Case Report

Accelerated theta-burst repetitive transcranial magnetic stimulation for depression in South Africa

Erine Bröcker, Leigh van den Heuvel, Soraya Seedat
South African Journal of Psychiatry | Vol 25 | a1346 | DOI: https://doi.org/10.4102/sajpsychiatry.v25i0.1346 | © 2019 Erine Bröcker, Leigh van den Heuvel, Soraya Seedat | This work is licensed under CC Attribution 4.0
Submitted: 03 December 2018 | Published: 27 November 2019

About the author(s)

Erine Bröcker, Department of Psychiatry, Faculty of Medical Health Sciences, Stellenbosch University, Cape Town, South Africa
Leigh van den Heuvel, Department of Psychiatry, Faculty of Medical Health Sciences, Stellenbosch University, Cape Town, South Africa
Soraya Seedat, Department of Psychiatry, Faculty of Medical Health Sciences, Stellenbosch University, Cape Town, South Africa


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Abstract

This case series documents local experience using accelerated theta-burst repetitive transcranial magnetic stimulation (rTMS) as a supplementary treatment for depression in both major depressive disorder (MDD) and bipolar disorder (BD). Nine consenting patients (MDD = 7; BD = 2) each received 20 accelerated theta-burst sessions over 8 days. Improvement was monitored using the Centre for Epidemiological Studies Depression (CES-D) Scale and the Clinical Global Impression (CGI) Scale at baseline, at day 5 and at day 8 of rTMS treatment. We performed a Wilcoxon matched-pairs signed-rank test to determine whether there was a difference in scores from baseline to post-treatment. The CES-D scores decreased significantly from baseline to post-treatment (Z = −2.547, p = 0.011) with five patients experiencing at least a 50% symptom reduction on the CES-D. CGI severity scores also decreased significantly between baseline and post-treatment (Z = −2.547, p = 0.011). The most commonly reported adverse effect was mild headaches, lasting a few hours during and after rTMS treatment. The findings suggest that the accelerated theta-burst rTMS protocol for depression is well tolerated with most patients also experiencing symptomatic improvement by day 8.

Keywords

theta-burst stimulation; TBS; Depression; accelerated repetitive transcranial magnetic stimulation; bipolar depression; BP; treatment resistant depression

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