Treatment Modality For Depression Research Articles

FMRI neurofeedback for the modulation of the neural networks associated with depression

ObjectivesFunctional magnetic resonance imaging (fMRI) neurofeedback has emerged as a potential treatment modality for depression, but little is known about its mechanism of action. This study aims to investigate the efficacy of fMRI neurofeedback in modulating neural networks in depression. MethodsFollowing PRISMA guidelines, a systematic review was conducted focusing on fMRI neurofeedback interventions in depression. A comprehensive search across multiple databases yielded 16 eligible studies for review. ResultsThe review demonstrated that fMRI neurofeedback can modulate BOLD activity even in strategy-free protocols and within a single session, with a significant learning effect evident over sessions. Neurofeedback targeting specific regions led to changes in connectivity across broad neural networks, including the default-mode and executive control networks, with effects being region-specific. However, methodological diversity and the absence of standardized protocols in the reviewed studies highlighted the need for more uniform research approaches. ConclusionsfMRI neurofeedback shows promise as a modulatory technique for depression, with the potential to induce significant changes in neural activity and connectivity of networks implicated in depression. SignificanceThe review underscores the necessity for standardized, reproducible neurofeedback protocols with control groups to enhance research comparability and generalizability.

Effect of pharmacogenomic testing on the clinical treatment of patients with depressive disorder: A randomized clinical trial

BackgroundPharmacotherapy is one of the primary treatment modalities for depression. However, there is considerable variability in the individual response to antidepressant medications. Personalized medicine guided by pharmacogenomic testing may hold promise in addressing this issue. MethodsIn this study, 665 depressive patients were randomly enrolled into two groups: the pharmacogenomic testing group (n = 333) and the control group (n = 332). In the testing group, participants underwent pharmacogenomic testing, and clinicians customized the treatment plan with the result, while the control group relied solely on clinicians' experience. The primary outcomes were the proportion of remission and response, assessed with Hamilton Depression Rating Scale (HDRS). The secondary outcomes included changes in HDRS scores over time and frequency of adverse drug reactions by the participants. ResultsAt week 8, the pharmacogenomic testing group showed significantly higher remission rates (24.0 % v.s. 15.1 %; RR = 1.117; P = 0.007) and response rates (39.3 % v.s. 25.7 %; RR = 1.225; P < 0.001) compared to the control group. By week 12, the pharmacogenomic testing group continued to demonstrate significant advantages in remission (31.0 % v.s. 20.0 %; RR = 1.159; P = 0.003) and response (48.7 % v.s. 37.3 %; RR = 1.224; P = 0.006). Additionally, adverse drug reactions were less frequent in the pharmacogenomic testing group. LimitationsThis study is not blind to clinicians and it's a single-center study.Conclusions: Pharmacogenomic testing-guided drug therapy can provide greater assistance in the treatment of depression.

The Economics of Treatment for Depression.

The global prevalence of depression has risen over the past three decades across all socioeconomic groups and geographic regions, with a particularly rapid increase in prevalence among adolescents (aged 12-17 years) in the United States. Depression imposes large health, economic, and societal costs, including reduced life span and quality of life, medical costs, and reduced educational attainment and workplace productivity. A wide range of treatment modalities for depression are available, but socioeconomic disparities in treatment access are driven by treatment costs, lack of culturally tailored options, stigma, and provider shortages, among other barriers. This review highlights the need for comparative research to better understand treatments' relative efficacy, cost-effectiveness, scalability, and potential heterogeneity in efficacy across socioeconomic groups and country and cultural contexts. To address the growing burden of depression, mental health policy could consider reducing restrictions on the supply of providers, implementing digital interventions, reducing stigma, and promoting healthy lifestyles.

Treatment of Perinatal Depression and Correlates of Treatment Response Among Pregnant Women Living with HIV in Uganda.

Perinatal depression is common among women living with HIV, but depression care is limited in low-resource settings. We examined (1) characteristics of women receiving Problem Solving Therapy (PST) versus antidepressant therapy (ADT), (2) treatment response by modality, and (3) correlates of treatment response. This analysis used data from 191 Ugandan women in the intervention arm of a cluster randomized controlled trial of task-shifted, stepped-care depression treatment for pregnant women living with HIV (PWLWH). Treatment response was defined as scoring < 5 on the nine-item Patient Health Questionnaire (PHQ-9). Bivariate analysis and multivariable logistic regression were used to examine characteristics of women by treatment group and correlates of treatment response. Of 134 participants with depression, 129 (96%) were treated: 84 (65%) received PST and 45 (35%) received ADT. Severe depression at treatment initiation was more common in those receiving ADT (28.9% versus 4.8%, Fischer's Exact Test < 0.001). Treatment response was higher for PST (70/84; 83.3%) than ADT (30/45; 66.7%; p = .03). ADT side effects were rare and minor; no infants had serious congenital defects. Of 22 participants (19%) who did not respond to treatment, only five received intensified management. Social support and interpersonal violence were associated with treatment response (adjusted odds ratio, [aOR] = 3.06, 95% CI = 1.08-8.66 and aOR = 0.64, 95% CI = 0.44-0.93). Both depression treatment modalities yielded high response rates in Ugandan PWLWH; ADT was well-tolerated. Our results highlight a need to build capacity to implement the stepped-care protocol for non-responders and screen for social support and interpersonal violence.

A network meta-analysis of 12,116 individuals from randomized controlled trials in the treatment of depression after acute coronary syndrome.

Post-acute coronary syndrome (ACS) depression is a common but not well understood complication experienced by ACS patients. Research on the effectiveness of various therapies remains limited. Hence, we sought to conduct a network meta-analysis to assess the efficacy of different interventions for post-ACS depression in improving patient outcomes. Three electronic databases were searched for randomised controlled trials describing different depression treatment modalities in post-ACS patients. Each article was screened based on inclusion criteria and relevant data were extracted. A bivariate analysis and a network meta-analysis was performed using risk ratios (RR) and standardized mean differences (SMD) for binary and continuous outcomes, respectively. A total of 30 articles were included in our analysis. Compared to standard care, psychosocial therapy was associated with the greatest reduction in depression scores (SMD:-1.21, 95% CI: -1.81 to -0.61, p<0.001), followed by cognitive behavioural therapy (CBT) (SMD: -0.75, 95% CI: -0.99 to -0.52, p<0.001), antidepressants (SMD: -0.73, 95% CI: -1.14 to -0.31, p<0.001), and lastly, combination therapy (SMD: -0.15, 95% CI: -0.28 to -0.03, p = 0.016). No treatment modalities was found to be more effective in reducing depression scores when compared to one another. Additional analysis showed that these treatment modalities did not have significant impact on the overall mortality, cardiac mortality and recurrent myocardial infarction. This network meta-analysis found that the treatment effect of the various psychological modalities on depression severity were similar. Future trials on psychological interventions assessing clinical outcomes and improvement in adherence to ACS-specific interventions are needed.

Advantages and Disadvantages of Using St. John's Wort as a Treatment for Depression

Background and objectives: St. John's wort (SJW) extracts are currently being used to treat depression of various degrees of severity. While many studies have shown it to be superior to placebo, data regarding the effectiveness of using SJW as a stand-alone treatment compared with standard antidepressants has yet to be proven conclusively. This study aims to understand the advantages and disadvantages of SJW as a treatment modality for depression.Methods: The authors searched PubMed, JAMA network, Springer Link, Elsevier, Google Scholar, and Scientific Progress databases, from 2011 through August 2021, using the following keywords: St John’s wort, Hypericum perforatum, depression, antidepressant, complementary alternative medicine, economic evaluation depression St. wort, St John’s wort and depression, antidepressant interactions. This yielded a total of 27 papers following a thorough removal of irrelevant content and dissemination in languages other than English.Results: In patients with mild and moderate depression, SJW proved superior to placebo. Certain studies comparing the efficacy of SJW versus selective serotonin reuptake inhibitors (SSRIs), especially fluoxetine, reported SJW to be more efficacious, while the majority reported no significant difference. Tricyclic antidepressants were also found to have similar efficacy as SJW. Moreover, treatment with SJW was also found to reduce postmenopausal depression. Regarding the safety profile, although SJW is better tolerated with fewer adverse effects when compared to standardized antidepressants, its predisposition to causing fatal serotonin syndrome, when used in conjunction with other serotonergic agents and drug interactions noted with CYP 450 drugs, raises a question in the safety profile.Conclusion: It is essential to acknowledge that SJW has been used as a treatment measure in Germany. Despite being only listed as a dietary supplement by the FDA and not a drug, SJW has shown to be comparable, if not more efficacious, than most standard treatment options for depression. SJW does prove to be an exciting piece of pharmacotherapy in the realm of mental health and post-menopausal treatment. More prospective studies will help us better understand its efficacy in mild and moderate depression and its ability to serve as a long-term agent. Considering its mechanism of action, its role in relieving patients suffering from an anxiety disorder is also worth considering.

Osteopathic Manipulative Treatment in Patients with Anxiety and Depression: A Pilot Study

Abstract Background &amp; Aims: The role of touch in managing psychiatric patients is controversial. The purpose of this pilot study was to determine the effectiveness of osteopathic manipulative treatment (OMT) in patients with anxiety and or depression. Methods: This was an 8-week pilot study comparing a treatment to a control group, each consisting of 10 randomly assigned adult participants with anxiety and or depression on psychotropics. No significant difference existed between groups for age or severity of disease. Participant responses for anxiety and depression were recorded weekly via a modified Generalized Anxiety Disorder 7 item (GAD-7) and Harvard National Depression Screening Day (HANDS) scales. From the initial cohort (n=20) a complete database was achieved for 16 of the patients. Statistical analysis was performed using RStudio. Results: Of the 16 patients who successfully participated in the study, 6 received OMT, and 10 were part of the control group. For statistical purposes, the data gathered from both groups were subdivided into two categories: depression and anxiety subgroups. The depression treatment group had a week 1 mean of 24.4 ± 11.2 (n=5) with a paired t-test showing significance at week 7 of 18.0 ± 10.9 (n=5), P = .00767 and week 8 of 15.2 ± 12.5 (n=5), P = .041.The anxiety treatment group had a week 1 mean of 26.0 ± 8.7 (n=5) with paired t-test significant at week 7 of 20.2 ± 10.7 (n=5), P = .019 and week 8 of 19.2 ± 11.1 (n=5), P = .00815.All patients in the treatment group showed significant improvements in their anxiety and depression levels compared to those in the control group, which worsened by week 8. Conclusions: Findings in this study indicate that OMT may be an effective adjunctive treatment modality for depression and anxiety.

Treatment of Depression With Alcohol and Substance Dependence: A Systematic Review.

Although alcohol and/or substance use disorders have been significantly associated with depression, data on the treatment outcomes of depression in this patient population are still scarce, especially among the higher risk of resistance to treatment. This study examines the management outcomes of depression in patients with alcohol and substance dependence during the last decade by searching the medical literature. The literature was searched through Medline, PsycInfo, Embase, and Ovid database from 2010 to 2020. Searching terms included were a combination of ‘’treatment’’ AND ‘’Depression’’ AND ‘’alcohol’’ OR “substance abuse". A total of 617 articles were retrieved. After this, original articles investigating depression treatment outcomes in patients with alcohol or substance use disorders or both were selected. Following the exclusion of review studies and including only original research studies, 23 articles appeared. We selected eight articles as eligible, covering a total of 132,373 patients with depression and either alcohol dependence or substance use disorder. Anti-depressants (mainly selective serotonin reuptake inhibitors) combined with psychotherapy and alcohol or substance abuse treatment represent the best treatment modality for depression in this clinical setting. In conclusion, patients with alcohol or substance dependence usually suffer from treatment-resistant depression. However, the treatment of depressive symptoms would help in substance or alcohol abstinence and reduce recurrent substance abuse.

Depression literacy and the related factors among a group of hospitals' staff in Iran.

Having a proper approach to depression requires having sufficient depressive literacy in the affected person. This study aimed to evaluate the level of depression literacy among hospital staff affiliated to Isfahan University of Medical Sciences (IUMS) and to reveal the risk factors and knowledge gaps. This was a cross-sectional study with 760 participants from university hospital staff at IUMS who were selected by a census method from April 2018 to December 2018. The data regarding depression signs and symptoms, anti-depressant drugs safety, non-medical treatment efficacy, etc. were collected using the Depression Literacy Questionnaire (D-Lit-22) and were analysed by SPSS-20, using the Pearson correlation coefficient, independent Samples t-test and analysis of variance (ANOVA) (p ⩽ .05). The mean age of participants was 35.33 ± 8.00 years old and 77.6% of them were female. The mean of the total score of depression literacy was 11.62 ± 3.53. Depression Literacy score was significantly higher in those with higher education levels, female gender and clinical staff (p < .001). The inability to distinguish depression from other mental disorders as well as having wrong beliefs about suitable treatment approaches were the most considerable gaps in depression literacy. Male gender, low level of academic education and working in non-medical wards are the main factors associated with lower depression literacy in our studied sample. The poor differentiation of depression and wrong beliefs in depression treatment modalities were the largest gaps which require more educational programmes.

CBT and medication in depression (Review).

Depression is a serious problem, primarily for the patient, but in-extenso, for society. The World Health Organization has long signaled an increase in the number of cases of mental health problems globally and, in particular, an increase in the number of people suffering from depression. In the context in which the most effective solutions are sought for the reduction and even remission of depressive symptoms. In the present review literature is analyzed on two current treatment modalities for depression: Cognitive behavioral therapy (CBT) and antidepressive medication (ADM). Both modalities act by the same internal mechanisms, in the same order, but studies found also differences between the ADM and CBT effects depending on early traumatic experiences of the patients, cognitive and genetic variables, other epigenetic factors and patient's history. A literature review is presented, which systematically collects actual data and synthesizes previous research findings in the field of depression treatment using ADM and CBT.

STEP.De study—a multicentre cluster-randomised effectiveness trial of exercise therapy for patients with depressive symptoms in healthcare services: study protocol

IntroductionAlthough exercise therapy has widely been shown to be an efficacious treatment modality for depression, evidence for its effectiveness and cost efficiency is lacking. The Sport/Exercise Therapy for Depression study...

Selective serotonin re-uptake inhibitors: risk of blood product transfusion and inotrope requirements in patients undergoing cardiac surgery.

Patients undergoing cardiac surgery exhibit a high prevalence of concomitant depression. The first-line pharmacological treatment modality for depression includes selective serotonin re-uptake inhibitors (SSRIs). Despite their efficacy, SSRIs are not without their own side-effects. We conducted a retrospective observational study to determine if preoperative SSRI therapy was associated with higher rates of perioperative blood product transfusion, and higher incidence of inotropic requirements in patients undergoing elective cardiac surgery. A total of 2,943 patients were included in the study. Patients undergoing emergency surgery or surgery without cardiopulmonary bypass (CPB) were excluded. Based on preoperative SSRI status patients were classed into either SSRI group (n=95), or non-SSRI group (n=2,848). Data was acquired from the Toronto Anesthesia Perioperative Outcomes Database. Baseline preoperative variables included age, sex, body surface area, smoking history, past medical history, preoperative medications, baseline hemoglobin, creatinine, and planned surgical procedures. Perioperative transfusion of blood products and inotropic utilization were collected. Univariate analysis showed that patients in SSRI group were more likely to be female, have history of congestive heart failure, preoperative anemia, and likelihood of having more complex surgery, received more inotropes and fresh frozen plasma, and were more likely to have chest reopening for bleeding. There was no difference in postoperative morbidity and mortality between the SSRI and non-SSRI groups. Separate statistical models were constructed to determine association between transfusion of red blood cells, fresh frozen plasma, platelets, composite inotrope use, and SSRI therapy. SSRI variable was not significant in any of the multivariate models, indicating the lack of evidence of association between the SSRIs and either blood product transfusion, or inotrope requirements. Significant predictors of blood product transfusion included smaller body surface area, female gender, older age, low baseline hemoglobin levels, elevated creatinine, increased CPB, presence of deep hypothermic circulatory arrest, complex cardiac surgery, history diabetes mellitus, and congestive heart failure. Predictors of inotrope use included older age, elevated creatinine, increased CPB time, history of diabetes mellitus, and congestive heart failure. The current study suggests that modifying preoperative therapy pertinent to SSRI treatment in patients undergoing elective cardiac surgery is not warranted.

Efficacy of Transcranial Magnetic Stimulation [TMS] among Major Depressive Disorder Patients: A Review

The objective of the review is to ascertain the efficacy of transcranial magnetic stimulation therapy among major depressive patients. The various research papers reviewed to know the magnitude of depression and the efficacy of TMS. Depression is a significant contributor to the global burden of disease and affects people in all communities across the world. India has the highest rate of major depression in the world. It is estimated that by the year 2020 the burden of depression will increase to 5.7% of the total burden of disease. It clearly depicts that the need for alternative and convenient treatment modality for depression as a whole. TMS proves to be one of the effective mode of treatment for depression. In terms of its convenience of treatment it's quite promising and lesser number and severity of side effects as compared to other mode of treatment. Currently, it's under practice in countries like Canada, UK, and Australia. In India it needs to be equipped in terms of training and education to the experts, very importantly creating awareness among patients and family about the treatment facility. TMS is hope for India and it necessitates rapid paradigm shift in order to curb the title of high prevalent country with regards to depression.

Synthesising participants’ accounts from different mental health trials: the stride study

Researchers are increasingly utilising opportunities to bring together data from different qualitative studies in order to compare across data sets. However, limited guidance exists on how to do this. This presentation details the approach we used when synthesising four data sets in a study comparing patients’ experiences of different treatment modalities for depression. All four studies entailed conducting in-depth interviews with participants diagnosed with depression and were nested within large, primary care depression trials. Interventions evaluated within the trials included antidepressants, listening visits, CBT and facilitated physical activity. Data were analysed to explore what patients valued in their relationships with practitioners. This focus arose inductively from reading and re-reading transcripts. 35 transcripts were analysed using a coding frame that reflected emerging themes and which could be applied across the transcripts. The analysis established the extent to which themes were evident within the combined data set, and examined differences and commonalities between the four data sets. We found that patients receiving different treatments valued the same key practitioner attributes. Thus, through synthesising multiple data sets, we gained new insights and identified commonalities which increased confidence in the conclusions drawn. The limitations of our work related to those which had existed in the original studies, e.g. few participants from ethnic minorities. The success of the study related the selection of the four data sets (all were interview-based), the inductive approach used to identify the focus of our analysis, and the use of generic codes which enabled comparisons to be made.

Depression Treatment Preferences After Acute Traumatic Spinal Cord Injury

ObjectiveTo examine preferences for depression treatment modalities and settings and predictors of treatment preference in persons with spinal cord injury (SCI). DesignCross-sectional surveys. SettingRehabilitation inpatient services. ParticipantsPersons with traumatic SCI (N=183) undergoing inpatient rehabilitation. InterventionsNot applicable. Main Outcome MeasuresPatient Health Questionnaire-9 depression scale, history of psychiatric diagnoses and treatments, and a depression treatment preference survey. ResultsAmong inpatients with SCI (28% had Patient Health Questionnaire-9 score ≥10 indicating probable major depression), a physical exercise program was the most preferred treatment option (78% somewhat or very likely to try) followed by antidepressants prescribed by a primary care provider (63%) and individual counseling in a medical or rehabilitation clinic (62%). All modalities were preferred over group counseling. Although not statistically significant, more depressed individuals stated a willingness to try antidepressants and counseling than nondepressed individuals. Subjects preferred treatment in a medical/rehabilitation setting over a mental health setting. Those with a prior diagnosis of depression and a history of antidepressant use were significantly more willing to take an antidepressant. Age ≥40 years was a significant predictor of willingness to receive individual counseling. ConclusionsTreatment preferences and patient education are important factors when choosing a depression treatment modality for patients with SCI. The results suggest that antidepressants, counseling, and exercise may be promising components of depression treatment in this population, particularly if they are integrated into medical or rehabilitation care.

Association of treatment modality for depression and burden of comorbid chronic illness in a nationally representative sample in the United States

ObjectiveWe examined associations between treatment modality for depression and morbidity burden. We hypothesized that patients with higher numbers of co-occurring chronic illness would be more likely to receive recommended treatment for depression with both antidepressant medication and psychotherapy. MethodsUsing a retrospective cross-sectional design, we analyzed data on 165,826 people over 16 years from 2004 to 2008. Using a single multinomial logistic regression model, we examined the likelihood of treatment modality for depression: no treatment, psychotherapy alone, medication alone, and psychotherapy and medication. We examined the following predictors of therapy: (a) morbidity burden; (b) five specific chronic conditions individually: diabetes mellitus II, coronary artery disease, congestive heart failure, hypertension, and chronic obstructive pulmonary disease or asthma; and (c) sociodemographic factors. ResultsThe likelihood of any treatment for depression, specifically psychotherapy with medication, increased with the number of co-occurring illnesses. We did not find a clear pattern of association between the five specific conditions and treatment modality, although we identified treatment patterns associated with multiple sociodemographic factors. ConclusionsThis study provides insight into the relationship between multimorbidity and treatment modalities which could prove helpful in developing implementation strategies for the dissemination of evidence-based approaches to depression care.

An Evaluation of Neuroplasticity and Behavior After Deep Brain Stimulation of the Nucleus Accumbens in an Animal Model of Depression

Recent interest has demonstrated the nucleus accumbens (NAcc) as a potential target for the treatment of depression with deep brain stimulation (DBS). To demonstrate that DBS of the NAcc is an effective treatment modality for depression and that chemical and structural changes associated with these behavioral changes are markers of neuroplasticity. A deep brain stimulator was placed in the NAcc of male Wistar-Kyoto rats. Groups were divided into sham (no stimulation), intermittent (3 h/d for 2 weeks), or continuous (constant stimulation for 2 weeks). Exploratory and anxietylike behaviors were evaluated with the open-field test before and after stimulation. Tissue samples of the prefrontal cortex (PFC) were processed with Western blot analysis of markers of noradrenergic activity that included the noradrenergic synthesizing enzyme tyrosine hydroxylase. Analysis of tissue levels for catecholamines was achieved with high-performance liquid chromatography. Morphological properties of cortical pyramidal neurons were assessed with Golgi-Cox staining. Subjects undergoing intermittent and continuous stimulation of the NAcc exhibited an increase in exploratory behavior and reduced anxietylike behaviors. Tyrosine hydroxylase expression levels were decreased in the PFC after intermittent and continuous DBS, and dopamine and norepinephrine levels were decreased after continuous stimulation. Golgi-Cox staining indicated that DBS increased the length of apical and basilar dendrites in pyramidal neurons of the PFC. Deep brain stimulation induces behavioral improvement in and neurochemical and morphological alterations of the PFC that demonstrate changes within the circuitry of the brain different from the target area of stimulation. This observed dendritic plasticity may underlie the therapeutic efficacy of this treatment.

Pharmacotherapy and psychotherapy of pediatric depression

Importance of the field: Depressive disorders in children and adolescents are prevalent and impairing. Current available treatments of childhood depression have advanced over the years but still leave many patients with residual symptoms.Areas covered in this review: We here review the pharmacotherapy and psychoptherapy of pediatric major depressive disorder. We conducted a Pubmed review on this topic covering the last 30 years.What the reader will gain: The reader will learn about the current evidence on the efficacy and safety of the different pediatric depression treatment modalities. We review evidence-based treatments, namely cognitive behavioral therapy, interpersonal therapy, and antidepressant treatments. We critically review the extant clinical trials for these treatments, and discuss both antidepressants efficacy and adverse events, including risk for suicidal events.Take home message: Current treatments lead to a sustained response rate of up to 80% and a remission rate of 60% by 6 months, but we are in need of more personalized treatment to optimize treatment response. The identification of biomarkers of response may be the first step towards personalized treatment development.

Depression Treatment Preferences After Traumatic Brain Injury

To determine preferences for depression treatment modalities and settings among persons with traumatic brain injury (TBI). Telephone survey. Depression status was determined using the Patient Health Questionnaire-9. Harborview Medical Center, Seattle, Washington, the level I trauma center serving Washington, Idaho, Montana, and Alaska. One hundred forty-five adults, English-speaking consecutive patients admitted with complicated mild to severe TBI. Telephone survey within 12 months post-TBI ascertaining preferences for depression treatment modalities and settings. More patients favored physical exercise or counseling as a depression treatment than other treatment modalities. Group therapy was the least favored modality. Patients favored speaking with a clinician in the clinic or over the telephone and were less likely to communicate with a clinician over the Internet. Subjects with probable major depression or a history of antidepressant use or outpatient mental health treatment were more likely to express a preference for antidepressants for treatment of depression. This study underscores the importance of understanding patient preferences and providing patient education in selecting a treatment for depression after TBI. Future studies should examine psychotherapy and alternative treatment modalities and delivery models for the management of depression in this vulnerable population.

Long Term Effects of Left Frontal rTMS on EEG and ERPs in Patients with Depression

Repetitive transcranial magnetic stimulation (rTMS) treatment for depression has been under investigation in many controlled studies over the last 20 years. Little is known about the neurobiological action of rTMS in patients. We therefore investigated pre- and post-treatment effects on QEEG, ERP's and behavior (BDI and NEO-FFI). rTMS treatment was applied in 8 subjects for an average of 21 sessions to the left Dorsolateral Prefrontal Cortex (left DLPFC). Clients were assessed on a QEEG and Oddball ERP evaluation pre- and post-treatment. Clients were stimulated over the left DLPFC with 10 Hz rTMS (100% MT). Furthermore, rTMS treatment was complimented by psychotherapy. All subjects showed full remission within 20 sessions and there was a significant reduction in depressive symptomatology (BDI score) after 10 and 15 sessions and a clear decrease in the Neuroticism and an increase on the extraversion scale of the NEO-FFI personality questionnaire. Pre- and post-QEEG measurements did not reveal treatment specific effects, but only an indirect right frontal increase in delta power. On the other hand, ERP measures did reveal treatment specific effects by showing an increased positivity in the post-treatment ERP's specifically left frontal. The P2 amplitude demonstrated a significant left frontal increase in amplitude, whereas for the negative N1 and N2 a significant decrease in amplitude was observed. The results of this pilot study demonstrate that rTMS can be a safe and efficacious treatment modality for depression. Furthermore, a specific left frontal increase in positivity for the ERP's was found (increased P2 and decreased N1 and N2 components) most likely related to the rTMS over the left DLPFC. Furthermore, there was no change in the alpha asymmetry lending support to the fact that frontal alpha asymmetry can be considered a trait marker for depression. The findings from this pilot study require future replication with larger sample sizes.