***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: A double-blind controlled trial of ECT versus simulated ECT is described . The results show that real ECT is significantly superior to simulated ECT in the treatment of depressive illness Objectives Anesthesia is required for both magnetic seizure therapy ( MST ) and electroconvulsive therapy ( ECT ) , although it has anticonvulsant properties . In this case , bispectral index ( BIS ) monitoring , a specific electroencephalogram-derived monitoring , can be used to find the optimal seizure induction time during anesthesia to elicit adequate seizures . A measurement of seizure adequacy in electroencephalogram is the postictal suppression . The purpose of this study was to investigate the influence of seizure induction time on the degree of postictal suppression by comparing BIS versus no-BIS monitoring in MST and ECT . Methods Twenty patients with treatment-resistant depression were r and omly assigned to either MST or ECT . Each patient underwent 3 treatments with the determination of seizure induction time by defined prestimulation BIS ( BIS condition ) and 3 treatments with determination of seizure induction time by controlled clinical trial protocol ( no-BIS condition ) . Statistical analysis was calculated by repeated- measures analysis of variance . Results The degree of postictal suppression was more pronounced in both MST and ECT , with BIS monitoring . In this connection , no differences between MST and ECT were found . Seizure induction time was significantly later in the BIS condition ( 181.3 ± 6 seconds ) compared with the no-BIS condition ( 114.3 ± 12 seconds ) ( P < 0.001 ) . Conclusions Adequacy of seizures , in the form of the degree of postictal suppression , was superior by determining the seizure induction time with BIS in both MST and ECT . Further research is needed to investigate the correlation between the degree of postictal suppression and treatment response Major depressive disorder ( MDD ) is a prevalent and disabling condition , and many patients do not respond to available treatments . Deep transcranial magnetic stimulation ( dTMS ) is a new technology allowing non-surgical stimulation of relatively deep brain areas . This is the first double-blind r and omized controlled multicenter study evaluating the efficacy and safety of dTMS in MDD . We recruited 212 MDD out patients , aged 22 - 68 years , who had either failed one to four antidepressant trials or not tolerated at least two antidepressant treatments during the current episode . They were r and omly assigned to monotherapy with active or sham dTMS . Twenty sessions of dTMS ( 18 Hz over the prefrontal cortex ) were applied during 4 weeks acutely , and then biweekly for 12 weeks . Primary and secondary efficacy endpoints were the change in the Hamilton Depression Rating Scale ( HDRS-21 ) score and response/remission rates at week 5 , respectively . dTMS induced a 6.39 point improvement in HDRS-21 scores , while a 3.28 point improvement was observed in the sham group ( p=0.008 ) , result ing in a 0.76 effect size . Response and remission rates were higher in the dTMS than in the sham group ( response : 38.4 vs. 21.4 % , p=0.013 ; remission : 32.6 vs. 14.6 % , p=0.005 ) . These differences between active and sham treatment were stable during the 12-week maintenance phase . dTMS was associated with few and minor side effects apart from one seizure in a patient where a protocol violation occurred . These results suggest that dTMS constitutes a novel intervention in MDD , which is efficacious and safe in patients not responding to antidepressant medications , and whose effect remains stable over 3 months of maintenance treatment Background The treatment of depression remains a challenge since at least 40 % of patients do not respond to initial antidepressant therapy and 20 % present chronic symptoms ( more than 2 years despite st and ard treatment administered correctly ) . Repetitive transcranial magnetic stimulation ( rTMS ) is an effective adjuvant therapy but still not ideal . Intermittent Theta Burst Stimulation ( iTBS ) , which has only been used recently in clinical practice , could have a faster and more intense effect compared to conventional protocol s , including 10-Hz high-frequency rTMS ( HF-rTMS ) . However , no controlled study has so far highlighted the superiority of iTBS in resistant unipolar depression . Methods / design This paper focuses on the design of a r and omised , controlled , double-blind , single-centre study with two parallel arms , carried out in France , in an attempt to assess the efficacy of an iTBS protocol versus a st and ard HF- rTMS protocol .  Sixty patients aged between 18 and 75 years of age will be enrolled . They must be diagnosed with major depressive disorder persisting despite treatment with two antidepressants at an effective dose over a period of 6 weeks during the current episode . The study will consist of two phases : a treatment phase comprising 20 sessions of rTMS to the left dorsolateral prefrontal cortex , localised via a neuronavigation system and a 6-month longitudinal follow-up . The primary endpoint will be the number of responders per group , defined by a decrease of at least 50 % in the initial score on the Montgomery and Asberg Rating Scale ( MADRS ) at the end of rTMS sessions . The secondary endpoints will be : response rate 1 month after rTMS sessions ; number of remissions defined by a MADRS score of < 8 at the endpoint and 1 month after ; the number of responses and remissions maintained over the next 6 months ; quality of life ; and the presence of predictive markers of the therapeutic response : clinical ( dimensional scales ) , neuropsychological ( evaluation of cognitive functions ) , motor ( objective motor testing ) and neurophysiological ( cortical excitability measurements ) . Discussion The purpose of our study is to check the assumption of iTBS superiority in the management of unipolar depression and we will discuss its effect over time . In case of a significant increase in the number of therapeutic responses with a prolonged effect , the iTBS protocol could be considered a first-line protocol in resistant unipolar depression . Trial registration Clinical Trials.gov , Identifier NCT02376491 . Registered on 17 February 2015 at http:// clinical trials.gov BACKGROUND Bipolar depression ( BD ) is a highly prevalent condition associated with marked cognitive deficits that persist even in the euthymic phase of the illness . Pharmacological treatments for BD might further aggravate cognitive impairment , highlighting the need of developing interventions that present cognitive safety . In this study , we evaluated the cognitive effects of H1-coil ( deep ) transcranial magnetic stimulation ( TMS ) in patients with treatment-resistant bipolar depression . METHODS Fourty-three patients were r and omized to receive 20 sessions of active ( 55 trains , 18 Hz , 120 % resting motor threshold intensity ) or sham rTMS within a double-blind , sham-controlled trial . A battery of 20 neuropsychological assessment s , grouped in 6 domains ( attention and processing speed , working memory and executive function , inhibitory control , language , immediate verbal memory , and long-term verbal memory ) was performed at baseline and after 4 and 8 weeks of trial onset . Depressive symptoms were assessed with the 17-item Hamilton Rating Scale for Depression . RESULTS Cognitive improvement was shown for all cognitive domains . It occurred regardless of intervention group and depression improvement . For the language domain , greater improvement was observed in the sham group over time . No correlations between depression ( at baseline or during treatment ) and cognitive improvement were found . LIMITATIONS Absence of healthy control group . CONCLUSION The results of this exploratory study provide evidence on the cognitive safety of H1-coil TMS for BD patients . Putative pro-cognitive effects of rTMS in BD were not observed and thus should be further investigated OBJECTIVES There is little evidence for differences in response and speed of response to electroconvulsive therapy ( ECT ) between patients with bipolar and patients with unipolar depressive disorder . In the only prospect i ve study to date , Daly et al. ( Bipolar Disord 2001 ; 3 : 95 - 104 ) found patients with bipolar depression to show more rapid clinical improvement and require fewer treatments than unipolar patients . In this study , response and speed of response of patients with unipolar and bipolar depression treated with ultra-brief pulse ECT  were compared . METHODS All patients ( n = 64 ) participated in a r and omized trial comparing ultra-brief pulse bifrontal ECT at 1.5 times seizure threshold and unilateral ECT at 6 times seizure threshold .  Thirteen patients ( 20.3 % ) had DSM-IV-defined bipolar depression . The Hamilton Rating Scale for Depression and Clinical Global Impression scale were administered at baseline and repeated weekly during and after the course of treatment by a blinded rater . At the same time point , the Beck Depression Inventory and the Patient Global Impression scale were administered . Speed of response was analyzed using survival analyses . RESULTS Patients with bipolar and unipolar depression did not differ in rates of response or remission following the ECT course , nor in response to unilateral or bifrontal ECT .  Patients with bipolar depression , however , showed a more rapid response than patients with unipolar depression . CONCLUSIONS Patients with bipolar depression tend to show more rapid clinical improvement with ECT than patients with unipolar depression OBJECTIVE Substantial progress has been made in identifying how the treatment parameters used in ECT impact on cognitive side effects . However , there is limited information regarding individual differences in vulnerability to these side effects . The authors examined patients ' pretreatment global cognitive status and postictal orientation recovery time as potential predictors of the magnitude of retro grade amnesia for autobiographical memories after ECT . METHOD Seventy-one in patients with major depressive disorder were r and omly assigned to four ECT conditions that varied in electrode placement ( right unilateral versus bilateral ) and stimulus dosage ( low versus high intensity ) . Orientation recovery time was assessed at virtually every session during the course of ECT .  Global cognitive status was assessed with the modified Mini-Mental State examination before treatment , during the week after termination of treatment , and 2 months after treatment ended . Retro grade amnesia was assessed at these same time points with the Autobiographical Memory Interview . RESULTS Pre-ECT global cognitive status and the duration of postictal disorientation were strong predictors of the magnitude of retro grade amnesia in the week after the course of ECT and at 2-month follow-up . In general , these relationships were maintained regardless of technical parameters in the administration of the ECT . CONCLUSIONS Patients who manifest global cognitive impairment before treatment and patients who experience prolonged disorientation in the acute postictal period may be the most vulnerable to persistent retro grade amnesia for autobiographical information Electroconvulsive therapy was investigated in a double blind trial . Altogether 186 clinical ly selected patients were referred to the trial , but 48 of these did not participate . According to the present state examination , 95 of the remaining 138 patients fell into one of the classes of major depression . Patients were r and omly allocated to a course of real or simulated electroconvulsive therapy . Treatment was given twice a week with a maximum of eight treatments . On the Hamilton depressive rating scale the improvement in the group given real treatment was significantly greater than that in the group given simulated treatment both at two weeks ( p = 0.014 ) and at four weeks ( p = 0.0001 ) . At follow up at 12 and 28 weeks there was no difference between the treatment groups . At the end of the four week trial consultants , who were blind to the allocation of treatment , rated the patients who had received real treatment as having made a significantly greater improvement than the patients who had received simulated treatment ( p less than 0.00005 ) . Further analysis showed that  electroconvulsive therapy  was effective in depression associated with delusions and in depression associated with retardation Since electroconvulsive therapy ( ECT ) can result in generalized seizures that lack efficacy , physiological markers of treatment adequacy are needed . Specific electroencephalographic ( EEG ) features differentiate seizures produced with barely suprathreshold right unilateral ( RUL ) ECT , an ineffective treatment , from effective forms of ECT . This study determined whether EEG features are sensitive to treatment condition using a broad dosing range for RUL ECT , as well as predictive of clinical and cognitive outcomes . Quantitative EEG measures and observer ratings were compared in predictive power . From a larger study , 54 in- patients with major depression were r and omized to low ( 1.5 × seizure threshold ( ST ) ) , moderate ( 2.5 × ST ) , or high-dose ( 6 × ST ) RUL ECT , or high-dose ( 2.5 × ST ) bilateral ( BL ) ECT . High dosage RUL and BL ECT were comparable in efficacy , and superior to low and moderate dosage RUL ECT . In the slow frequency b and s ( δ ) , BL ECT result ed in greater ictal power , ictal coherence , and postictal suppression than each RUL ECT condition , but the EEG measures failed to discriminate the RUL ECT groups . EEG measures were modestly associated with clinical outcome , with greater ictal power , δ coherence , and postictal suppression positive predictors . None of the EEG measures were associated with cognitive outcomes . Inability to distinguish forms of RUL ECT differing markedly in dosage and efficacy suggests that EEG measures have limited potential as markers of treatment adequacy . Rather than assaying treatment adequacy , the EEG features associated with efficacy may reflect individual differences in the strength of inhibitory processes that terminate 
    Output:
    
The most studied treatment comparisons were high frequency left rTMS and tDCS versus sham therapy , whereas recent treatments remain understudied .
All treatment strategies were at least as acceptable as sham therapy .