Repetitive Transcranial Magnetic Stimulation (RTMS) In Treatment-Resistant Bipolar Depression

Cohen, R 1; Carvalho, M 1; Gonçalves, L 1; Maeda, F 2

1Centro Brasileiro de Estimulação Magnética Transcraniana CBrEMT, Pós Graduando da Universidade Federal de São Paulo (UNIFESP)/ Escola Paulista de Medicina.
2Laboratory for Magnetic Brain Stimulation, Division of Behavioral Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA





To assess the effectiveness and safety of Repetitive Transcranial Magnetic Stimulation (rTMS) as an adjunctive therapy in refractory bipolar depression in a naturalistic setting.



Paciente feminina, 65 anos, quadro de depressão psicótica refratária a fármacos, com resposta prévia satisfatória a ECT, mas acompanhada de comprometimento cognitivo severo.



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.



Right prefrontal rTMS appears safe in depressed bipolar subjects. TMS may possess notable potential as a treatment for mood disorder.