Entwicklung und aktuelle Forschungstrends der antidepressiven repetitiven transkraniellen Magnetstimulation (rTMS)

C. Schönfeldt-Lecuona; H. Walter; B. J. Connemann; J. Kassubek; M. Spitzer; U. Herwig

doi:10.1055/s-2002-34670

Fortschritte der Neurologie · Psychiatrie, Table of Contents

Fortschr Neurol Psychiatr 2002; 70(10): 520-530
DOI: 10.1055/s-2002-34670

Originalarbeit

Entwicklung und aktuelle Forschungstrends der antidepressiven repetitiven transkraniellen Magnetstimulation (rTMS)

Historical Review and Recent Research Trends of the Antidepressant Repetitive Transcranial Magnetic Stimulation (rTMS)C. Schönfeldt-Lecuona¹ , H. Walter¹ , B. J. Connemann¹ , J. Kassubek¹ , M. Spitzer¹ , U. Herwig¹

¹Abteilung Psychiatrie III, Universitätsklinik Ulm (Direktor: Prof. Dr. med. Dr. phil. M. Spitzer)

Abstract

Zusammenfassung

Die antidepressive Wirkung der repetitiven transkraniellen Magnetstimulation (rTMS) wurde in den letzten Jahren in zahlreichen Studien untersucht. Das Spektrum der Ergebnisse reicht von der Beurteilung der Methodik als unwirksam bis hin zu Besserungsraten um mehr als 50 %. Ein Vergleich der Ergebnisse verschiedener Arbeitsgruppen wird dadurch erschwert, dass sich die meisten Studien hinsichtlich der Stimulationsparameter, der Patientenauswahlkriterien und weiterer Designaspekte voneinander erheblich unterscheiden. Explizit pathophysiologisch begründete Parameter für eine antidepressiv wirksame Stimulation wurden bisher nicht gefunden; dies sollte Thema künftiger Untersuchungen sein, wobei unterstützend auch funktionell bildgebende Techniken herangezogen werden können. Dieser Artikel bietet eine Übersicht der bisher publizierten Studien, eine kritische Analyse der verschiedenen Stimulationsprotokolle und zeigt mögliche Zukunftsperspektiven der antidepressiven TMS auf.

Abstract

The antidepressant effect of repetitive transcranial magnetic stimulation (rTMS) has been studied intensively over the last years. Numerous studies worldwide yielded variable results ranging from ineffectivity to an efficacy rate of more than 50 % for the reduction of depressive symptoms. A comparison of the effectiveness of TMS across studies is difficult due to the variety of chosen stimulation parameters, different inclusion criteria, and different designs. The discrepancies in results could be partially in account to these factors. From a pathophysiological point of view, there are no empirically justified parameters published carrying out an antidepressant TMS. Further studies are required to find optimal stimulation parameters using complementary methods like functional imaging techniques or regarding other factors that could interfere with its efficacy. An overview of studies published in the last ten years, a critical analysis of stimulation procedures and protocols, and possible future perspectives of this method are reviewed in this article.

Full Text

References

Literatur

1 George M S, Wassermann E M, Williams W A, Callahan A, Ketter T A, Basser P, Hallett M, Post R M. Daily repetitive transcranial magnetic stimulation (rTMS) improves mood in depression. Neuroreport. 1995; 6 1853-1856
2 Pascual-Leone A, Catala M D, Pascual-Leone Pascual A. Lateralized effect of rapid-rate transcranial magnetic stimulation of the prefrontal cortex on mood. Neurology. 1996; 46 499-502
3 George M S, Wassermann E M, Kimbrell T A, Little J T, Williams W E, Danielson A L, Greenberg B D, Hallett M, Post R M. Mood improvement following daily left prefrontal repetitive transcranial magnetic stimulation in patients with depression: a placebo-controlled crossover trial. Am J Psychiatry. 1997; 154 1752-1756
4 Epstein C M, Figel G S, McDonald W M, Amazon-Leece J, Figel L. Rapid rate transcranial magnetic stimulation in young and middle-aged refractory depressed patients. Psychiatric Annals. 1998; 28 36-39
5 Loo C, Mitchell P, Sachdev P, McDarmont B, Parker G, Gandevia S. Double-blind controlled investigation of transcranial magnetic stimulation for the treatment of resistant major depression. Am J Psychiatry. 1999; 156 946-948
6 Grunhaus L, Dannon P N, Schreiber S, Dolberg O H, Amiaz R, Ziv R, Lefkifker E. Repetitive transcranial magnetic stimulation is as effective as electroconvulsive therapy in the treatment of nondelusional major depressive disorder: an open study. Biol Psychiatry. 2000; 47 314-324
7 Greenberg B D, George M S, Martin J D, Benjamin J, Schlaepfer T E, Altemus M, Wassermann E M, Post R M, Murphy D L. Effect of prefrontal repetitive transcranial magnetic stimulation in obsessive-compulsive disorder: a preliminary study. Am J Psychiatry. 1997; 154 867-869
8 Grisaru N, Chudakov B, Yaroslavsky Y, Belmaker R H. Transcranial magnetic stimulation in mania: a controlled study. Am J Psychiatry. 1998; 155 1608-1610
9 McCann U D, Kimbrell T A, Morgan C M, Anderson T, Geraci M, Benson B E, Wassermann E M, Willis M W, Post R M. Repetitive transcranial magnetic stimulation for posttraumatic stress disorder [letter]. Arch Gen Psychiatry. 1998; 55 276-279
10 Hoffman R E, Boutros N N, Berman R M, Roessler E, Belger A, Krystal J H, Charney D S. Transcranial magnetic stimulation of left temporoparietal cortex in three patients reporting hallucinated “voices”. Biol Psychiatry. 1999; 46 130-132
11 Grisaru N, Chudakov B, Yaroslavsky Y, Belmaker R H. Catatonia treated with transcranial magnetic stimulation [letter]. Am J Psychiatry. 1998; 155 1630
12 Epstein C M. Transcranial magnetic stimulation: language function. J Clin Neurophysiol. 1998; 15 325-332
13 Tergau F, Naumann U, Paulus W, Steinhoff B J. Low-frequency repetitive transcranial magnetic stimulation improves intractable epilepsy [letter]. Lancet. 1999; 353 2209
14 Pascual-Leone A, Peris M, Tormos J M, Pascual A P, Catala M D. Reorganization of human cortical motor output maps following traumatic forearm amputation. Neuroreport. 1996; 7 2068-2070
15 Pascual-Leone A, Valls-Sole J, Brasil-Neto J P, Cohen L G, Hallett M. Akinesia in Parkinson's disease. I. Shortening of simple reaction time with focal, single-pulse transcranial magnetic stimulation. Neurology. 1994; 44 884-891
16 Löwenstein K, Borchardt M. Symptomatologie und elektrische Reizung bei einer Schussverletzung des Hinterhauptlappens. Nervenheilkunde. 1918; 58 264-292
17 Penfield W. The cerebral cortex in man. Arch Neurol Psychiat. 1938; 40 417-442
18 Merton P A, Hill D K, Morton H B, Marsden C D. Scope of a technique for electrical stimulation of human brain, spinal cord, and muscle. Lancet. 1982; 2 597-600
19 Barker A T, Jalinous R, Freeston I L. Non-invasive magnetic stimulation of human motor cortex [letter]. Lancet. 1985; 1 1106-1107
20 Wassermann E M. Risk and safety of repetitive transcranial magnetic stimulation: report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation, June 5 - 7, 1996. Electroencephalogr Clin Neurophysiol. 1998; 108 1-16
21 Herwig U, Schonfeldt-Lecuona C. The study of central nervous information processing with transcranial magnetic stimulation. Fortschr Neurol Psychiatr. 2000; 68 289-300
22 Kammer T, Beck S, Thielscher A, Laubis-Herrmann U, Topka H. Motor thresholds in humans: a transcranial magnetic stimulation study comparing different pulse waveforms, current directions and stimulator types. Clin Neurophysiol. 2001; 112 250-258
23 Ilmoniemi R J, Ruohonen J, Karhu J. Transcranial magnetic stimulation - a new tool for functional imaging of the brain. Crit Rev Biomed Eng. 1999; 27 241-284
24 Jalinous R. Technical and practical aspects of magnetic nerve stimulation. J Clin Neurophysiol. 1991; 8 10-25
25 George M S, Lisanby S H, Sackeim H A. Transcranial magnetic stimulation: applications in neuropsychiatry [comment]. Arch Gen Psychiatry. 1999; 56 300-311
26 Rudiak D, Marg E. Finding the depth of magnetic brain stimulation: a re-evaluation. Electroencephalogr Clin Neurophysiol. 1994; 93 358-371
27 Rossini P M, Barker A T, Berardelli A, Caramia M D, Caruso G, Cracco R Q, Dimitrijevic M R, Hallett M, Katayama Y, Lucking C H. et al . Non-invasive electrical and magnetic stimulation of the brain, spinal cord and roots: basic principles and procedures for routine clinical application. Report of an IFCN committee. Electroencephalogr Clin Neurophysiol. 1994; 91 79-92
28 Amassian V E, Cracco R Q, Maccabee P J, Cracco J B, Rudell A P, Eberle L. Transcranial magnetic stimulation in study of the visual pathway [In Process Citation]. J Clin Neurophysiol. 1998; 15 288-304
29 Hess A, Kunesch E, Classen J, Hoeppner J, Stefan K, Benecke R. Task-dependent modulation of inhibitory actions within the primary motor cortex [In Process Citation]. Exp Brain Res. 1999; 124 321-330
30 Rothwell J C. Physiological studies of electric and magnetic stimulation of the human brain. Electroencephalogr Clin Neurophysiol Suppl. 1991; 43 29-35
31 Chen R, Classen J, Gerloff C, Celnik P, Wassermann E M, Hallett M, Cohen L G. Depression of motor cortex excitability by low-frequency transcranial magnetic stimulation. Neurology. 1997; 48 1398-1403
32 Maeda F, Keenan J P, Tormos J M, Topka H, Pascual-Leone A. Modulation of corticospinal excitability by repetitive transcranial magnetic stimulation. Clin Neurophysiol. 2000; 111 800-805
33 Muellbacher W, Ziemann U, Boroojerdi B, Hallett M. Effects of low-frequency transcranial magnetic stimulation on motor excitability and basic motor behavior. Clin Neurophysiol. 2000; 111 1002-1007
34 Gerschlager W, Siebner H R, Rothwell J C. Decreased corticospinal excitability after subthreshold 1 Hz rTMS over lateral premotor cortex. Neurology. 2001; 57 449-455
35 Pascual-Leone A, Valls-Sole J, Wassermann E M, Hallett M. Responses to rapid-rate transcranial magnetic stimulation of the human motor cortex. Brain. 1994; 117 847-858
36 Peinemann A, Lehner C, Mentschel C, Munchau A, Conrad B, Siebner H R. Subthreshold 5-Hz repetitive transcranial magnetic stimulation of the human primary motor cortex reduces intracortical paired-pulse inhibition. Neurosci Lett. 2000; 296 21-24
37 Romeo S, Gilio F, Pedace F, Ozkaynak S, Inghilleri M, Manfredi M, Bernardelli A. Changes in the cortical silent period after repetitive magnetic stimulation of cortical motor areas. Exp Brain Res. 2000; 135 504-510
38 Weiss S R, Li X L, Rosen J B, Li H, Heynen T, Post R M. Quenching: inhibition of development and expression of amygdala kindled seizures with low frequency stimulation. Neuroreport. 1995; 6 2171-2176
39 Fleischmann A, Sternheim A, Etgen A M, Li C, Grisaru N, Belmaker R H. Transcranial magnetic stimulation downregulates beta-adrenoreceptors in rat cortex. J Neural Transm. 1996; 103 1361-1366
40 Ben-Shachar D, Belmaker R H, Grisaru N, Klein E. Transcranial magnetic stimulation induces alterations in brain monoamines. J Neural Transm. 1997; 104 191-197
41 Keck M E, Sillaber I, Ebner K. Specific effects of acute rapid-rate TMS treatment on neuroendocrine para-meters in rats. Electroenc Clin Neurophysiol. 1998; 107 79
42 Mano Y, Funakawa I, Nakamuro T, Takayanagi T, Matsui K. [The kinesiological, chemical and pathological analysis in pulsed magnetic stimulation to the brain]. Rinsho Shinkeigaku. 1989; 29 982-988
43 Juckel G, Mendlin A, Jacobs B L. Electrical stimulation of rat medial prefrontal cortex enhances forebrain serotonin output: implications for electroconvulsive therapy and transcranial magnetic stimulation in depression. Neuropsychopharmacology. 1999; 21 391-398
44 Pascual-Leone A, Cohen L G, Shotland L I, Dang N, Pikus A, Wassermann E M, Brasil-Neto J P, Valls-Sole J, Hallett M. No evidence of hearing loss in humans due to transcranial magnetic stimulation. Neurology. 1992; 42 647-651
45 Counter S A. Neurobiological effects of extensive transcranial electromagnetic stimulation in an animal model. Electroencephalogr Clin Neurophysiol. 1993; 89 341-348
46 Gordon B, Lesser R P, Rance N E, Hart Jr J, Webber R, Uematsu S, Fisher R S. Parameters for direct cortical electrical stimulation in the human: histopathologic confirmation. Electroencephalogr Clin Neurophysiol. 1990; 75 371-377
47 Nahas Z, Bohning D E, Molloy M A, Oustz J A, Craig Risch S, George M S. 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
48 Cerletti E, Bini B. L'ettroshock. Arch Gen Neurol Psychiat. 1938; 19 266
49 Calev A. Neuropsychology and ECT: past and future research trends. Psychopharmacol Bull. 1994; 30 461-469
50 Soares J C, Mann J J. The anatomy of mood disorders - review of structural neuroimaging studies. Biol Psychiatry. 1997; 41 86-106
51 Bench C J, Friston K J, Brown R G, Frackowiak R S, Dolan R J. Regional cerebral blood flow in depression measured by positron emission tomography: the relationship with clinical dimensions. Psychol Med. 1993; 23 579-590
52 Bench C J, Frackowiak R SJ, Dolan R J. Changes in regional blood cerebral blood flow on recovery from depression. Psychol Med. 1995; 25 247-251
53 Mann J J, Malone K M, Diehl D J, Perel J, Cooper T B, Mintum M A. Demonstration in vivo of reduced serotonin responsivity in the brain of untreated depressed patients. Am J Psychiatry. 1996; 153 174-182
54 Nahas Z, Teneback C C, Kozel A, Speer A M, DeBrux C, Molloy M, Stallings L, Spicer K M, Arana G, Bohning D E, Risch S C, George M S. Brain effects of TMS delivered over prefrontal cortex in depressed adults: role of stimulation frequency and coil-cortex distance. J Neuropsychiatry Clin Neurosci. 2001; 13 459-470
55 Speer A M, Kimbrell T A, Wassermann E M, Repella J, Willis M W, Herscovitch P, Post R M. Opposite effects of high and low frequency rTMS on regional brain activity in depressed patients. Biol Psychiatry. 2000; 48 1133-1141
56 Paus T, Jech R, Thompson C J, Comeau R, Peters T, Evans A C. Transcranial magnetic stimulation during positron emission tomography: a new method for studying connectivity of the human cerebral cortex. J Neurosci. 1997; 17 3178-3184
57 Siebner H R, Willoch F, Peller M, Auer C, Boecker H, Conrad B, Bartenstein P. Imaging brain activation induced by long trains of repetitive transcranial magnetic stimulation. Neuroreport. 1998; 9 943-948
58 Fox P, Ingham R, George M S, Mayberg H, Ingham J, Roby J, Martin C, Jerabek P. Imaging human intra-cerebral connectivity by PET during TMS. Neuroreport. 1997; 8 2787-2791
59 Strafella A P, Paus T, Barrett J, Dagher A. Repetitive transcranial magnetic stimulation of the human prefrontal cortex induces dopamine release in the caudate nucleus. J Neurosci. 2001; 21 RC157
60 Höflich G, Kasper S, Hufnagel A, Ruhrmann S, Möller H J. Application of transcranial magnetic stimulation in treatment of drug-resistant major depression - a report of two cases. Hum Psychopharmacol. 1993; 8 361-365
61 Grisaru N, Yarovslavsky U, Abarbanel J, Lambert T, Belmaker R H. Transcranial magnetic stimulation in depression and schizophrenia. Eur Neuropsychopharmacol. 1994; 4 287-288
62 Koppi S, Conca A, Swoboda E, Konig P. [Transcranial magnetic stimulation in depressed patients: a new antidepressive therapeutic principle? Presentation of a pilot trial]. Wien Med Wochenschr. 1996; 146 49-54
63 Kolbinger H, Hoflich G, Hufnagel A, Moller H J, Kasper S. Transcranial magnetic stimulation (TMS) of major depression - a pilot study. Hum Psychopharmacol. 1995; 10 305-310
64 Conca A, Koppi S, Konig P, Swoboda E, Krecke N. Transcranial magnetic stimulation: a novel antidepressive strategy?. Neuropsychobiology. 1996; 34 204-207
65 Klein E, Kreinin I, Chistyakov A, Koren D, Mecz L, Marmur S, Ben-Shachar D, Feinsod M. Therapeutic efficacy of right prefrontal slow repetitive transcranial magnetic stimulation in major depression: a double-blind controlled study [see comments]. Arch Gen Psychiatry. 1999; 56 315-320
66 Feinsod M, Kreinin B, Chistyakov A, Klein E. Preliminary evidence for a beneficial effect of low-frequency, repetitive transcranial magnetic stimulation in patients with major depression and schizophrenia. Depress Anxiety. 1998; 7 65-68
67 Menkes D L, Bodnar P, Ballesteros R A, Swenson M R. Right frontal lobe slow frequency repetitive transcranial magnetic stimulatiom (SF r-TMS) is an effective treatment for depression: a case control pilot study of safety and efficacy. J Neurol Neurosurg Psychiatry. 1999; 67 113-115
68 Kimbrell T A, Little J T, Dunn R T, Frye M A, Geenberg B D, Wassermann E M, Repella J D, Danielson A L, Willis M W, Benson B E, Speer A M, Osuch E, Gorge M S, Post R M. Frequency dependence of antidepressant response to left prefrontal repetitive transcranial magnetic stimulation (rTMS) as a function of baseline cerebral glucose metabolism. Biol Psychiatry. 1999; 46 1603-1613
69 Eschweiler G W, Wegerer C, Schlotter W, Spandl C, Stevens A, Bartels M, Buchkremer G. Left prefrontal activation predicts therapeutic effects of repetitive transcranial magnetic stimulation (rTMS) in major depression. Psychiatry Res (Neuroimaging). 2000; 99 161-172
70 Schiffer F, Stinchfield Z, Pascual-Leone A. Prediction of clinical response to transcranial magnetic stimulation for depression by baseline lateral visual-field stimulation. Neuropsychiatry Neuropsychol Behav Neurol. 2002; 15 18-27
71 Teneback C C, Nahas Z, Speer A M, Molloy M, Stallings L E, Spicer K M, Risch S C, George M S. Changes in prefrontal cortex and paralimbic activity in depression following two weeks of daily left prefrontal TMS. J Neuropsychiatry Clin Neurosci. 1999; 11 426-435
72 Grunhaus L, Dannon P N, Schreiber S. Effcts of transcranial magnetic stimulation on severe depression: similarities with ECT (Abstract). Biol Psychiatry. 1998; 43 76
73 Pridmore S, Katsikitis M, van Roof M. rTMS versus ECT in severe major depressive episode. Electroenceph clin Neurophysiol. 1998; 107 96
74 Pridmore S. Substitution of rapid transcranial magnetic stimulation treatments for electroconvulsive therapy treatments in a course of electroconvulsive therapy. Depress Anxiety. 2000; 12 118-123
75 Eschweiler G W, Plewnia C, Bartels M. [Which patients with major depression benefit from prefrontal repetitive magnetic stimulation]. Fortschr Neurol Psychiatr. 2001; 69 402-409
76 McNamara B, Ray J L, Arthurs J, Boniface S. Transcranial magnetic stimulation for depression and other psychiatric disorders. Psychol Med. 2001; 31 1141-1146
77 Walter H, Riepe M W, Groen G. Funktionelle Bildgebung als klinisches Instrument in der Psychiatrie. Nervenheilkunde. 1999; 18 322-331
78 Herwig U, Padberg F, Unger J, Spitzer M, Schönfeldt Lecuona C. Transcranial magnetic stimulation in therapy studies: Examination of the reliability of “standard” coil positioning. Biol Psychiatry. 2001; 50 58-61
79 Figiel G S, Epstein C, McDonald W M, Amazon-Leece J, Figiel L, Saldivia A, Glover S. The use of rapid-rate transcranial magnetic stimulation (rTMS) in refractory depressed patients. J Neuropsychiatry Clin Neurosci. 1998; 10 20-25
80 Padberg F, Zwanzger P, Thoma H, Kathmann N, Haag C, Greenberg BD, Hampel H, Moller H J. Repetitive transcranial magnetic stimulation (rTMS) in pharmacotherapy-refractory major depression: comparative study of fast, slow and shann rTMS. Psychiatry Res. 1999; 88 163-171
81 Kozel F A, Nahas Z, deBrux C, Molloy M, Lorberbaum J P, Bohning D, Risch S C, George M S. How coil-cortex distance relates to age, motor threshold, and antidepressant response to repetitive transcranial magnetic stimulation. J Neuropsychiatry Clin Neurosci. 2000; 12 376-384
82 Di Lazzaro V, Oliviero A, Meglio M, Cioni B, Tamburrini G, Tonali P, Rothwell J C. Direct demonstration of the effect of lorazepam on the excitability of the human motor cortex. Clin Neurophysiol. 2000; 111 794-799
83 Manganotti P, Bongiovanni L G, Zanette G, Turazzini M, Fiaschi A. Cortical excitability in patients after loading doses of lamotrigine: a study with magnetic brain stimulation. Epilepsia. 1999; 40 316-321
84 Ziemann U, Lonnecker S, Steinhoff B J, Paulus W. Motor excitability changes under antiepileptic drugs. Adv Neurol. 1999; 81 291-298
85 Ziemann U, Chen R, Cohen L G, Hallett M. Dextromethorphan decreases the excitability of the human motor cortex. Neurology. 1998; 51 1320-1324
86 Hasey G. Transcranial magnetic stimulation in the treatment of mood disorder: a review and comparison with electroconvulsive therapy. Can J Psychiatry. 2001; 46 720-727
87 Markwort S, Cordes P, Aldenhoff J. [Transcranial magnetic stimulation as an alternative to electroshock therapy in treatment resistant depressions. A literature review]. Fortschr Neurol Psychiatr. 1997; 65 540-549
88 Avery D H, Claypoole K, Robinson L, Neumaier J F, Dunner D L, Scheele L, Wilson L, Roy-Byrne P. Repetitive transcranial magnetic stimulation in the treatment of medication-resistant depression: preliminary data [In Process Citation]. J Nerv Ment Dis. 1999; 187 114-117
89 Berman R M, Narasimhan M, Sanacora G, Miano A P, Hoffman R, Hu X S, Charney D S, Boutros N N. A randomized clinical trial of repetitive magnetic stimulation in the treatment of major depression. Biol Psychiatry. 2000; 47 332-337
90 Nahas Z, Speer A M, Molloy M, Arana G W, Risch S C, George M S. Preliminary results concerning the roles of frequency and intensity in the antidepressant effect of daily left prefrontal rTMS. Biol Psychiatry (Abstract). 1998; 43 94
91 Geller V, Grisaru N, Abarbanel J M, Lemberg T, Belmaker R H. Slow magnetic stimulation of prefrontal cortex in depression and schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry. 1997; 21 105-110
92 Carson A J, MacHale S, Allen K, Lawrie S M, Dennis M, House A, Sharpe M. Depression after stroke and lesion location: a systematic review. Lancet. 2000; 356 122-126
93 Lisanby S H, Luber B, Schroeder C, Osman M, Fink D, Jalinous R, Amassian V E, Arezo J, Sackheim H A. Intracerebral measurement of rTMS and ECS induced voltage in vivo. Biol Psychiatry. 1998; 43 100
94 Lisanby S H, Gutman D, Luber B, Schroeder C, Sackeim H A. Sham TMS: intracerebral measurement of the induced electrical field and the induction of motor-evoked potentials. Biol Psychiatry. 2001; 49 460-463
95 Conca A, Konig P, Lingg A, Hausmann A. Bilateral rTMS at low and high frequencies in depressives. Biol Psychiatry. 1999; 45 70S
96 Lisanby S H, Luber B, Fink D, Osman M, Schroeder C, Sackheim H A. Magnetic stimulation therapy: a novel convulsive technique. Biol Psychiatry. 1999; 45 64S
97 Lisanby S H, Luber B, Sackeim H A, Finck A D, Schroeder C. Deliberate seizure induction with repetitive transcranial magnetic stimulation in nonhuman primates. Arch Gen Psychiatry. 2001; 58 199-200
98 Andreasen N C, Grove W M, Maurer R. Cluster analysis and the classification of depression. Br J Psychiatry. 1980; 137 256-265
99 Wu J C, Gillin J C, Buchsbaum M S, Hershey T, Johnson J C, Bunney Jr W E. Effect of sleep deprivation on brain metabolism of depressed patients. Am J Psychiatry. 1992; 149 538-543
100 Ebert D, Feistel H, Barocka A. Effects of sleep deprivation on the limbic system and the frontal lobes in affective disorders: a study with Tc-99m-HMPAO SPECT. Psychiatry Research Neuroimaging. 1991; 40 247-251
101 Ebert D, Feistel H, Barocka A, Kaschka W. Increased limbic flow and total sleep deprivation in major depression with melancholia. Psychiatry Research Neuroimaging. 1994; 55 101-109
102 Mayberg H S, Brannan S K, Mahurin R K, Jerabek P A. et al . Cingulate function in depression: a potential predictor of treatment response. Neuroreport. 1997; 8 1057-1061
103 Mayberg H S, Liotti M, Brannan S K, McGinnis S, Mahurin R K, Jerabek P A, Silva J A, Tekell J L, Martin C C, Lancaster J L, Fox P T. Reciprocal limbic-cortical function and negative mood: converging PET findings in depression and normal sadness. Am J Psychiatry. 1999; 156 675-682
104 Abercrombie H C, Schaefer S M, Larson C L, Oakes T R, Holden J E, Benca R M, Krahn D D, Davdson R J. Further evidence for cingulate function as a predictor of treatment response. Neuroimage. 1999; 9 S637
105 Brody A L, Saxena S, Stoessel P, Gillies L A, Fairbanks L A, Alborzian S, Phelps M E, Huang S C, Wu H M, Ho M L, Ho M K, Au S C, Maidment K, Baxter Jr L R. Regional brain metabolic changes in patients with major depression treated with either paroxetine or interpersonal therapy: preliminary findings. Arch Gen Psychiatry. 2001; 58 631-640
106 Brody A L, Barsom M W, Bota R G, Saxena S. Prefrontal-subcortical and limbic circuit mediation of major depressive disorder. Semin Clin Neuropsychiatry. 2001; 6 102-112
107 Walter H. Neurowissenschaft der Emotionen und Psychiatrie. Nervenheilkunde. 1998; 18 116-126
108 Triggs W J, McCoy K JM, Greer R, Rossi F, Bowers D, Kortenkamp S, Nadeau S E, Heilman K M, Goodman W. Effects of left transcranial magnetic stimulation on depressed mood, cognition, and corticomotor threshold. Biol Psychiatry. 1999; 45 1440-1446
109 George M S, Nahas Z, Molloy M, Speer A M, Oliver N C, Li X B, Arana G W, Risch S C, Ballenger J C. A controlled trial of daily left prefrontal cortex TMS for treating depression. Biol Psychiatry. 2000; 48 962-970
110 Manes F, Jorge R, Morcuende M, Yamada T, Paradiso S, Robinson R G. A controlled study of repetitive transcranial magnetic stimulation as a treatment of depression in the elderly. Int Psychogeriatr. 2001; 13 225-231
111 Garcia-Toro M, Pascual-Leone A, Romera M, Gonzalez A, Mico J, Ibarra O, Arnillas H, Capllonch I, Mayol A, Tormos J M. Prefrontal repetitive transcranial magnetic stimulation as add on treatment in depression. J Neurol Neurosurg Psychiatry. 2001; 71 546-548

Dr. med. C. Schönfeldt-Lecuona

Abteilung Psychiatrie III Universität Ulm

Leimgrubenweg 12

89075 Ulm

Email: carlos.schoenfeldt@medizin.uni-ulm.de