Clinical impacts of single transcranial magnetic stimulation (sTMS) as an add-on therapy in severely depressed patients under SSRI treatment

Research on single and rapid transcranial magnetic stimulation (sTMS/rTMS) indicates an antidepressive efficacy of those methods. In our 4 week study of sTMS, 12 patients affected by severe non-psychotic major depression (DSM -III-R) were enrolled and put on standardized combined antidepressant medic ation with the serotonin re-uptake inhibitor citalopram, and the serotonin modulating drug, trazodone. They underwent sTMS in a specific method as an add-on therapy, Age, gender, illness and episode duration, episode number, Hamilton Rating Depression Scale-24 (HRDS), Mini-Mental State (MMS), drug l evels assessed by HPLC, magnesium and thyroid stimulating hormone (TSH) wer e recorded. For each patient functional brain imaging was performed by (18) FDG and Tc-99m HMPAO SPECT at the beginning of the study, as were EEG traci ngs which also were recorded at the end. Lorazepam was allowed as co-medica tion, Of the patients, 66.7 per cent (N = 8) could be identified as sTMS re sponders. Possible predictors for sTMS response as add-on therapy may be du ration, pattern of improvement in global and in specific single items of th e HRDS, lorazepam dosage, functional involvement of basal ganglia and corti cal temporal lobe and the initially lower mean frequency and lability of th e alpha-activity in EEG. These variables possibly predict the clinical outc ome of depressed patients treated by sTMS as an add-on therapy. Copyright ( C) 2000 John Wiley & Sons, Ltd.