Effectiveness of rTMS With Double-Cone-Coil in Patients With Major Depression
Effectiveness of rTMS With Double-Cone-Coil in Patients With Major Depression
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.
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.
Inclusion Criteria:

 -  Episode of depression (unipolar or bipolar)( ICD-10)

 -  Female or male between 18 and 70 years old

 -  Skills to participate in all study procedures

 -  18 or more points in the Hamilton rating scale or depression

 -  Stable antidepressant drugs

 -  Written informed consent

 Exclusion Criteria:

 -  Clinically relevant unstable internal or neurological comorbidity

 -  Evidence of significant brain malformations or neoplasm, head injury

 -  Cerebral vascular events

 -  Neurodegenerative disorders affecting the brain or prior brain surgery

 -  Metal objects in and around body that can not be removed

 -  Pregnancy

 -  Alcohol or drug abuse

 -  Epilepsy or a pathological EEG

 -  Heart pacemaker

 -  High dose tranquillizers