Hypomanic shift observed during rTMS treatment of patients with unipolar depressive disorder: four case reports

Eylem Ozten,Oguz Karamustafalioglu,Gokben Hizli Sayar

doi:10.1186/1744-859x-12-12

Abstract

ObjectiveRepetitive transcranial magnetic stimulation (rTMS) can enhance the excitement of the brain through adjusting the biological activities of the cerebral cortex and has wide biological effects, making it one basic mechanism of therapy for depression. In the treatment of unipolar depressive disorder, almost in every treatment method, hypomanic and manic shifts can be observed. There is still a lack of data regarding manic and hypomanic symptoms triggered by rTMS applications.MethodWe describe four cases with unipolar depression in which high-frequency rTMS over the left dorsolateral prefrontal cortex applied as an add-on antidepressive strategy may have induced a hypomanic episode.ResultsIn these cases, 25 Hz rTMS combined with antidepressants may have contributed to the occurrence of hypomanic symptoms.ConclusionUsing an intensive methodology of rTMS may induce hypomanic or manic symptoms.

Highlights

Repetitive transcranial magnetic stimulation can increase the excitability of the brain through changing the activity of the cerebral cortex
In these cases, 25 Hz Repetitive transcranial magnetic stimulation (rTMS) combined with antidepressants may have contributed to the occurrence of hypomanic symptoms
Mania has been observed in depression treatments based on pharmacotherapy, electroconvulsive therapy, vagus nerve stimulation, sleep deprivation, and deep brain stimulation used to treat obsessive-compulsive disorder (OCD) [3,4,5,6]

Summary

Introduction

Repetitive transcranial magnetic stimulation (rTMS) can increase the excitability of the brain through changing the activity of the cerebral cortex. The same authors showed that during rTMS treatment for unipolar depression, the emergent hypomania/mania rate was 0.34%, while the rate in bipolar disorder depressive episodes, it was 3.1%. Ella et al reported manic symptoms in a patient with recurrent major depressive disorder treated with 1 Hz rTMS applied over the right dorsolateral prefrontal cortex (RDLPFC) at 1,200 pulses/day and tranylcypromine, haloperidol, and lorazepam [10].

Results

Conclusion