The authors of this paper do not have any affiliation or financial interest in any organization that might pose a conflict of interest in connection with this manuscript.
Augmentative repetitive navigated transcranial magnetic stimulation (rTMS) in drug-resistant bipolar depression
Article first published online: 9 JAN 2009
© 2009 The Authors. Journal compilation © 2009 Blackwell Munksgaard
Volume 11, Issue 1, pages 76–81, February 2009
How to Cite
Dell’Osso, B., Mundo, E., D’Urso, N., Pozzoli, S., Buoli, M., Ciabatti, M., Rosanova, M., Massimini, M., Bellina, V., Mariotti, M. and Carlo Altamura, A. (2009), Augmentative repetitive navigated transcranial magnetic stimulation (rTMS) in drug-resistant bipolar depression. Bipolar Disorders, 11: 76–81. doi: 10.1111/j.1399-5618.2008.00651.x
- Issue published online: 9 JAN 2009
- Article first published online: 9 JAN 2009
- Received 5 October 2007, revised and accepted for publication 11 April 2008
- bipolar depression;
- brain navigation;
- dorsolateral prefrontal cortex;
- transcranial magnetic stimulation
Objectives: The efficacy of transcranial magnetic stimulation (TMS) has been poorly investigated in bipolar depression. The present study aimed to assess the efficacy of low-frequency repetitive TMS (rTMS) of the right dorsolateral prefrontal cortex (DLPFC) combined with brain navigation in a sample of bipolar depressed subjects.
Methods: Eleven subjects with bipolar I or bipolar II disorder and major depressive episode who did not respond to previous pharmacological treatment were treated with three weeks of open-label rTMS at 1 Hz, 110% of motor threshold, 300 stimuli/day.
Results: All subjects completed the trial showing a statistically significant improvement on the 21-item Hamilton Depression Rating Scale (HAM-D), Montgomery-Åsberg Depression Rating Scale, and Clinical Global Impression severity of illness scale (ANOVAs with repeated measures: F = 22.36, p < 0.0001; F = 12.66, p < 0.0001; and F = 10.41, p < 0.0001, respectively). In addition, stimulation response, defined as an endpoint HAM-D score reduction of ≥50% compared to baseline, was achieved by 6 out of 11 subjects, 4 of whom were considered remitters (HAM-D endpoint score ≤ 8). Partial response (endpoint HAM-D score reduction between 25% and 50%) was achieved by 3/11 patients. No manic/hypomanic activation was detected during the treatment according to Young Mania Rating Scale scores (ANOVAs with repeated measures: F = 0.62, p = 0.61). Side effects were slight and were limited to the first days of treatment.
Conclusions: Augmentative low-frequency rTMS of the right DLPFC combined with brain navigation was effective and well tolerated in a small sample of drug-resistant bipolar depressive patients, even though the lack of a sham controlled group limits confidence in the results.