Switch to Mania After Slow rTMS of the Right Prefrontal Cortex

Abstract

Sir: Polypharmacy is an increasingly recognized risk factor for unintended medication side effects and adverse events. Recently, a case of priapism attributed to combined treatment with risperidone, olanzapine, and fluvoxamine was described.

Switch to hypomania induced by repetitive transcranial magnetic stimulation and partial sleep deprivation added to antidepressant: A case report

“…Ella et al 17 reported two cases of manic switch during slow (1 Hz) rTMS treatment of the right DLPFC in resistant major depression, but the number of stimuli per session they used (1,200 stimuli/day) was much higher than we used (300 stimuli/day), and was applied during 3 weeks (15 sessions); in both cases switch occurred few days after the last sessions, that was similar to our case.…”

“…Until now, to our knowledge, only a few studies using low frequencies of stimulation in depression reported switch to hypomania/mania [17][18][19] .…”

Ameliorating prefrontal cortical dysfunction in mental illness: inhibition of phosphotidyl inositol-protein kinase C signaling

“…These functional imaging studies have demonstrated marked underactivity of the right PFC in mania, including the right orbital and right polar prefrontal regions, and the right inferior frontal gyrus that is needed for behavioral inhibition (Altshuler et al 2005; Blumberg et al 2003; Blumberg et al 1999; Rubinsztein et al 2001). Indeed, transmagnetic stimulation to the right PFC can actually induce delusions and manic episodes in depressed patients (Ella et al 2002; Zwanzger et al 2002). Thus, severe dysfunction of the PFC, particularly in the right hemisphere, is highly consistent with the symptoms of mania.…”

Transcranial magnetic stimulation as a therapeutic tool in psychiatry

“…Some reports observed shifts into mania after high frequency left prefrontal rTMS and low frequency right prefrontal rTMS (Garcia-Toro 1999; Nedjat and Folkerts 1999;Dolberg et al 2001;Ella et al 2002;Fitzgerald et al 2003;Sakkas et al 2003). However, this concerned only a few individuals.…”