance becomes more acceptable, if needed. As with any small pilot, these results should be viewed as highly preliminary. Shortcomings of the study include small sample size and the lack of a sham control arm. In addition, although psychotherapy was not administered, daily contact with the professional psychiatric research staff administering rTMS treatments could have influenced the outcome. Depression was recurrent in eight of nine of our treatment population and, of these, four of six of our treatment population had been successfully treated with medication for previous episodes (two received no treat- ment). The patients in the study were not treatment refractory, but rather unwilling to pursue other systemic treatments such as medication during their postpartum period. Thus, rTMS appears to be ideally targeted toward mothers with PPD who are treatment responsive, but would otherwise forgo treatment because of concerns about the adverse impacts of medication. Previous rTMS studies have not demonstrated the impressive remission rates and maintenance of remission observed in this small pilot study. 28 This raises a concern that these results might be spurious. Several factors could account for this discrepancy. First, the study was open- label, thus our patients were aware they were receiving active treatment and may have experienced a placebo response. However, recent studies have shown that a placebo response is lower in rTMS trials in which it is not used as an add-on therapy. 28,41 Second, our population was not treatment refractory and many had responded successfully to treatment in previous episodes. No current rTMS treatment literature exists describing nontreatment- resistant patients? responses to rTMS. This is clearly an area that needs to be further explored. Third, our treatment protocol was more aggressive than most published proto- cols with higher dosing over longer treatment periods. Finally, PPD may be more responsive to rTMS than other forms of MDD because it may be a unique form of MDD or a form of MDD that may be more self-limiting. This area of interest could also benefit from further examination. Conclusions This small pilot study is encouraging. Future large-scale, sham-controlled studies are needed to confirm our obser- vations. Feedback provided by participants highlighted the need for onsite child care to enhance treatment convenience and should be included in any future studies. The potential use of rTMS as a prophylactic treatment for depression occurring during pregnancy and during the postpartum period, when medication management is undesirable, represents an additional opportunity for the use of rTMS. There is an urgency to develop an alternative therapy for treating women who have PPD. We believe rTMS may become a preferred treatment for PPD. We express our sincere thanks to the women partici- pating in this unique pilot program. Our appreciation is also extended to Neuronetics, Inc., for supplying the Neuronetics Model 2100 CRS TMS System. References 1. Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol 2005;106:1071-1083. 2. Gaynes BN, Gavin N, Meltzer-Brody S, et al. Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evid Rep Technol Assess (Summ) 2005;119:1-8. rTMS treats PPD 41 3. Grace SL, Evindar A, Stewart DE. The effect of postpartum depres- sion on child cognitive development and behavior: a review and critical analysis of the literature. Arch Womens Ment Health 2003;6: 263-274. 4. Wisner KL, Chambers C, Sit DK. Postpartum depression: a major public health problem. JAMA 2006;296:2616-2618. 5. Burke L. The impact of maternal depression on familial relationships. Int Rev Psychiatry 2003;15:243-255. 6. Hatton DC, Harrison-Hohner J, Coste S, Dorato V, Curet LB, McCarron DA. Symptoms of postpartum depression and breastfeed- ing. J Hum Lact 2005;21:444-449. 7. Herrera E, Reissland N, Shepherd J. Maternal touch and maternal child-directed speech: effects of depressed mood in the postnatal period. J Affect Disord 2004;81:29-39. 8. Mian AI. Depression in pregnancy and the postpartum period: balancing adverse effects of untreated illness with treatment risks. J Psychiatr Pract 2005;11:389-396. 9. Oates M. Perinatal psychiatric disorders: a leading cause of maternal morbidity and mortality. Br Med Bull 2003;67:219-229. 10. Wisner KL, Gracious BL, Piontek CM, Peindle K, Perel JM. Postpartum disorders: Phenomenology, treatment approaches, and relationship to infanticide. In: Spinelli MG, editor. Infanticide: psychosocial and legal perspectives on mothers who kill. Washington, DC: American Psychiatric Publication; 2003. p. 35-60. 11. Dennis CL. The effect of peer support on postpartum depression: a pilot randomized controlled trial. Can J Psychiatry 2003;48:115-124. 12. Milgrom J, Negri LM, Gemmill AW, McNeil M, Martin PR. A randomized controlled trial of psychological interventions for post- natal depression. Br J Clin Psychol 2005;44:529-542. 13. Ugarriza DN. Group therapy and its barriers for women suffering from postpartum depression. Arch Psychiatr Nurs 2004;18:39-48. 14. Grigoriadis S, Ravitz P. An approach to interpersonal psychotherapy for postpartum depression: focusing on interpersonal changes. Can Fam Physician 2007;53:1469-1475. 15. Cooper PJ, Murray L, Wilson A, Romaniuk H. Controlled trial of the short- and long-term effect of psychological treatment of post-partum depression: I, impact on maternal mood. Br J Psychiatry 2003;182: 412-419. 16. Miller LJ. Postpartum depression. JAMA 2002;287:762-765. 17. Battle CL, Zlotnick C, Pearlstein T, et al. Depression and breastfeed- ing: which postpartum patients take antidepressant medications? Depress Anxiety 2008;25:888-891. 18. Chabrol H, Teissedre F, Armitage J, Danel M, Walburg V. Accept- ability of psychotherapy and antidepressants for postnatal depression among newly delivered mothers. J Reprod Infant Psychol 2004;22: 5-12. 19. Pearlstein TB, Zlotnick C, Battle CL, et al. Patient choice of treatment for postpartum depression: a pilot study. Arch Womens Ment Health 2006;9:303-308. 20. Greenberg RM, Kellner CH. Electroconvulsive therapy: a selected review. Am J Geriatr Psychiatry 2005;13:268-281. 21. Forray A, Ostroff RB. The use of electroconvulsive therapy in postpartum affective disorders. J ECT 2007;23:188-193. 22. Fraser LM, O?Carroll RE, Ebmeier KP. The effect of electroconvulsive therapy on autobiographical memory: a systematic review. J ECT 2008;24:10-17. 23. Lisanby SH, Maddox JH, Prudic J, Devanand DP, Sackeim HA. The effects of electroconvulsive therapy on memory of autobiographical and public events. Arch Gen Psychiatry 2000;57:581-590. 24. Loo CK, Schweitzer I, Pratt C. Recent advances in optimizing electro- convulsive therapy. Aust N Z J Psychiatry 2006;40:632-638. 25. FDA. 510k premarket approval. Available: pdf8/K083538.pdf. Accessed on December 20, 2008. 26. Waltman A. FDA Clears NeuroStarR TMS therapy for the treatment of depression. Available: Accessed on October 8, 2008. 27. Gross M, Nakamura L, Pascual-Leone A, Fregni F. Has repetitive trans- cranial magnetic stimulation (rTMS) treatment for depression improved? A systematic review and meta-analysis comparing the recent vs. the earlier rTMS studies. Acta Psychiatr Scand 2007;116:165-173. 28. Lam RW, Chan P, Wilkins-Ho M, Yatham LN. Repetitive transcranial magnetic stimulation for treatment-resistant depression: a systematic review and metaanalysis. Can J Psychiatry 2008;53:621-631. 29. Loo CK, Mitchell PB. A review of the efficacy of transcranial magnetic stimulation (TMS) treatment for depression, and current and future strat- egies to optimize efficacy. J Affect Disord 2005;88:255-267. 30. O?Reardon J, Solvason H, Janicak P, et al. Efficacy and safety of trans- cranial magnetic stimulation therapy in the acute treatment of major depression: a multi-site randomized controlled trial. Biol Psychiatry 2007;62:1208-1216. 31. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 1987;150:782-786. 32. Cox JL, Chapman G, Murray D, Jones P. Validation of the Edinburgh Postnatal Depression Scale (EPDS) in non-postnatal women. J Affect Disord 1996;39:185-189. 33. Hamilton M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 1967;6:278-296. 34. Rush AJ, Gullion CM, Basco MR, Jarrett RB, Trivedi MH. The Inven- tory of Depressive Symptomatology (IDS): psychometric properties. Psychol Med 1996;26:477-486. 35. Guy W. ECDEU Assessment Manual for Psychopharmacology. Washington (DC): National Institute of Mental Health, US Depart- ment of Health, Education, and Welfare; 1976. 36. Brockington IF, Oates J, George S, et al. A screening questionnaire for mother-infant bonding disorders. Arch Womens Ment Health 2001;3: 133-140. 37. Brockington IF, Fraser C, Wilson D. The Postpartum Bonding Ques- tionnaire: a validation. Arch Womens Ment Health 2006;9:233-242. 38. Cohen R, Ferreiraa M, Ferreirra M, Fregni F. Use of repetitive trans- cranial magnetic stimulation for the management of bipolar disorder during the postpartum period. Brain Stimulation 2008;1:224-226. 39. Nahas Z, Bohning DE, Molloy MA, Oustz JA, Risch SC, George MS. Safety and feasibility of repetitive transcranial magnetic stimulation in the treatment of anxious depression in pregnancy: a case report. J Clin Psychiatry 1999;60:50-52. 40. Ogden M, Lyndon W, Pridmore S. Repetitive transcranial magnetic stimulation (rTMS) in major depressive episode with postpartum onsetda case study. German J Psychiatry 1999;2:43-45. 41. Brunoni AR, Lopes M, Kaptchuk TJ, Fregni F. Placebo response of non-pharmacological and pharmacological trials in major depression: a systematic review and meta-analysis. PLoS ONE 2009;4:e4824. Repetitive transcranial magnetic stimulation treats postpartum depression Methods Patients Study design Repetitive TMS treatment Clinical ratings/measures Statistical analysis Results Discussion Conclusions References , Paul B. Fitzgerald, Professor (Correspondence) Monash Alfred Psychiatry Research Centre, The Alfred and Monash University School of Psychology and Psychiatry, The Alfred, First Floor Old Baker Building, Commercial Road, Melbourne, Victoria, 3004, Australia. Email: [emailprotected] The emerging use of brain stimulation treatments for psychiatric disorders Paul B. Fitzgerald Objective: The aim of this study was to review the current state of development and applica- tion of a wide range of | Gen Paper

-Explore yourreactions to use of the repetitive transcranial magnetic stimulation and deep brain st

error: Content is protected !!