Effectiveness of Theta-burst Stimulation (TBS) in Patients With Major Depression
Effectiveness of Theta-burst Stimulation (TBS) in Patients With Major Depression
Repetitive Transcranial Magnetic Stimulation (rTMS) as well as Theta- Burst Stimulation of
 the frontal cortex are used to modulate the neuronal excitability in patients with
 depression. In the proposed study we investigate whether high frequent rTMS or Theta-Burst
 Stimulation of the DLPFC is more effective in patients with a depressive episode.
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, 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 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. Pilot data indicate that the mild effects of the rTMS could be increased by a
 special kind of TMS, the Theta-burst stimulation. In the proposed study we investigate
 whether high frequent rTMS or Theta-Burst Stimulation of the DLPFC is more effective in
 patients with a depressive episode.
Inclusion Criteria:

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

 -  Female or male between 18 and 70 years

 -  Skills to participate in all study procedures

 -  18 or more points in the Hamiliton 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