***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Normal individuals were used to quantitate electroencephalographic ( EEG ) changes during concurrent administration of 0.5 and 100 Hz cranial electrotherapy stimulation ( CES ) . METHODS Twelve normal , right-h and ed males were used in a r and omized , double-blind crossover design study . A 3 amplifier system incorporating noise-cancellation was used to collect one channel of EEG ( O1-Cz configuration ) for 30 min . Either 0.5 , 100 Hz , or sham CES treatment was administered for 20 min of each session . Statistical analyses were applied to time- and frequency-domain EEG variables . RESULTS Relative to sham control , 0.5 and 100 Hz CES caused the alpha b and mean frequency to shift downward . Additionally , 100 Hz CES also caused a decrease of the alpha b and median frequency and beta b and power fraction . CONCLUSIONS Both 0.5 and 100 Hz CES provide frequency distribution shifts that suggest beneficial changes in mental state . However , compared to 0.5 Hz CES , 100 Hz CES effected a greater overall change . It is suggested that similar tests be performed on individuals with various behavioral and neurological disorders to determine if comparable EEG changes can be realized and correlated with beneficial effects of CES therapy BACKGROUND Depression is one of the most disabling diseases , and causes a significant burden both to the individual and to society . WHO data suggests that depression causes 6 % of the burden of all diseases in Europe in terms of disability adjusted life years ( DALYs ) . Yet , the knowledge of the economic impact of depression has been relatively little research ed in Europe . AIMS OF THE STUDY The present study aims at estimating the total cost of depression  in Europe based on published epidemiologic and economic evidence . METHODS A model was developed to combine epidemiological and economic data on depression in Europe to estimate the cost . The model was populated with data collected from extensive literature review s of the epidemiology and economic burden of depression in Europe . The cost data was calculated as annual cost per patient , and epidemiologic data was reported as 12-month prevalence estimates . National and international statistics for the model were retrieved from the OECD and Eurostat data bases . The aggregated annual cost estimates were presented in Euro for 2004 . RESULTS In 28 countries with a population of 466 million , at least 21 million were affected by depression . The total annual cost of depression in Europe was estimated at Euro 118 billion in 2004 , which corresponds to a cost of Euro 253 per inhabitant . Direct costs alone totalled dollar 42 billion , comprised of outpatient care ( Euro 22 billion ) , drug cost ( Euro 9 billion ) and hospitalization ( Euro 10 billion ) . Indirect costs due to morbidity and mortality were estimated at Euro 76 billion . This makes depression the most costly brain disorder in Europe , accounting for 33 % of the total cost . The cost of depression corresponds to 1 % of the total economy of Europe ( GDP ) . DISCUSSION Our cost results are in good agreement with previous research findings . The cost estimates in the present study are based on model simulations for countries where no data was available . The predictability of our model is limited to the accuracy of the input data employed . As there is no earlier cost-of-illness study conducted on depression in Europe , it is , however , difficult to evaluate the validity of our results for individual countries and thus further research is needed . CONCLUSION The cost of depression poses a significant economic burden to European society . The simulation model employed shows good predictability of the cost of depression in Europe and is a novel approach to estimate the cost-of-illness in Europe . IMPLICATION S FOR HEALTH CARE PROVISION AND POLICIES : Health and social care policy and commissioning must be evidence -based . The empirical results from this study confirm previous findings , that depression is a major concern to the economic welfare in Europe which has consequences to both healthcare providers and policy makers . One important way to stop this explosion in cost is through increased research efforts in the field . Moreover , better detection , prevention , treatment and patient management are imperatives to reduce the burden of depression and its costs . Mental healthcare policies and better access to healthcare for mentally ill are other challenges to improve for Europe . IMPLICATION S FOR FURTHER RESEARCH This study has identified several research gaps which are of interest for future research . In order to better underst and the impact of depression to European society long-term prospect i ve epidemiology and cost-of-illness studies are needed . In particular data is lacking for Central European countries . On the basis of our findings , further economic evaluations of treatments for depression are necessary in order to ensure a cost-effective use of European healthcare budgets The study assessed the effectiveness of electrosleep therapy in the treatment of depression , anxiety , and  sleep difficulties  in a small , heterogeneous sample of psychiatric in patients . A double-blind format was employed , one group receiving active treatment while the other received simulated treatment . The results showed active electrosleep to be no better than placebo in bettering quality of sleep or in lessening symptoms of depression or anxiety The effects of cerebral electric therapy ( electrosleep ) and placebo on self-ratings of anxiety , depression , and hostility were compared . No difference in the amount of improvement shown by the two groups appeared on any of the five measures employed , although a major placebo effect was evident on all of the criteria . The results argue against the use of electrosleep as a treatment for these symptoms except when it may be employed for its placebo value Twenty-eight patients participated in a controlled double-blind study to determine the effectiveness of electrosleep as a treatment modality . To our knowledge this is the first study in the English literature in which the peripheral rhythmic electrical stimulation has been eliminated , thereby allowing the results of the current effect on the brain to be independently evaluated . Both global ratings by patients and physicians on the fifth day of treatment and on two-week follow-up indicate that current effect is not associated with significant improvement , although patient global ratings on day 5 indicate a trend in this direction . Self-rating scales by patients indicate no significant improvement for anxiety , insomnia , or somatic complaints . Depressive self-rating scales do show a significant improvement on day 5 of treatment , but no carry over effect to the two-week follow-up 
    Output:
    
The main outcomes to be assessed were:(1 ) the efficacy of CES in reducing symptoms of depression as reflected in change scores on st and ardized depression rating scales.(2 ) the tolerability of CES treatment to participants , as reflected in rates of discontinuation due to adverse effects .