title: Augmentative repetitive navigated transcranial magnetic stimulation (rTMS) in drug-resistant bipolar depression.
abstract: OBJECTIVE
  The efficacy of transcranial magnetic stimulation (TMS) has been poorly investigated in bipolar depression. The present study aimed to assess the efficacy of low-frequency repetitive TMS (rTMS) of the right dorsolateral prefrontal cortex (DLPFC) combined with brain navigation in a sample of bipolar depressed subjects.
  
  
  METHODS
  Eleven subjects with bipolar I or bipolar II disorder and major depressive episode who did not respond to previous pharmacological treatment were treated with three weeks of open-label rTMS at 1 Hz, 110% of motor threshold, 300 stimuli/day.
  
  
  RESULTS
  All subjects completed the trial showing a statistically significant improvement on the 21-item Hamilton Depression Rating Scale (HAM-D), Montgomery-Asberg Depression Rating Scale, and Clinical Global Impression severity of illness scale (ANOVAs with repeated measures: F = 22.36, p < 0.0001; F = 12.66, p < 0.0001; and F = 10.41, p < 0.0001, respectively). In addition, stimulation response, defined as an endpoint HAM-D score reduction of > or =50% compared to baseline, was achieved by 6 out of 11 subjects, 4 of whom were considered remitters (HAM-D endpoint score < or = 8). Partial response (endpoint HAM-D score reduction between 25% and 50%) was achieved by 3/11 patients. No manic/hypomanic activation was detected during the treatment according to Young Mania Rating Scale scores (ANOVAs with repeated measures: F = 0.62, p = 0.61). Side effects were slight and were limited to the first days of treatment.
  
  
  CONCLUSIONS
  Augmentative low-frequency rTMS of the right DLPFC combined with brain navigation was effective and well tolerated in a small sample of drug-resistant bipolar depressive patients, even though the lack of a sham controlled group limits confidence in the results.
authors.affiliation: Department of Psychiatry, University of Milan, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena. Milano, Italy. bernardo.dellosso@policlinico.mi.it
authors.forename: Bernardo
authors.initials: B
authors.lastname: Dell'Osso
authors.forename: Emanuela
authors.initials: E
authors.lastname: Mundo
authors.forename: Nazario
authors.initials: N
authors.lastname: D'Urso
authors.forename: Sara
authors.initials: S
authors.lastname: Pozzoli
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Buoli
authors.forename: MariaTeresa
authors.initials: M
authors.lastname: Ciabatti
authors.forename: Mario
authors.initials: M
authors.lastname: Rosanova
authors.forename: Marcello
authors.initials: M
authors.lastname: Massimini
authors.forename: Valentina
authors.initials: V
authors.lastname: Bellina
authors.forename: Maurizio
authors.initials: M
authors.lastname: Mariotti
authors.forename: A Carlo
authors.initials: AC
authors.lastname: Altamura
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001714:Bipolar Disorder / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017397:Prefrontal Cortex / Q000502:physiology; D011569:Psychiatric Status Rating Scales; D050781:Transcranial Magnetic Stimulation; D055815:Young Adult