The antidepressive potency of repetitive transcranial magnetic stimulation (rTMS) seems to depend on variables such as the stimulation placements, different frequencies, stimulus intensities, coil shape and interstimulus intervals. The aim of this pilot study was to investigate the augmentation properties of rTMS combining low and high frequencies. Thirty six depressed medicated in-patients were recruited and assigned to three different rTMS treatment modalities as an add-on strategy (each n = 12). In group 1 a stimulus intensity of 110% of the motor threshold (MT) was used with a frequency of 10 Hz over the left dorsolatero prefrontal cortex (DLPC). The right DLPC was stimulated in the same session with 110% MT at 1 Hz. In group 2 the patients were stimulated only over the left DLPC with alternating trains of 110% MT at 10 Hz and trains of 110% MT at 1 Hz in the same session. In group 3 the high frequency stimulation over the left DLPC was performed as an internal control group. None of the treatment modalities was superior but different side effects were observed. These preliminary findings suggest that rTMS, at varying frequencies and stimulation placements, evokes different psychoactive effects of clinical relevance.

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appeared when the diuretic was withheld. The treatment strategy was then changed to taper the dosage of amusulpride from 800 to 400 mg per day and to stop using the diuretic. Within one week with this strategy, the bilateral pedal edema resolved entirely. The patient's psychiatric condition remained stable on this dosage of amisulpride. In our case, treatment of amisulpride alone or an adverse interaction between amisulpride and lorazepam may be responsible for the patient's bilateral pedal edema. The latter is less likely because amisulpride and lorazepam have not been reported to have significant pharmacokinetic interaction. In addition, amisulpride appeared to be associated with the patient's pedal edema in a dose-related fashion since the pedal edema disappeared after prescribing a lower dosage of amisulpride. The finding of elevated IgE with normal values of C3 and C4 was similar to a previous report regarding risperidone-associated allergic reaction [4]. In that report, the authors suggested that the allergic reaction in their case might be type I or type IV allergic reaction since IgE level was elevated and C3/C4 levels were within normal limits. It suggests that the pathogenesis of pedal edema in both cases might be caused by a similar mechanism. However, the pathophysiological mechanism of amisulpride-associated pedal edema is still not clear as of edema associated with other new antipsychotic agents. It is subject to further clinical investigation and research concerning this issue.

Acute electroconvulsive therapy has anticonvulsive effects. The aim of the present study was to investigate the anticonvulsive efficiency of maintenance electroconvulsive therapy. Records of patients treated with maintenance electroconvulsive therapy were screened retrospectively, and the changes in seizure duration were measured. The patients were subdivided into responders and non-responders. Responders had no significant seizure duration changes within the first week of maintenance electroconvulsive therapy. In contrast, the seizure duration of the non-responder group increased significantly within the first week. It was concluded that the early increase in seizure duration at constant energy could be predictive of relapse.

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