Background: Theory of mind (ToM) and alexithymia have been reported to relate with depression in recent studies. However, data regarding the role of alexithymia and ToM in depression remain uncertain. Aim: The aim of the current study was to determine the levels of alexithymia and ToM abilities as well as their relationship with each other and clinical features in major depressive disorder (MDD). Materials and Methods: Patients diagnosed with MDD and healthy controls were undergone sociodemographic data, Beck Depression Inventory, Beck Anxiety Inventory, Toronto Alexithymia Scale (TAS-20), and reading the mind in the eyes test (RMET) to determine the depression, anxiety, alexithymia, and ToM abilities. Results: Depression, anxiety, and alexithymia levels were higher, while ToM abilities were found to be decreased in MDD patients relative to controls. A positive correlation was observed between depression levels and alexithymia levels in terms of difficulty in identifying feelings subscale and total scores of TAS-20 (P = 0.006, P = 0.036, respectively), while a positive correlation was also observed between anxiety levels and alexithymia levels in terms of difficulty in describing feelings subscale scores of TAS-20 (P = 0.02) in depressed group. No correlation was found between depression, anxiety levels, and RMET accuracy scores. Conclusion: Our results suggest alexithymia and impaired ToM abilities might be prominent but prone to be distinct clinical constructs in MDD patients.

Repetitive transcranial magnetic stimulation (rTMS) is an effective and novel treatment method that has been approved for the treatment of refractory depression by the U.S. Food and Drug Administration. The most common side effects of rTMS are a transient headache that usually responds to simple analgesics, local discomfort in the stimulation area, dizziness, ipsilateral lacrimation and, very rarely, generalized seizure. TMS is also regarded as a beneficial tool for investigating mechanisms underlying headache. Although rTMS has considerable benefits in terms of headache, there is the potential for rare side effects. In this report, we present the case of a patient with no history of autonomic headache who underwent a course of rTMS for refractory unipolar depression caused by an inadequate response to pharmacotherapy. After his fourth rTMS session, the patient developed sudden headaches with characteristics of trigeminal autonomic cephalalgia on the stimulated side, representing a noteworthy example of the potential side effects of rTMS.

Objectives: Recent studies have shown that oxidative stress is involved in the neurobiology of depression. We investigated the effects of repetitive transcranial magnetic stimulation (rTMS) on a novel oxidative stress marker, thiol-disulfide homeostasis, in subjects with medication-resistant major depression (MRD).Methods: Twenty-six subjects with MRD underwent 15 rTMS sessions. Sociodemographic and baseline and post-rTMS Montgomery-Asberg Depression Rating Scale (MADRS) data were collected. Serum levels of native thiol, total thiol, and disulfide and their pairwise ratios were measured in baseline and post-rTMS blood samples.Results: Serum levels of native and total thiol were significantly decreased after rTMS treatment (P< 0.05). Serum levels of thiol-disulfide and their ratios did not significantly differ (P> 0.05) between rTMS treatment responders (>50% reduction in MADRS score, n = 11) and rTMS treatment nonresponders (n = 15). The percentage MADRS score changes did not correlate with the changes in the levels of serum thiol-disulfide from baseline to post-rTMS treatment in any subject (P> 0.05).Conclusions: Our results showed that rTMS treatment was effective in subjects with MRD and was associated with changes in serum thiol levels regardless of improvement in depression severity. Thus, the results did not support a possible therapeutic relationship between rTMS and thiol-disulfide homeostasis in subjects with MRD.

Wernicke encephalopathy (WE) is a neuropsychiatric condition associated with thiamine deficiency that includes a triad of mental status changes, ophthalmoplegia, and ataxia. Worsening WE may lead to Korsakoff syndrome(KS), in which cognitive impairments such as confabulation and memory deficits and also psychiatric symptoms may occur. Diagnosis of Wernicke-Korsakoff syndrome can be complicated in many cases. We present the case of a prisoner who commenced a hunger strike and developed WE. The preceding factors were associated with his oral intake refusal, which originated from his mental disorder with psychotic content. We discuss the clinical and treatment concerns for this complicated condition.