Transcranial magnetic stimulation for treatment resistant depression: six case reports and review.

BACKGROUND

Depressive disorder is a common, recurrent, and chronic disorder that is a leading cause of functional impairment and disability An estimated 20-40% of patients do not benefit sufficiently from existing therapies. Repetitive transcranial magnetic stimulation (rTMS) is an emerging treatment for psychiatric illness. Evidences support its use in depression, either alone or combined with antidepressants. During rTMS, a time-varying current is discharged in an insulated coil attached to the scalp surface, generated a brief dynamic magnetic field that can freely, non-invasively penetrate the skull and induce the eddy current in the neural tissue. The rTMS works as a neuro-stimulator and neuro-modulator at the same time, which can modify the functionality of the brain circuits involved in the pathophysiology of mental illness especially in depressive disorder.

MATERIAL AND METHOD

The authors reported six cases of various types of depressive disorder, double depression, borderline personality disorder with depression, psychotic depression with nihilistic delusion, post-schizophrenic depression, and treatment resistant depression non-respond to electroconvulsive therapy (ECT).

RESULTS

Four in six cases responded well with 10 daily sessions of rTMS. However, a patient with psychotic depression yielded no response. Five patients with moderate depression reached the remission criteria of Hamilton Depression Rating Scale-17 items (HAM-D-17). The means HAM-D-17 of rTMS responders were decreased from 22.4 (SD = 4.1) to 5.2 (SD = 2.9). A patient with psychotic depression did not show any benefit from rTMS and got subsequent modified ECT.

CONCLUSION

This is the first cases report of using rTMS for the treatment of depression in Thailand. The rTMS gave promising results in various forms of depression. Due to its safety needing no anesthesia, suitable for out-patient care, rTMS might be a treatment alternative in the acute phase of moderate non-psychotic depression. The authors also reviewed the current evidence.