Treatment emergent affective switch in depression: A possible role of theta burst stimulation

A Systematic Review of the Safety and Tolerability of Theta Burst Stimulation in Children and Adolescents

“…One case report described a seizure induced by iTBS ( 32 ). One case series described treatment emergent manic symptoms induced by iTBS ( 31 ). Commonly reported adverse events included: headache (6.6–16.7%), dry eyes (16.7% in one study), abdominal pain (16.7% in one study) fatigue (10% in one study), dizziness (9% in one study), and nausea (5–7%).…”

“…Shere and colleagues report on three participants with depression (based on DSM-IV-TR) who received bilateral TBS protocol ( 31 ). The TBS protocol was delivered at 1800 intermittent pulses with a 2-sec stimulation interval and an 8-sec inter-train interval over the left DLPFC followed by 1800 continuous pulses over the right DLPFC.…”

Theta burst stimulation in adolescent depression: An open-label evaluation of safety, tolerability, and efficacy

“…Improvement in cognition could reflect the specific effects of TBS, improvement in depression, or even practice effects [26]. The emergence of affective-switch in two of our patients [22] underscores the importance of careful symptom monitoring and considering a mood-stabilizer cover, especially in adolescents with bipolar depression [27].…”

“…Novel adverse effects noted were affective switch (n ¼ 2, one after three days and the other after ten days of TBS) and transient lachrymation (n ¼ 1). Details of the two individuals with affective switches have been detailed earlier [22]. Seventy-two percent found these adverse effects mild.…”

A chart-based study of theta burst stimulation for depression at a tertiary care center

“…Two patients dropped out due to intolerable stimulation site discomfort/pain and one discontinued because of logistic challenges. One patient with bipolar depression experienced treatment-emergent affective switch after 10 sessions [4]. None experienced seizures.…”