title: Brain SPECT guided repetitive transcranial magnetic stimulation (rTMS) in treatment resistant major depressive disorder.
abstract: Repetitive transcranial magnetic stimulation (rTMS) has emerged as a potential treatment in treatment resistant major depressive disorder (MDD). However, there is no consensus about the exact site of stimulation for rTMS. Single-photon emission computed tomography (SPECT) offers a potential technique in deciding the site of stimulation. The present study was conducted to assess the difference in outcome of brain SPECT assisted rTMS versus standard protocol of twenty sessions of high frequency rTMS as add on treatment in 20 patients with treatment resistant MDD, given over a period of 4 weeks. Thirteen subjects (group I) received high frequency rTMS over an area of hypoperfusion in the prefrontal cortex, as identified on SPECT, whereas 7 subjects (group II) were administered rTMS in the left dorsoslateral prefrontal cortex (DLPFC) area. Improvement was monitored using standardized instruments. Patients in the group I showed a significantly better response compared to those in the group II. In group I, 46% of the subjects were responders on MADRS, 38% on BDI and 77% on CGI. The parallel figures of responders in Group II were 0% on MADRS, 14% on BDI and 43% on CGI. There were no remitters in the study. No significant untoward side effects were noticed. The study had limitations of a small sample size and non-controlled design, and all the subjects were also receiving the standard antidepressant therapy. Administration of rTMS over brain SPECT specified area of hypoperfusion may have a better clinical outcome compared to the standard protocol.
authors.affiliation: Department of Psychiatry, Institute of Human Behaviour & Allied Sciences, New Delhi 110095, India.
authors.forename: Shailesh
authors.initials: S
authors.lastname: Jha
authors.affiliation: Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India. Electronic address: drrakeshchadda@gmail.com.
authors.forename: Rakesh K
authors.initials: RK
authors.lastname: Chadda
authors.affiliation: Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Nand
authors.initials: N
authors.lastname: Kumar
authors.affiliation: Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: C S
authors.initials: CS
authors.lastname: Bal
mesh_terms: D000328:Adult; D003865:Major Depressive Disorder / Q000628:therapy*; D061218:Depressive Disorder, Treatment-Resistant / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017397:Prefrontal Cortex / Q000503:physiopathology*; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*
keywords: Brain SPECT; Outcome; Treatment resistant depression; rTMS