REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (RTMS) IN TREATMENT-RESISTANT BIPOLAR DEPRESSION
Cohen,R 1; Carvalho,M 1; Gonçalves,L 1; Maeda, F 2
1 Centro Brasileiro de Estimulação Magnética Transcraniana CBrEMT, Pós Graduando da Universidade Federal de São Paulo (UNIFESP)/ Escola Paulista de Medicina.
2 Laboratory for Magnetic Brain Stimulation, Division of Behavioral Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
OBJECTIVE : To assess the effectiveness and safety of Repetitive Transcranial Magnetic Stimulation (rTMS) as an adjunctive therapy in refractory bipolar depression in a naturalistic setting.
METHODS : Twenty two depressed patients with DSM-IV non-psychotic bipolar disorder (12 BPI, 10 BPII) were assigned to receive rTMS at low frequency (1 Hz) to the right prefrontal cortex. Treatment was administered in 15 daily sessions over 3 weeks. Severity of depression (HDRS 17-item, BDI) was assessed before, during, and after completion of the treatment protocol. Safety was evaluated by recording adverse events.
RESULTS: Sixteen of 22 (72.7%) patients had a 50% or greater improvement in their HDRS score. The reduction from baseline of the HDRS score was 61.7% (22.0 +/-6.6 pre vs 10.9 +/-7.3 post TMS) and of the BDI score was 62.9% (23.0 +/-12.0 pre vs 11.3 +/-9.4 post TMS). One patient had an episode of hypomania after the 6th session and therapy was discontinued. No other patient discontinued. rTMS was well tolerated with no significant adverse events.
CONCLUSION: Right prefrontal rTMS appears safe in depressed bipolar subjects. TMS may possess notable potential as a treatment for mood disorder.