There has been considerable argument on whether a “true” sham or masked TMS exists. The one-wing, twowing, 45-degrec, and 90-dcgrcc positions have been explored and have nevertheless been found to induce a modest, amount of magnetic field in the cortex.21 The use of sham coils seems to be the preferred method (Neotonus, Marietta, Ga, USA), though there have been no published research using this coil. Side effects associated with TMS

and rTMS Inhibitors,research,lifescience,medical Overall, TMS and rTMS have so far been remarkably safe. Initial concerns about, the possibility of the induction of seizures have been allayed since the introduction of the guidelines for the safe administration of TMS. Additional concerns like headaches, cognitive effects, effects of irradiation, and local facial or scalp pain during the administration of TMS are rare.7 TMS studies in depression Following the observations

that TMS could provoke transient mood elevations or acute crying in normal volunteers,22,23 several researchers described the antidepressant effects of single-pulse Inhibitors,research,lifescience,medical TMS in small sample of patients with major depression.24-28 Hoflich and collaborators from Germany published the first report on the antidepressant effects of TMS.27 Inhibitors,research,lifescience,medical These authors treated two patients with delusional major GDC 0449 depressive disorder (MOD) with 10 sessions of TMS (14-mm round coil, 250 stimulations at 0.3 Hz per day, at the vertex, and at 5% to 30% above MT) and followed these treatments with 10 sessions of electroconvulsive therapy Inhibitors,research,lifescience,medical (ECT). ECT was superior to TMS in both patients; however, a mild antidepressant effect, of TMS was observed in one of the patients. Additional sTMS studies are those of Kolbinger et al,28 Grisaru et al,24 Conca et al,25; and Geller et al.25 These studies

were all performed with round coils, at relatively low frequencies, and with coil locations at, either the vertex or the LDLPFC. The antidepressant effects of TMS in these studies were very modest. Conca et al24 compared the Inhibitors,research,lifescience,medical effects of TMS as an add-on Adenosine treatment to ongoing antidepressant medication in patients with MDD without delusions. The authors randomly assigned patients to one of two groups, one treated with sTMS and medication, and the other with medication alone. TMS was administered over several cortical regions with a round coil. The authors found a greater remission of depressive symptoms in the sTMS group after just, three sTMS sessions; this difference was even more significant by the end of the 10th and final sTMS session. Conca et al repeated this design in a follow-up study of 12 MDD patients without, delusions.29 These authors administered 500 pulses a day for up to 10 days at maximal machine output, and over several cortical regions. They reported a significant, response rate for sTMS-treated patients.