P281 Augmentative repetitive transcranial magnetic stimulation (RTMS) in highly treatment-resistant unipolar and bipolar depression – First Polish experiences

Abstract

Introduction While repetitive transcranial magnetic stimulation (rTMS) is a well-established method of treatment of unipolar depression the data concerning bipolar population are scanty. Moreover there is little known on possible augmenting effect of rTMS added to a stable treatment regimen. Objectives The present study aims to assess the efficacy of HF-rTMS of the left dorsolateral prefrontal cortex (DLPFC) in mixed population of patients with highly treatment resistant unipolar and bipolar depression in clinical settings. This is the first study on this method in such a population in Poland. Patients and methods Forty-three patients with bipolar and unipolar depression who did not respond to previous pharmacological treatment or electroconvulsive therapy (ECT) or had contraindications for ECT were treated with four weeks of open-label rTMS at 10 Hz, 120% of motor threshold, 3000 stimuli/day. rTMS was added to antidepressants in an adequate dosage for at least 4 weeks and stable doses of mood stabilizers. Results The data concerning 40 patients (30 with treatment resistant bipolar depression) aged 51.2 ± 12.5 were analyzed. Statistically significant improvement on the 21-item Hamilton Depression Rating Scale (HAM-D), Beck Depression Inventory (BDI), Clinical Global Impression severity of illness scale (CGI), Patient Global Impression of Severity (PGI) was shown. (ANOVA with repeated measures. Conclusion Augmentative HF-rTMS of the left DLPFC was effective, safe and well tolerated in a mixed sample of predominantly bipolar patients with highly treatment resistant depression. This method should become more widely accessible for patients in everyday clinical practice.