Transcranial Magnetic Stimulation for Treatment Resistant Depression: Six Case Reports and Review†
Thawatchai Krisanaprakornkit MD*, Suchat Paholpak MD*, Kanida Tassaniyom MD*, Vijitra Pimpanit BSc (Nursing and Midwifery)**
Affiliation : † This work was presented at The 11th Congress of the ASEAN Federation for Psychiatry and Mental Health (AFPMH), 27 August, 2008 Royal Paragon Hall, Bangkok, Thailand * Department of Psychiatry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand ** Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Background : Depressive disorder is a common, recurrent, and chronic disorder that is a leading cause of functional
impairment and disability. An estimated 20-40% of patients do not benefit sufficiently from existing therapies. Repetitive
transcranial magnetic stimulation (rTMS) is an emerging treatment for psychiatric illness. Evidences support its use in
depression, either alone or combined with antidepressants. During rTMS, a time-varying current is discharged in an
insulated coil attached to the scalp surface, generated a brief dynamic magnetic field that can freely, non-invasively penetrate
the skull and induce the eddy current in the neural tissue. The rTMS works as a neuro-stimulator and neuro-modulator at the
same time, which can modify the functionality of the brain circuits involved in the pathophysiology of mental illness especially
in depressive disorder.
Material and Method: The authors reported six cases of various types of depressive disorder, double depression, borderline
personality disorder with depression, psychotic depression with nihilistic delusion, post-schizophrenic depression, and
treatment resistant depression non-respond to electroconvulsive therapy (ECT).
Results : Four in six cases responded well with 10 daily sessions of rTMS. However, a patient with psychotic depression
yielded no response. Five patients with moderate depression reached the remission criteria of Hamilton Depression Rating
Scale-17 items (HAM-D-17). The means HAM-D-17 of rTMS responders were decreased from 22.4 (SD = 4.1) to 5.2 (SD
= 2.9). A patient with psychotic depression did not show any benefit from rTMS and got subsequent modified ECT.
Conclusion : This is the first cases report of using rTMS for the treatment of depression in Thailand. The rTMS gave
promising results in various forms of depression. Due to its safety, needing no anesthesia, suitable for out-patient care, rTMS
might be a treatment alternative in the acute phase of moderate non-psychotic depression. The authors also reviewed the
current evidence.
Keywords : Repetitive transcranial magnetic stimulation, rTMS, treatment resistant depression
