ACCELERATED TRANSCRANIAL MAGNETIC STIMULATION IN TREATMENT-RESISTANT DEPRESSION PATIENT

OBJECTIVE: Transcranial Magnetic Stimulation (TMS) has approved

for treatment-resistant depression in 2008. The most commonly

recommended TMS protocol for depressed patients is stimulation of

the left dorsolateral prefrontal cortex (DLPFC) or inhibition of the

right DLPFC. TMS applied more than once a day is called accelerated

TMS (aTMS). We aim to present a patient with treatment-resistant

depression who benefited from aTMS.

CASE: The patient was admitted with unhappiness, anhedonia, suicidal

thoughts, insomnia, nausea, and vomiting. In his history, we learned that

he had a depressive episode two years ago and used sertraline 100 mg/

day, but it did not improve, and he attempted suicide at that time. He

was currently using bupropion 450 mg/day and aripiprazole 10 mg/day.

However, his depressive symptoms still continued, and his Hamilton

Depression Rating Scale-17 (HDRS-17) score of 20 was moderate

depression. Since the patient did not improve with drug treatments,

we decided to apply aTMS to the patient, and aTMS was applied to

the left DLPFC with intermittent theta burst stimulation (iTBS) (5

Hz, 600 pulses) and to the right DLPFC with continuous theta burst

stimulation (cTBS) (5 Hz, 600 pulses) for a total of 15 sessions 3 times

per day. The patient’s HDRS-17 score was 20 on day 1, 9 on day 5, and

2 on day 8 of the aTMS. No side effects were observed during aTMS.

The patient, who is on Bupropion 300 mg/day and Quetiapine XR

150 mg/day, has no active psychiatric complaints and continues to be

followed up in our clinic with a remission for about one year. Verbal

and written consent was obtained from the patient for the case report.

DISCUSSION: Our findings in this case suggest that aTMS could be

an effective option for patients with treatment-resistant depression. In

our case, significant improvement was observed following aTMS, with

no side effects.