Effects of antidepressant pharmacotherapy after repetitive transcranial magnetic stimulation in major depression: an open follow-up study.
An increasing number of clinical studies demonstrates antidepressant effects of repetitive transcranial magnetic stimulation (rTMS). However, limited data are available so far concerning the stability of these effects and the efficacy of subsequent maintenance therapy. Therefore, we examined whether antidepressant pharmacotherapy can stabilize clinical improvement after rTMS monotherapy. Twenty-six drug-free patients suffering from a major depressive episode (DSM-IV criteria) participated in an open rTMS trial over two weeks (10-13 sessions, 10 Hz, left prefrontal stimulation at 100% motor threshold intensity). Subsequently, the patients were followed up during standardized antidepressant pharmacotherapy with mirtazapine for a further 4 weeks. The interval between the last rTMS and the first day of pharmacotherapy varied between one and five days. After two weeks of rTMS monotherapy 39% of the patients responded to rTMS by at least 50% reduction in their Hamilton Rating Scale for Depression (HRSD) scores. Treatment interruption after rTMS resulted in a significant increase in the HRSD score of rTMS responders. The degree of the deterioration was dependent on the length of interval without treatment. However, this deterioration was reverted and the further clinical course stabilized by subsequent mirtazapine treatment. The overall response rate after rTMS and mirtazapine treatment (alone or in combination) was 77%. Our results suggest that (1) antidepressant pharmacotherapy is able to further improve the clinical response to rTMS and (2) that responders to rTMS monotherapy should receive subsequent psychopharmalogical treatment without interruption in order to avoid a deterioration of symptoms.
Schüle
Cornelius
C
Department of Psychiatry, Ludwig-Maximilian-University, Nussbaumstr. 7, 80336, Munich, Germany.
Zwanzger
Peter
P
Baghai
Thomas
T
Mikhaiel
Patrick
P
Thoma
Heike
H
Möller
Hans-Jürgen
HJ
Rupprecht
Rainer
R
Padberg
Frank
F
D000328:Adult; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008803:Mianserin / Q000031:analogs & derivatives / Q000627:therapeutic use*; D008875:Middle Aged; D000078785:Mirtazapine; D011569:Psychiatric Status Rating Scales; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome
D000929:Antidepressive Agents, Tricyclic; D008803:Mianserin; D000078785:Mirtazapine