Repetitive Transcranial Magnetic Stimulation (rTMS) in the Treatment of Patients with Drug-Resistant Depression Case Studies
Abstract
Nine patients with depressive disorder (diagnosis F32, F33 according to ICD-10) who had failed to respond to at least one course of antidepressant medication (median 3) were stimulated with rTMS. Methodology: Response to the treatment was defined as 50% decrease of depressive symptoms (rated according to MADRS).
We used high-frequency rTMS (20 Hz, 2-sec trains with 20 or 40 s intertrain interval, 30 or 45 trains in one session, 80-100% of motor threshold, 9-18 sessions) to the left dorsolateral prefrontal cortex. Results: 3 patients (30%) met the response criteria after 9-18 sessions.
In one patient 12 sessions of rTMS (20 Hz, 100% of motor threshold), were not effective, therefore he was switched to 1 Hz, 100% of motor threshold rTMS. This led to therapeutic effect after 5 sessions, which however persisted only for 1 week.
Conclusion: In our case study 30% of patients responded to rTMS and the treatment was well tolerated. This result is in agreement with other recent studies, showing effect of rTMS in 10-42% of drug-resistant depressive patients.
However this was a case study design not enabling any further conclusions except the fact that rTMS was well tolerated