Reptitive transcranial magnetic stimulation (rTMS) in acute and long-term treatment of therapy-resistant depression - a case report

We report on a patient with therapy-resistant major depression according to DSM-IV criteria who has been hospitalized for 60 months during the last 7 years. Not even five electroconvulsive therapy (ECT) series (61 single appl ications) brought lasting remission of symptoms. As cognitive deficits deve loped and prolonged postnarcotic recovery times were observed,further ECT w as contraindicated. The left frontal cortex was chosen as the target site f or repetitive transcranial magnetic stimulation (rTMS) treatment. For ident ification, a neuronavigational system was used that allows online monitorin g of the position of the magnetic coil in relation to the individual cortex . The therapeutic progress was monitored by standardized psychiatric rating s (HAMD, BDI). In addition, cognitive performance was tested during the cou rse of treatment. Only a few rTMS applications already caused an obvious br ightening in mood, remission of depressive delusional symptoms, and an incr ease in personal interests and activities, After 4 weeks of daily treatment ,the patient was discharged from the ward. The rTMS treatments and psychoth erapeutic counseling have been continued on an outpatient basis. Thus, phar maco- and psychotherapeutic interventions combined with rTMS led to persist ent symptom remission and social reintegration.