rTMS for the Treatment of Depression: a

rTMS for the Treatment of Depression: a Comprehensive Review of Effective Protocols on Right DLPFC Ali Yadollahpour, Seyed Ahmad Hosseini & Ahmad Shakeri

International Journal of Mental Health and Addiction ISSN 1557-1874 Int J Ment Health Addiction DOI 10.1007/s11469-016-9669-z

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Author's personal copy Int J Ment Health Addiction DOI 10.1007/s11469-016-9669-z

rTMS for the Treatment of Depression: a Comprehensive Review of Effective Protocols on Right DLPFC Ali Yadollahpour 1 & Seyed Ahmad Hosseini 2 & Ahmad Shakeri 1

# Springer Science+Business Media New York 2016

Abstract Major depressive disorders (MDDs) are the most common and debilitating diseases worldwide. Repetitive transcranial magnetic stimulation (rTMS) has been widely used as an alternative or adjunctive treatment for different types of depression disorders, including drugresistant major depressions. Despite controversial findings on the therapeutic outcomes of this technique, the general consent is developing this technique as an alternative treatment for depression disorders. Notwithstanding one protocol of rTMS has been approved by FDA for the acute treatment of major depression, studies are ongoing for finding more efficient protocols. This study aimed to comprehensively overview the effective rTMS protocols applied on left dorsolateral prefrontal cortex DLPFC for MDDs. The databases of PubMed (1985–2015), Web of Sciences (1985–2015), and Google Scholar (1980–2015) were searched using the set terms. The obtained results were screened for the relevant contents by two authors, and the appropriate studies were selected for further review. The most widely used protocols for depression are 1Hz for right and 10Hz for left DLPFC. In addition, the main parameters of these protocols and the main neurophysiological mechanisms of two common frequencies of 1 and 10 Hz are summarized. Different protocols of rTMS, particularly low versus high frequencies, result in significantly different electrophysiological and neurocognitive changes in the subject. Low frequency rTMS modulates frontal alpha power asymmetry and high frequency protocols influence more broader regions and wider electrophysiological characteristics of the brain. Keywords Repetitive transcranial magnetic stimulation . Depression . Treatment . Effective protocols . Right dorsolateral prefrontal cortex

* Ali Yadollahpour [email protected]

1

Department of Medical Physics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Golestan Blv., Ahvaz, Iran 6135715794

2

Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

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Depression is a mental illness and neuropsychological dysfunction with relatively high prevalence worldwide (Kazdin 2000; Marcus et al. 2012). The America Psychological Association reports that depression is the most common disease worldwide (Kazdin 2000; Lepine and Briley 2011). World Health Organization predicts that by 2020, depression will be the second largest cause of disability, after heart ischemic disease (Parikh and Lam 2001). Neuroimaging, neurophysiological and hemodynamic images of brains of the depressed patients have show that certain regions of the depressed brain involved in the development of depression, including the dorsolateral prefrontal cortex (DLPF), subgenual cingulate gyrus, and limbic nucleus (Jaracz and Rybakowski 2002). Functional images of the brain in depressed patients have shown that in addition to electrical activity of different brain regions, different functions of the brain are disturbed during depression. Infrared spectroscopy studies have shown that metabolic activity of specific regions of the brain is modulated in depression (Fukuda et al. 2003). Positron emission tomography (PET) has shown dysfunction of serotonin hormone receptors (Drevets et al. 1999) and disturbance of glucose local metabolism in the prefrontal cortex (Kling et al. 1986). In depression, excitability of the brain cortex generally decreases (Fountoulakis et al. 2008). Therefore, one of the main approaches for treatment of this disorder is increasing the excitability of brain cortex (Maeda et al. 2000).

Non-pharmacological Treatment According to the guidelines of the American Psychiatric Association, current approved treatment options for MDD include drug therapy, psychotherapy, drug therapy with psychotherapy, and electroconvulsive therapy (ECT) (Ali and Mahmud 2014; American Psychiatric Association 2001). Despite using different antidepressants drugs, some portion of depressed patients are resistant to drug treatment (Fava and Davidson 1996). Therefore, developing nonpharmacologic treatments is necessary. Developing nonpharmacologic techniques with no side effects and safety has always been of interest to researchers and clinicians in any disorders. During the recent years, physical agents such as electrical and magnetic fields, sound waves and laser have been extensively used as alternative or adjunctive treatments for different disorders ranging from musculoskeletal and metabolic disorders, wounds, and neuropsychiatric disorders (Mostafa et al. 2015; Yadollahpour and Rashidi 2014a, b; Yadollahpour et al. 2014b; Yadollahpour and Rezaee 2014; Zohre et al. 2015). This is the same for depression, particularly for drug-resistant cases. In this regard, several therapeutic techniques have been developed for the treatment of various types of depression (Aarre et al. 2003; Chistyakov et al. 2005a, b; Cooke 2003; Cordes et al. 2005). Electroconvulsive therapy (ECT), Vagus nerve stimulation (VNS), and deep brain stimulation (DBS) are some of these techniques with promising potentials (Chistyakov et al. 2005a, b; Loo et al. 2011; Howland et al. 2011; Knotkova et al. 2012; Sparing and Mottaghy 2008). Although these techniques have shown therapeutic potentials for depression, they are invasive and each of them has their own side effects. Transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), and neurofeedback, which are non-invasive, are relatively new developed techniques for the treatment of depression (Sparing and Mottaghy 2008; Wagner et al. 2007). The rTMS has shown promising therapeutic outcome for different types of depressive disorders especially for drug-treatment resistant cases. This non-invasive technique is safe, cost-effective, and easy to use, which has been reportedly capable of modulating the brain in neurophysiological, behavioral, and cognitive


function levels. Various protocols of rTMS have been used for the treatment of depression. These techniques used different stimulation parameters including frequency, field intensity, number of total pulses, number of sessions per week, and number of total sessions. In addition, site of stimulation is another important rTMS treatment parameters. The therapeutic efficacy of these protocols and mechanisms of action are not fully understood. The present study aims to comprehensively and descriptively overview the common rTMS protocols applied on DLPFC, particularly left DLPFC, and the proposed mechanisms of action for depression treatment.

Methods We searched the databases of PubMed (1985–2015), Web of Sciences (1985–2015), and Google Scholar (1980–2015) using the following keywords: Bdepression treatment^, or Bmajor depressive disorder^, and BrTMS^ or Brepetitive transcranial magnetic stimulation^, and BDLPFC^ or Bdorsolateral prefrontal cortex^, and Bmechanisms of action^. The obtained results were screened for the title and abstract by two authors, who came to consensus whether the studies are related to the review. Because of the immense body of literature in this field, this study was not aimed to provide a systematic review; but to provide a comprehensive and descriptive overview of efficient rTMS protocols for depression treatment applied to DLPFC. In addition, the main parameters of these protocols and the main neurophysiological mechanisms of two common frequencies of 1 and 10 Hz are summarized.

Results and Discussion Basic Principles of rTMS in Depression Transcranial magnetic stimulation (TMS) is a common technique used in the field of noninvasive brain stimulation since its first introduction by Barker et al. in 1985 (Barker et al. 1987). TMS operates based on the Faraday’s principle of electromagnetic induction. In this technique, transmission of high intensity and rapidly rising electrical current (about 10 kA in 100–200 μs) through loops of wire in the form of figure-of-eight or circular coil induces a time-varying magnetic field vertical to the plane of the coil, inducing an orthogonal electric field which subsequently induces local current in conductive material surrounding coil such as the brain. In this method, the magnetic field (up to 4 T) is used to enter extremely resistant structures, such as the skull, while the electric field creates secondary currents leading to neuronal activation (Wagner et al. 2007; Kobayashi and Pascual-Leone 2003; Hallett 2007). Ionic current generated in the brain can cause neuronal depolarization and action potential (Hoffman and Cavus 2002). Because of the nature of the brain and the fact that it is mainly stimulated through electrical current, the brain is very sensitive to external electromagnetic fields. The induced currents can modulate the neurophysiological functions of neural cells, which in turn can lead to modulation of hemodynamic, physiological, and cognitive and behavioral functions of different regions and systems of the brain. This technique has been used in treatment of several disorders, such as epilepsy, anxiety, tinnitus, mania, addiction, obsessive compulsive disorder, etc. (Howland et al. 2011; Hoffman and Cavus 2002; Yadollahpour et al. 2014a; Höppner et al. 2011; George et al. 1999). In several studies, these techniques are used to investigate the cause-effect relationships in cortical areas and


alteration of different neurophysiological properties of brain, such as plasticity, motor function, cortical excitability, and augmentation of synaptic strength (Hallett 2000; Wassermann and Lisanby 2001). Since the approval of rTMS application for the treatment of depression by FDA, various protocols of stimulation have been investigated and evaluated for their therapeutic efficacy. Some of these protocols showed high therapeutic efficacy. The main parameters influencing the treatment outcome of rTMS in depression are frequency, magnetic field intensity (defined as percentage of motor threshold of the subject), site of stimulation, number of pulse per session, and number of sessions per day (Cooke 2003; Hoffman and Cavus 2002; Grunhaus et al. 2000). The LDLPFC and RDLPFC are the most common sites for the rTMS applications. The low frequencies rTMS (≤10 Hz) are usually applied on RDLPFC, whereas high frequencies rTMS are used for LDLPFC (Berlim et al. 2011; Berman et al. 2000; Eche et al. 2012; Eschweiler et al. 2000; McDonald et al. 2011).

rTMS Protocols for Depression Treatment Table 1 presents the different protocols of rTMS applied on RDLPF. The DLPFC is the main target for stimulation in depression. Findings of neuroimaging and neurophysiological studies of the brain demonstrate that mood is regulated by a network of brain regions, including the prefrontal, cingulate, parietal, and temporal cortical regions. This network is functionally connected to different parts of the striatum, thalamus, and hypothalamus. Therefore, we can expect that focal lesions in any section of this network can result in mood disturbances. Furthermore, depressed patients show alterations in cerebral blood flow and metabolism in different regions of this network, mainly the dorsolateral, orbitofrontal, and medial frontal regions. One of the regions within the network responsible for depression is accessible by rTMS and highly connected with other crucial nodes in the network, such as other prefrontal and anterior cingulate regions is DLPFC. Therefore, the first line studies of rTMS for treatment of depression focused on the DLPFC as a site of stimulation. The mostly wide used protocol of rTMS for RDLPFC is 1Hz. The typical intensity range is 90 to 110 % of the subject’s motor threshold. The majority of the studies reviewed applied 2 weeks stimulations containing one session daily for five consecutive days per week. The number of total pulses is usually 1200. In addition to these standard protocols, different protocols have been proposed for the stimulation of RDLPFC, in which the majority increases the number of total pulses or number of total sessions. It seems increasing the number of total pulses or number of total sessions can increase the therapeutic efficacy. However, there are somehow contradictory findings in this regard where increasing the number of total pulses or total sessions did not result in better outcome (Aarre et al. 2003; McDonald et al. 2011; Höppner et al. 2010). In addition, increasing the number of sessions or number of total pulses can increase the patent’s agitation and stopping the treatment process. The site for stimulation of DLPFC is based on the motor evoked potential (MEP) elicited by single pulse rTMS and recording or observing the response of contralateral hand muscle. The site is usually located 5 cm anterior to the optimal location for producing MEPs in a hand muscle. High frequency (10 Hz) focal stimulation of the LDLPF C is the most widely used frequency for treatment of MDD. However, studies have shown that low frequency (1HZ) stimulation on RDLPFC is also effective treatment. Currently, the therapeutic efficacy of simultaneous stimulation affects different regions of brain such as right and left DLPFC, stimulating other cortical and subcortical foci, and general stimulation of the whole brain are

DB comparing active 10 RDLPFC/1/%110 (Hz) LDLPFC rTMS vs. active 1 (Hz) RDLPFC rTMS vs. sham LDLPFC rTMS

Lisanby et al. 2001

RDLPFC/1/%110

Comparing active 20 (Hz) LDLPFC vs. active 1 (Hz) RDLPFC vs. sham LDLPFC rTMS

DB, placebo-controlled

DB, randomized, parallel group, comparing active 20 (Hz) LDLPFC rTMS vs. active 1 (Hz) RDLPFC rTMS

DB sham controlled

Höppner et al. 2003

Kauffmann et al. 2004

Isenberg et al. 2005

Januel et al. 2006

16

NA

RDLPFC/1/%110

RDLPFC/1/%90

5

RDLPFC/1 %110

10

RDLPFC/1/100 % 20

12

32

11

14

7

10

20

12

35

16,000

1200

Total pulses

HDRS

HDRS 17itema MADRSb

Assessment

16/4

20/5

10/5

10/5

1920

1200

1200

1200

HDRS

Response rate: 32 %

No significant difference in response between two groups P = 0.56

N.Af

HDRS BAI

A significant pre- to post-treatment difference in response, no significant intergroup difference in response between P = .025

A significant difference in response between two groups

Mean %reduction dHRSD: 20 % in active group vs. Mean % reduction HRSD: 13 % in sham group

A significant difference in responsec between two groups

Outcome

HDRS MADRS BDIe

10–20/5 After two 3000–6000 MADRS weeks if the participant did not respond, more two weeks stimulation

10/5

10/5

No. of No. of No. of Sess./Sess. active per week sham patients patients

Fitzgerald et al. 2003a, b DB placebo-controlled

RDLPFC/1/%110

DB placebo-controlled

Klein et al. 1999

Stimulation site/F (Hz)/Int.(%MT)

Study design

Study

Table 1 rTMS protocols applied on right dorsolateral prefrontal cortex (RDLPFC)

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8

–

RDLPFC/1/%100 Single blind randomized comparing active 10 (Hz) LPF rTMS vs. active 1 (Hz) RDLPFC

Eche et al. 2012

f

e

d

c

b

a

20

20/5

20/5

15/5

Not available

Beck Depression Inventory

Mean % reduction HRSD scores are expressed as mean changes from endpoint compared with baseline

Response: ≥50 % reduction in depression ratings from baseline

Montgomery-Asberg Depression Rating Scale

Hamilton Depression Rating Scale

F frequency, Int. intensity, sess. session, db double-blind

15

15

Randomized, controlled, two RDLPFC/1/%110 arm, clinical trial.

20

Aguirre et al. 2011

RDLPFC/1/%110

DB, randomized

Pallanti et al. 2010

10

10/5

15

RDLPFC/1 %110

DB, randomized, parallel group, sham- controlled trial

Stern et al. 2007

No. of No. of No. of Sess./Sess. active per week sham patients patients

Stimulation site/F (Hz)/Int.(%MT)

Study design

Study

Table 1 (continued)

1200

24,000

6300

16,000

Total pulses

MADRS

HDRS

HDRS

N.A

Assessment

Post-treatment 50 % antidepressant effect

Both treatment groups significantly improved, but no statistical differences

significant difference in response between two groups

A significant difference in response between two groups P = 0.028

A significant difference in response between two groups P = 0.032

Outcome



under investigation. During recent years, several new techniques have been developed to predict disease progression and treatment response to therapeutic interventions (Yadollahpour 2014; Norouzi et al. 2016). Accordingly, quantitative electroencephalography has been dramatically used for objective diagnosis of depression as well as predicting treatment response to the interventions such as rTMS. This line of research promises significant advances for near future in developing efficient and patient specific treatments.

rTMS Mechanisms of Actions in Depression Treatment According to different neurophysiological and behavioral effects, there are distinctions between low (≤1 HZ) and high frequencies (>5 HZ) rTMS (Wassermann and Lisanby 2001). Generally, low frequencies rTMS exert inhibiting effects, whereas high frequencies induce excitatory effects (Hoffman and Cavus 2002; Maeda et al. 2000). In depression, left dorsolateral prefrontal cortex (RDLPFC) shows hypoactivation or lower metabolism compared with healthy brains. In contrast, right dorsolateral prefrontal cortex (RDLPFC) undergoes hyperactivation or higher metabolism than the healthy brains. Hypoand hyper-activation is respectively manifested by higher and lower alpha activity in EEG. Decreasing frontal alpha asymmetry reportedly is an index of recovering from depression. Neurophysiological studies have found that depressed patients show an asymmetry of activation between left and right hemispheres in different regions of brains such as frontal, central, temporal, superior frontolateral, and medial regions. These asymmetries are observed for different frequency bands of EEG such as alpha, beta and delta bands. Left-to-right asymmetries of the depressed patients are higher than the healthy subjects. For example, depressed patients have increased alpha current density in the left hemisphere compared to the right hemisphere (Allen et al. 2004; Deslandes et al. 2008; Gordon et al. 2010; Knott et al. 2011). We can say that in depression, the left-to-right balance of activity is disturbed. For the treatment of depression with rTMS, considering the imbalanced asymmetry and based on the theory of resonance, researchers usually use high frequency rTMS (higher than 10 Hz) to LDLPFC or low frequency rTMS to RDLPFC to balance the left/right frontal asymmetry (Fitzgerald et al. 2003b; Isenberg et al. 2005; Leuchter et al. 2013). Generally low frequency rTMS reduces excitability of brain cortex, and high frequency rTMS increases excitability of cortex (Hoffman and Cavus 2002; Eche et al. 2012). The main effects of rTMS exerting the therapeutic effects are oscillatory rhythms of brains, modulating motor function, and altering mood states (Howland et al. 2011; Wagner et al. 2007; Leuchter et al. 2013). Various studies have been performed on the mechanisms of action of rTMS for the treatment of depression (Valiulis et al. 2012; Gershon et al. 2003; Speer et al. 2000). The findings of the previous studies have shown that different protocols of rTMS, particularly low versus high frequencies, result in significantly different electrophysiological changes (Chistyakov et al. 2005a, b; Howland et al. 2011; Speer et al. 2000; Kim et al. 2006; Hoogendam et al. 2010). However, some studies comparing low and high frequencies rTMS on right and left DLPFC have failed to show clinical outcome differences between the two protocols (Isenberg et al. 2005; Fitzgerald et al. 2003a, 2009; Höppner et al. 2003). High frequency (≥10 Hz) rTMS on DLPFC result in broader changes off EEG band power, such as increasing delta power on the left hemisphere and alpha power growth on the right, as well as increasing of theta power in parietal-occipital regions. In contrast, low frequencies (1 Hz) rTMS do not significantly alter the power of basic EEG bands (Valiulis et al. 2012; Speer et al. 2000). However, some studies have reported low frequencies rTMS modulate left-right alpha power asymmetrical indices of


frontal area towards the right hemisphere, and this modification is correlated with the clinical outcome. Various studies have shown that the neurobiological and electrophysiological mechanisms of the two common rTMS protocols (1 Hz RDLPFC vs. 10 Hz LDLPFC) are significantly different. Low frequency rTMS modulates frontal alpha power asymmetry and high frequency protocols influence more broader regions and wider electrophysiological characteristics of the brain. This study overviews the common protocols of rTMS applied on the DLPFC, focusing on the main contributing parameters and mechanisms of action. The most widely used site of stimulation for depression treatment is left and right DLPFC with corresponding 10 and 1 Hz stimulation. The neurophysiological effects of low frequency rTMS are significantly different from the high frequency stimulation. Low frequency rTMS modulates frontal alpha power asymmetry, whereas high frequency protocols influence more broader regions and wider electrophysiological characteristics of the brain. Acknowledgments The authors would like to thank research deputy of Ahvaz Jundishapur University of Medical Sciences who financially support the work. We also thank the faculty members of medical physics department, school of medicine for their comment in conducting this study. Compliance with Ethical Standards Source of Funding This study was a part of MSc thesis in Medical Physics, and was financially supported by Ahvaz Jundishapur University of Medical Sciences (Grant No.: 940189). Disclosures Authors have equally contributed in the designing, conducting, and preparation of this manuscript and have no conflict of interests on publishing this manuscript.

References Aarre, T. F., Dahl, A. A., Johansen, J. B., Kjonniksen, I., & Neckelmann, D. (2003). Efficacy of repetitive transcranial magnetic stimulation in depression: a review of the evidence. Nordic Journal of Psychiatry, 57(3), 227–232. Aguirre, I., Carretero, B., Ibarra, O., Kuhalainen, J., Martínez, J., Ferrer, A., Salva, J., Roca, M., Gili, M., Montoya, P., & Garcia-Toro, M. (2011). Age predicts low-frequency transcranial magnetic stimulation efficacy in major depression. Journal of Affective Disorders, 130(3), 466–469. Ali, Y., & Mahmud, N. A. (2014). Neurofeedback treatments for depression disorders: review of current advances. Oriental Journal of Computer Science and Technology, 7(3), 443–452. Allen, J. J., Urry, H. L., Hitt, S. K., & Coan, J. A. (2004). The stability of resting frontal electroencephalographic asymmetry in depression. Psychophysiology, 41(2), 269–280. American Psychiatric Association. (2001). Work group on borderline personality disorder. Practice guideline for the treatment of patients with borderline personality disorder. Barker, A. T., Freeston, I. L., Jalinous, R., & Jarratt, J. A. (1987). Magnetic stimulation of the human brain and peripheral nervous system: an introduction and the results of an initial clinical evaluation. Neurosurgery, 20(1), 100–109. Berlim, M. T., McGirr, A., Beaulieu, M. M., & Turecki, G. (2011). High frequency repetitive transcranial magnetic stimulation as an augmenting strategy in severe treatment-resistant major depression: a prospective 4-week naturalistic trial. Journal of Affective Disorders, 130(1–2), 312–317. Berman, R. M., Narasimhan, M., Sanacora, G., Miano, A. P., Hoffman, R. E., Hu, X. S., Charney, D. S., & Boutros, N. N. (2000). A randomized clinical trial of repetitive transcranial magnetic stimulation in the treatment of major depression. Biological Psychiatry, 47(4), 332–337. Chistyakov, A. V., Kaplan, B., Rubichek, O., Kreinin, I., Koren, D., Hafner, H., Feinsod, M., & Klein, E. (2005a). Effect of electroconvulsive therapy on cortical excitability in patients with major depression: a transcranial magnetic stimulation study. Clinical Neurophysiology, 116(2), 386–392.

Author's personal copy Int J Ment Health Addiction Chistyakov, A. V., Kaplan, B., Rubichek, O., Kreinin, I., Koren, D., Feinsod, M., & Klein, E. (2005b). Antidepressant effects of different schedules of repetitive transcranial magnetic stimulation vs. clomipramine in patients with major depression: relationship to changes in cortical excitability. The International Journal of Neuropsychopharmacology, 8(2), 223–233. Cooke, R. G. (2003). Repetitive transcranial magnetic stimulation for depression. Journal of Psychiatry & Neuroscience, 28(5), 400. Cordes, J., Mobascher, A., Arends, M., Agelink, M. W., & Klimke, A. (2005). A new method for the treatment of depression: repetitive transcranial magnetic stimulation. Deutsche Medizinische Wochenschrift, 130(14), 889–892. Deslandes, A. C., de Moraes, H., Pompeu, F. A., Ribeiro, P., Cagy, M., Capitão, C., Alves, H., Piedade, R. A., & Laks, J. (2008). Electroencephalographic frontal asymmetry and depressive symptoms in the elderly. Biological Psychology, 79(3), 317–322. Drevets, W. C., Frank, E., Price, J. C., Kupfer, D. J., Holt, D., Greer, P. J., Huang, Y., Gautier, C., & Mathis, C. (1999). PET imaging of serotonin 1A receptor binding in depression. Biological Psychiatry, 46(10), 1375– 1387. Eche, J., Mondino, M., Haesebaert, F., Saoud, M., Poulet, E., & Brunelin, J. (2012). Low- vs high-frequency repetitive transcranial magnetic stimulation as an add-on treatment for refractory depression. Frontiers in Psychiatry, 3, 13. Eschweiler, G. W., Wegerer, C., Schlotter, W., Spandl, C., Stevens, A., Bartels, M., & Buchkremer, G. (2000). Left prefrontal activation predicts therapeutic effects of repetitive transcranial magnetic stimulation (rTMS) in major depression. Psychiatry Research, 99(3), 161–172. Fava, M., & Davidson, K. G. (1996). Definition and epidemiology of treatment-resistant depression. Psychiatric Clinics of North America, 19(2), 179–200. Fitzgerald, P., Brown, T., Marston, N., Daskalakis, Z., & Kulkarni, J. (2003a). A double-blind placebo controlled trial of transcranial magnetic stimulation in the treatment of depression. Archives of General Psychiatry, 60(10), 1002–1008. Fitzgerald, P. B., Brown, T. L., Marston, N. A., Daskalakis, Z. J., De Castella, A., & Kulkarni, J. (2003b). Transcranial magnetic stimulation in the treatment of depression: a double-blind, placebo-controlled trial. Archives of General Psychiatry, 60(10), 1002–1008. Fitzgerald, P. B., Hoy, K., Daskalakis, Z. J., & Kulkarni, J. (2009). A randomized trial of the anti-depressant effects of low-and high-frequency transcranial magnetic stimulation in treatment-resistant depression. Depression and Anxiety, 26(3), 229–234. Fountoulakis, K. N., Giannakopoulos, P., Kövari, E., & Bouras, C. (2008). Assessing the role of cingulate cortex in bipolar disorder: neuropathological, structural and functional imaging data. Brain Research Reviews, 59(1), 9–21. Fukuda, M., Uehara, T., Ida, I., & Mikuni, M. (2003). Establishing biological markers for diagnosis and treatment of depression: possible availability of PET, NIRS, and DST. Nihon Rinsho, 61(9), 1667–1682. George, M. S., Avery, D., Nahas, Z., Molloy, M., Oliver, N. C., Risch, S. C., & Arana, G. W. (1999). rTMS studies of mood and emotion. Electroencephalography and Clinical Neurophysiology, 51, 304–314. Gershon, A. A., Dannon, P. N., & Grunhaus, L. (2003). Transcranial magnetic stimulation in the treatment of depression. American Journal of Psychiatry, 160(5), 835–845. Gordon, E., Palmer, D. M., & Cooper, N. (2010). EEG alpha asymmetry in schizophrenia, depression, PTSD, panic disorder, ADHD and conduct disorder. Clinical EEG and Neuroscience, 41(4), 178– 183. Grunhaus, L., Dannon, P. N., Schreiber, S., Dolberg, O. H., Amiaz, R., Ziv, R., & Lefkifker, E. (2000). Repetitive transcranial magnetic stimulation is as effective as electroconvulsive therapy in the treatment of nondelusional major depressive disorder: an open study. Biological Psychiatry, 47(4), 314–324. Hallett, M. (2000). Transcranial magnetic stimulation and the human brain. Nature, 406(6792), 147–150. Hallett, M. (2007). Transcranial magnetic stimulation: a primer. Neuron, 55(2), 187–199. Hoffman, R. E., & Cavus, I. (2002). Slow transcranial magnetic stimulation, long-term depotentiation, and brain hyperexcitability disorders. The American Journal of Psychiatry, 159(7), 1093–1102. Hoogendam, J. M., Ramakers, G. M., & Di Lazzaro, V. (2010). Physiology of repetitive transcranial magnetic stimulation of the human brain. Brain Stimulation, 3(2), 95–118. Höppner, J., Schulz, M., Irmisch, G., Mau, R., Schläfke, D., & Richter, J. (2003). Antidepressant efficacy of two different rTMS procedures. European Archives of Psychiatry and Clinical Neuroscience, 253(2), 103–109. Höppner, J., Berger, C., Walter, U., Padberg, F., Buchmann, J., Herwig, U., & Domes, G. (2010). Influence of repetitive transcranial magnetic stimulation on special symptoms in depressed patients. Restorative Neurology and Neuroscience, 28(4), 577–586. Höppner, J., Broese, T., Wendler, L., Berger, C., & Thome, J. (2011). Repetitive transcranial magnetic stimulation (rTMS) for treatment of alcohol dependence. World Journal of Biological Psychiatry, 12(1), 57–62.

Author's personal copy Int J Ment Health Addiction Howland, R. H., Shutt, L. S., Berman, S. R., Spotts, C. R., & Denko, T. (2011). The emerging use of technology for the treatment of depression and other neuropsychiatric disorders. Annals of Clinical Psychiatry, 23(1), 48–62. Isenberg, K., Downs, D., Pierce, K., Svarakic, D., Garcia, K., Jarvis, M., North, C., & Kormos, T. C. (2005). Low frequency rTMS stimulation of the right frontal cortex is as effective as high frequency rTMS stimulation of the left frontal cortex for antidepressant-free, treatment-resistant depressed patients. Annals of Clinical Psychiatry, 17(3), 153–159. Januel, D., Dumortier, G., Verdon, C. M., Stamatiadis, L., Saba, G., Cabaret, W., Benadhira, R., Rocamora, J. F., Braha, S., Kalalou, K., & Vicaut, P. E. (2006). A double-blind sham controlled study of right prefrontal repetitive transcranial magnetic stimulation (rTMS): therapeutic and cognitive effect in medication free unipolar depression during 4 weeks. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 30(1), 126–130. Jaracz, J., & Rybakowski, J. (2002). Studies of cerebral blood flow in metabolism in depression using positron emission tomography (PET). Psychiatria Polska, 36(4), 617–628. Kauffmann, C. D., Cheema, M. A., & Miller, B. E. (2004). Slow right prefrontal transcranial magnetic stimulation as a treatment for medication-resistant depression: a double-blind, placebo-controlled study. Depression and Anxiety, 19(1), 59–62. Kazdin, A. E. (2000). Encyclopedia of psychology. Washington, D.C.: American Psychological Association. Kim, E. J., Kim, W. R., Chi, S. E., Lee, K. H., Park, E. H., Chae, J. H., Park, S. K., Kim, H. T., & Choi, J. S. (2006). Repetitive transcranial magnetic stimulation protects hippocampal plasticity in an animal model of depression. Neuroscience Letters, 1–2, 79–83. Klein, E., Kreinin, I., Chistyakov, A., Koren, D., Mecz, L., Marmur, S., Ben-Shachar, D., & Feinsod, M. (1999). Therapeutic efficacy of right prefrontal slow repetitive transcranial magnetic stimulation in major depression: a double-blind controlled study. Archives of General Psychiatry, 56(4), 315–320. Kling, A. S., Metter, E. J., Riege, W. H., & Kuhl, D. E. (1986). Comparison of PET measurement of local brain glucose metabolism and CAT measurement of brain atrophy in chronic schizophrenia and depression. American Journal of Psychiatry, 143(2), 175–180. Knotkova, H., Rosedale, M., Strauss, S. M., Horne, J., Soto, E., Cruciani, R. A., Malaspina, D., & Malamud, D. (2012). Using transcranial direct current stimulation to treat depression in HIV-infected persons: the outcomes of a feasibility study. Frontiers in Psychology, 3, 59. Knott, V., Mahoney, C., Kennedy, S., & Evans, K. (2011). EEG power, frequency, asymmetry and coherence in male depression. Psychiatry Research: Neuroimaging, 106(2), 123–140. Kobayashi, M., & Pascual-Leone, A. (2003). Transcranial magnetic stimulation in neurology. Lancet Neurology, 2(3), 145–156. Lepine, J.P., & Briley, M. (2011). The increasing burden of depression. Neuropsychiatric Disease and Treatment, 7(Suppl 1):3–7. Leuchter, A. F., Cook, I. A., Jin, Y., & Phillips, B. (2013). The relationship between brain oscillatory activity and therapeutic effectiveness of transcranial magnetic stimulation in the treatment of major depressive disorder. Frontiers in Human Neuroscience, 7. Lisanby, S., Pascual-Leone, A., Sampson, S., Boylan, L., Burt, T., & Sackeim, H. (2001). Augmentation of sertraline antidepressant treatment with transcranial magnetic stimulation. Biological Psychiatry. New York: Elsevier Science Inc. Loo, C., Katalinic, N., Mitchell, P. B., & Greenberg, B. (2011). Physical treatments for bipolar disorder: a review of electroconvulsive therapy, stereotactic surgery and other brain stimulation techniques. Journal of Affective Disorders, 132(1–2), 1–13. Maeda, F., Keenan, J. P., Tormos, J. M., Topka, H., & Pascual-Leone, A. (2000). Modulation of corticospinal excitability by repetitive transcranial magnetic stimulation. Clinical Neurophysiology, 111(5), 800–805. Marcus, M., Van Ommeren, M., Chisholm, D., & Saxena, S. (2012). WHO Department of Mental Health and Substance Abuse, 1, 6–8 Perth. McDonald, W. M., Durkalski, V., Ball, E. R., Holtzheimer, P. E., Pavlicova, M., Lisanby, S. H., Avery, D., Anderson, B. S., Nahas, Z., Zarkowski, P., & Sackeim, H. A. (2011). Improving the antidepressant efficacy of transcranial magnetic stimulation: maximizing the number of stimulations and treatment location in treatment-resistant depression. Depression and Anxiety, 28(11), 973–980. Mostafa, J., Ali, Y., Zohre, R., & Samaneh, R. (2015). Electromagnetic fields and ultrasound waves in wound treatment: a comparative review of therapeutic outcomes. Biosciences, Biotechnology Research Asia, 12, 185–195. Norouzi, J., Yadollahpour, A., Mirbagheri, S. A., Mazdeh, M. M., & Hosseini, S. A. (2016). Predicting renal failure progression in chronic kidney disease using integrated intelligent fuzzy expert system. Pallanti, S., Bernardi, S., Di Rollo, A., Antonini, S., & Quercioli, L. (2010). Unilateral low frequency versus sequential bilateral repetitive transcranial magnetic stimulation: is simpler better for treatment of resistant depression? Neuroscience, 167(2), 323–328.

Author's personal copy Int J Ment Health Addiction Parikh, S. V., & Lam, R. W. (2001). Clinical guidelines for the treatment of depressive disorders, I. Definitions, prevalence, and health burden. Canadian Journal of Psychiatry, 46, 13S–20S. Sparing, R., & Mottaghy, F. M. (2008). Noninvasive brain stimulation with transcranial magnetic or direct current stimulation (TMS/tDCS)-From insights into human memory to therapy of its dysfunction. Methods, 44(4), 329–337. Speer, A. M., Kimbrell, T. A., Wassermann, E. M., Repella, J. D., Willis, M. W., Herscovitch, P., & Post, R. M. (2000). Opposite effects of high and low frequency rTMS on regional brain activity in depressed patients. Biological Psychiatry, 48(12), 1133–1141. Stern, W. M., Tormos, J. M., Press, D. Z., Pearlman, C., & Pascual-Leone, A. (2007). Antidepressant effects of high and low frequency repetitive transcranial magnetic stimulation to the dorsolateral prefrontal cortex: a double-blind, randomized, placebo-controlled trial. Journal of Neuropsychiatry & Clinical Neurosciences, 19(2), 179–186. Valiulis, V., Gerulskis, G., Dapsys, K., Vistartaite, G., Siurkute, A., & Maciulis, V. (2012). Electrophysiological differences between high and low frequency rTMS protocols in depression treatment. Acta Neurobiologiae Experimentalis (Wars), 72, 283–295. Wagner, T., Valero-Cabre, A., & Pascual-Leone, A. (2007). Noninvasive human brain stimulation. Annual Review of Biomedical Engineering, 9, 527–565. Wassermann, E. M., & Lisanby, S. H. (2001). Therapeutic application of repetitive transcranial magnetic stimulation: a review. Clinical Neurophysiology, 112(8), 1367–1377. Yadollahpour, A. (2014). Applications of expert systems in management of chronic kidney disease: a review of predicting techniques. Oriental Journal of Computer Science and Technology, 7(2), 306–315. Yadollahpour, A., & Rashidi, S. (2014a). A review of electromagnetic field based treatments for different bone fractures. Biosciences, Biotechnology Research Asia, 11(2), 611–620. Yadollahpour, A., & Rashidi, S. (2014b). Therapeutic applications of electromagnetic fields in musculoskeletal disorders: a review of current techniques and mechanisms of action. Biomedical and Pharmacology Journal, 7(1), 23–32. Yadollahpour, A., & Rezaee, Z. (2014). Electroporation as a New cancer treatment technique: a review on the mechanisms of action. Biomedical & Pharmacology Journal, 7(1), 53–62. Yadollahpour, A., Firouzabadi, S. M., Shahpari, M., & Mirnajafi-Zadeh, J. (2014a). Repetitive transcranial magnetic stimulation decreases the kindling induced synaptic potentiation: effects of frequency and coil shape. Epilepsy Research, 108(2), 190–201. Yadollahpour, A., Rashidi, S., & Ghotbeddin, Z. (2014b). Electromagnetic fields for the treatments of wastewater: a review of applications and future opportunities. Journal of Pure and Applied Microbiology, 8(5), 3711– 3719. Zohre, R., Ali, Y., Mostafa, J., & Samaneh, R. (2015). Nondrug antimicrobial techniques: electromagnetic fields and photodynamic therapy. Biomedical & Pharmacology Journal, 8, 147–155.