Premium
Augmentative repetitive navigated transcranial magnetic stimulation (rTMS) in drug‐resistant bipolar depression
Author(s) -
Dell’Osso Bernardo,
Mundo Emanuela,
D’Urso Nazario,
Pozzoli Sara,
Buoli Massimiliano,
Ciabatti MariaTeresa,
Rosanova Mario,
Massimini Marcello,
Bellina Valentina,
Mariotti Maurizio,
Carlo Altamura A
Publication year - 2009
Publication title -
bipolar disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.285
H-Index - 129
eISSN - 1399-5618
pISSN - 1398-5647
DOI - 10.1111/j.1399-5618.2008.00651.x
Subject(s) - transcranial magnetic stimulation , psychology , rating scale , bipolar disorder , repeated measures design , young mania rating scale , depression (economics) , clinical global impression , mania , dorsolateral prefrontal cortex , medicine , audiology , psychiatry , stimulation , prefrontal cortex , mood , neuroscience , cognition , placebo , developmental psychology , statistics , alternative medicine , mathematics , pathology , economics , macroeconomics
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.