Does switching between high frequency rTMS and theta burst stimulation improve depression outcomes?

Chen, Leonard; Thomas, Elizabeth; Kaewpijit, Pakin; Miljevic, Aleksandra; Hahn, Lisa; Lavale, Alexandra; Hoy, Kate E.; Galletly, Cherrie; Fitzgerald, Paul B.

doi:10.1016/j.brs.2022.06.005

Cited by 2 publications

(1 citation statement)

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“…Limitations of this case report include the potential effects of reduction of clonazepam doses on the response to rTMS and ketamine combination therapy; however, clonazepam had already been reduced during ketamine monotherapy, which did not lead to clinically significant effects. rTMS protocol changes from 20 Hz to TBS could be responsible for the overall improvement, although both are thought to have similar effects ( 8 ), and switching between modalities was recently shown to only bring about modest additional improvement ( 31 ). The addition of pramipexole during the maintenance phase of the patient’s combination therapy may have contributed to sustained remission; however, the patient had received this medication in the past without any benefits, and the doses used we far below what is proposed for TRD ( 32 ).…”

Section: Discussionmentioning

confidence: 99%

Transcranial magnetic stimulation and intravenous ketamine combination therapy for treatment-resistant bipolar depression: A case report

et al. 2022

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About a third of patients suffering from major depression develop treatment-resistant depression (TRD). Although repetitive transcranial magnetic stimulation (rTMS) and intravenous ketamine have proven effective for the management of TRD, many patients remain refractory to treatment. We present the case of a patient suffering from bipolar TRD. The patient was referred to us after failure to respond to first-and second-line pharmacotherapy and psychotherapy. After minimal response to both rTMS and ketamine alone, we attempted a combination rTMS and ketamine protocol, which led to complete and sustained remission. Various comparable and complimentary mechanisms of antidepressant action of ketamine and rTMS are discussed, which support further study of this combination therapy. Future research should focus on the feasibility, tolerability, and efficacy of this novel approach.

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Section: Discussionmentioning

confidence: 99%