Repetitive Transcranial Magnetic Stimulation for Treatment of Depression in a Patient With Severe Traumatic Brain Injury

Alessandro Iliceto,Korak Sarkar,Rachel L Seiler

doi:10.31486/toj.17.0075

Alessandro Iliceto, Korak Sarkar + Show 1 more

Open Access

https://doi.org/10.31486/toj.17.0075

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Abstract

Traumatic brain injury (TBI) commonly presents with a constellation of findings, including physical, cognitive, and psychological disturbances. Traditionally, few options have been available for long-term management of mood symptoms for post-TBI patients who are refractory to medications. Repetitive transcranial magnetic stimulation (rTMS) is a promising alternative treatment. A 37-year-old male with history of anxiety and bipolar depression incurred a TBI after a 60-foot fall. After his physical recovery, the patient had refractory depression. Eight months after the TBI event, he underwent a 6-week course of rTMS treatment and had a 70.8% improvement in mood symptoms by the end of the therapy as indicated by the Patient Health Questionnaire-9, transitioning from severe to mild depression according to the scoring system. Clinical correlation during the months following conclusion of rTMS therapy showed no signs of remission or adverse side effects. The patient remains stable and lives independently 1 year after treatment with mood-stabilizing medications. This case provides evidence for successful treatment of refractory depressive symptoms after severe TBI with the addition of rTMS to psychotherapy and mood-stabilizing medications, supporting the safety and tolerability of this novel therapeutic approach. Further studies are needed to validate the contribution of rTMS for management of mood symptoms in patients with TBI.

Highlights

Traumatic brain injuries (TBIs) are projected to affect a growing number of Americans each year, already increasing from an estimated 1.9 million in 2007 to 2.8 million in 2013, according to a 2017 report.[1]
The improvement in mood symptoms demonstrated by this patient is consistent with results of the few published case studies on the use of rTMS16,17 and provides further support for the safe and effective clinical use of Repetitive transcranial magnetic stimulation (rTMS) for refractory depression in post-TBI patients, without significant side effects
The results of the Patient Health Questionnaire-9 (PHQ-9) that the patient completed throughout his treatment period showed a clear improvement in Repetitive Transcranial Magnetic Stimulation in Traumatic Brain Injury

Summary

Background

Traumatic brain injury (TBI) commonly presents with a constellation of findings, including physical, cognitive, and psychological disturbances. Case Report: A 37-year-old male with history of anxiety and bipolar depression incurred a TBI after a 60-foot fall. After his physical recovery, the patient had refractory depression. Eight months after the TBI event, he underwent a 6-week course of rTMS treatment and had a 70.8% improvement in mood symptoms by the end of the therapy as indicated by the Patient Health Questionnaire-9, transitioning from severe to mild depression according to the scoring system. Conclusion: This case provides evidence for successful treatment of refractory depressive symptoms after severe TBI with the addition of rTMS to psychotherapy and mood-stabilizing medications, supporting the safety and tolerability of this novel therapeutic approach.

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