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MRI-guided dmPFC-rTMS as a Treatment for Treatment-resistant Major Depressive Disorder
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rTMS in resistant mixed states: an exploratory study.

Stefano Pallanti1, Giacomo Grassi2, Sarah Antonini3

  • 1Department of Psychiatry and Behavioral Medicine, University of California, Davis, USA; Department of Neurofarba, University of Florence, Via delle Gore 2H, 50100 Florence, Italy; Institute of Neuroscience, Florence, Italy; Deprtament of Psychiatry, Icahn School of Medicine, NY, USA.

Journal of Affective Disorders
|March 4, 2014
PubMed
Summary
This summary is machine-generated.

Right low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) shows promise for treating bipolar mixed states. This augmentation strategy improved both depressive and manic symptoms in patients receiving mood stabilizers.

Keywords:
Bipolar disorderLow frequencyMixed statesrTMS

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Area of Science:

  • Neuroscience
  • Psychiatry
  • Clinical Therapeutics

Background:

  • Repetitive transcranial magnetic stimulation (rTMS) is effective for unipolar depression but less studied in bipolar disorders.
  • Bipolar mixed episodes present significant challenges, including severe symptoms, high suicide risk, and poor treatment response.
  • Right low-frequency rTMS (LF-rTMS) is a potential augmentation strategy for managing these complex states.

Purpose of the Study:

  • To investigate the efficacy of LF-rTMS as an add-on treatment for bipolar mixed episodes.
  • To assess the impact of LF-rTMS on depressive and manic symptoms in patients with bipolar disorder.

Main Methods:

  • Forty patients with bipolar disorder received a mood stabilizer plus LF-rTMS (1Hz to right DLPFC) for 3 weeks.
  • Symptom severity was evaluated using the Hamilton Depression Rating Scale (HAM-D) and Young Mania Rating Scale (YMRS).
  • Statistical analysis involved repeated measures ANOVA to assess changes in symptom severity and illness status.

Main Results:

  • A 46.6% response rate was observed for depressive symptoms (HAM-D), with 28.6% achieving remission.
  • A 15% response rate was observed for manic symptoms (YMRS), with all responders achieving remission.
  • A statistically significant time effect was noted for both depressive and manic symptom scores.

Conclusions:

  • LF-rTMS applied to the right Dorsolateral Prefrontal Cortex (DLPFC) may serve as a viable augmentation strategy for bipolar mixed states.
  • This treatment approach shows potential for alleviating both depressive and manic symptoms concurrently.
  • Limitations include the open-label design and absence of a sham-controlled group.