title: Induction of a mixed depressive episode during rTMS treatment in a patient with refractory major depression.
abstract: Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive experimental technique which has mostly been investigated in the treatment of mood disorders with possible efficacy in depression. Among its potential side effects, there have been some reports of rTMS-induced (hypo)mania in the literature but none for rTMS-induced mixed episodes. We report the case of a 39-year-old woman suffering from refractory chronic major depression who developed a depressive mixed episode associated with a mild serotonin syndrome during her second week of rTMS treatment. She was receiving a combination of antidepressants, the doses of which were kept unchanged during rTMS treatment. Mixed as well as manic episodes may be induced by transcranial magnetic stimulation, complications already observed with antidepressants and electroconvulsive therapy. Therefore, caution should be exercised among clinicians using this experimental procedure, particularly in the treatment of bipolar depressed patients.
authors.affiliation: Division of Adult Psychiatry, University Hospitals of Geneva, Switzerland. Fady.Rachid@hcuge.ch
authors.forename: Fady
authors.initials: F
authors.lastname: Rachid
authors.forename: Jean
authors.initials: J
authors.lastname: Golaz
authors.forename: Guido
authors.initials: G
authors.lastname: Bondolfi
authors.forename: Gilles
authors.initials: G
authors.lastname: Bertschy
mesh_terms: D000328:Adult; D000639:Amitriptyline / Q000008:administration & dosage; D014151:Anti-Anxiety Agents / Q000008:administration & dosage; D018687:Antidepressive Agents, Second-Generation / Q000008:administration & dosage; D000929:Antidepressive Agents, Tricyclic / Q000008:administration & dosage; D018692:Antimanic Agents / Q000008:administration & dosage; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008691:Methadone / Q000008:administration & dosage; D019964:Mood Disorders / Q000188:drug therapy / Q000209:etiology* / Q000523:psychology; D009294:Narcotics / Q000008:administration & dosage; D009888:Opipramol / Q000008:administration & dosage; D017374:Paroxetine / Q000008:administration & dosage; D011222:Prazepam / Q000008:administration & dosage; D011569:Psychiatric Status Rating Scales; D020230:Serotonin Syndrome / Q000209:etiology / Q000523:psychology; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000150:complications / Q000188:drug therapy / Q000523:psychology; D050781:Transcranial Magnetic Stimulation / Q000009:adverse effects* / Q000379:methods; D014196:Trazodone / Q000008:administration & dosage; D014635:Valproic Acid / Q000008:administration & dosage
chemical_list: D014151:Anti-Anxiety Agents; D018687:Antidepressive Agents, Second-Generation; D000929:Antidepressive Agents, Tricyclic; D018692:Antimanic Agents; D009294:Narcotics; D000639:Amitriptyline; D017374:Paroxetine; D014635:Valproic Acid; D009888:Opipramol; D011222:Prazepam; D008691:Methadone; D014196:Trazodone