Abnormalities of Gamma Amino Butyric Acid (GABA), the major inhibitory neurotransmitter, and Glx (glutamate, major excitatory neurotransmitter + glutamine) have been implicated in the pathology of depression. Modulation of GABA and Glx at left dorsolateral prefrontal cortex, the site of application of repetitive transcranial magnetic stimulation (rTMS) to treat major depressive disorder for patients not adequately responsive to medication treatment, was investigated using MEGA-PRESS spectroscopy. No change in GABA level was observed, while Glx/creatine level increased with rTMS therapy. Patients with higher Glx/Creatine level tended to respond better to rTMS, and the response was inversely correlated with increase in Glx/Creatine.
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