This technique is able to modulate the electrical cortical potentials by the mean of a coil (placed on the head, FIg 1) which provides a repetitive electromagnetic induction of the brain. 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 is crucial for the emotional control.
Based on a great number of clinical studies (especially with 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 case of the patients with major depression the left DLPFC activity would be decreased while the right DLPFC function increased. Thus, rTMS can modify the DLPFC activity in patients with MDD (by reducing right DLPFC activity or by increasing left DLPFC excitability).
More then 40 studies indicated that rTMS can lead to long-term and sustained remission of treatment-resistant MDD and improve the quality of life. 50% of the patients respond positively to the treatment and 32% have a complete remission of the depressive symptoms. The rTMS is also known to improve the antidepressant effects of psychotherapy or drugs such as paroxetine or escitalopram. rTMS could be performed even for pregnant patients. Side effets are mild (generally mild discomfort at the stimulus site of the scalp).
rTMS is contraindicated in patients with a history of seizures although the incidence of such complication is quite low (<0.1%). Different protocols of rTMS (as outpatient) are possible for depression over 3-6 weeks. Many patient needs a unique traitement. However, for some of them it is possible to repeat the treatment (every 4 or 6 months). The psychiatrist should contact us (www.neurolacote.ch) to introduce his patient with MDD. The rTMS is a valid alternative for patients having sides effects of antidepressant drugs or resistant to common pharmacological thérapie.
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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.
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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
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