In our center (www.neurolacote.ch) we perform rTMS of the brain, which is a treatment for major depression.
This technique is able to modulate the electrical brain cortical function by a coil which provides repetitive electromagnetic induction on the skull. Low frequency stimulation (<= 1 Hz) reduces the neuronal excitability, whereas high-frequency stimulation (>= 5Hz) enhances it. The dorso-prefrontal-lateral cortex (DLPFC) of the brain regulates emotional control.
Based on a great number of neuroimaging studies and clinical data (especially for patients with post-stroke depression), the valence hypothesis posits that the DLPFC of the right hemisphere is dominant for processing negative emotions whereas the DLPFC of the left hemisphere elaborates the positive emotions. In patients with major depression the left DLPFC activity is decreased while the right DLPFC function is increased. Thus, rTMS can modify the activity of the DLPFC in patients with major depression (by reducing right DLPFC activity or by increasing left DLPFC excitability).
Several studies indicated that rTMS can lead to long-term and sustained remission of treatment-resistant MDD (as showed by standard depression questionnaires), improving the quality of life and functional status of patients. rTMS is also known to improve the antidepressant effect of psychotherapy commonly prescribed drugs (such as paroxetine or escitalopram). rTMS could be also preformed in pregnant patients. Side effets are mild (generally mild discomfort at the stimulus site of the scalp). Different protocols of rTMS (on outpatient basis) are possible for depression over 2 or 4 weeks.
rTMS is contraindicated in patients with a history of seizures although the incidence rate is relatively low (<0.1%).
The psychiatrist of the patient with MDD should contact us (www.neurolacote.ch ; 0041 22 9959744) to discuss about the rTMS treatment
References
Richieri R. et al. Predictive value of dorso-lateral prefrontal connectivity for rTMS response in treatment-resistant depression: A brain perfusion SPECT study.Brain Stimul. 2018 Sep – Oct;11(5):1093-1097.
Donse L. Simultaneous rTMS and psychotherapy in major depressive disorder: Clinical outcomes and predictors from a large naturalistic study.Brain Stimul. 2018 Mar – Apr;11(2):337-345.
Berlim MT et al. Response, remission and drop-out rates following high-frequency repetitive transcranial magnetic stimulation (rTMS) for treating major depression: a systematic review and meta-analysis of randomized, double-blind and sham-controlled trials. Psychol Med. 2014 Jan;44(2):225-39.
Gaynes BN et al. Repetitive transcranial magnetic stimulation for treatment-resistant depression: a systematic review and meta-analysis. J Clin Psychiatry. 2014 May;75(5):477-89.
Kaster TS et al. Efficacy, tolerability, and cognitive effects of deep transcranial magnetic stimulation for late-life depression: a prospective randomized controlled trial. Neuropsychopharmacology. 2018 Jun 18.
Felipe RM et al.Transcranial magnetic stimulation for treatment of major depression during pregnancy: a review.
Trends Psychiatry Psychother. 2016 Oct-Dec;38(4):190-197.
