Stimolazione magnetica transcranica nella depressione bipolare resistente al trattamento=Transcranial magnetic stimulation in drug-resistant bipolar depression

Aim of the study: The aim of the present study was to evaluate the efficacy of augmentative low-frequency repetitive Transcranial Magnetic Stimulation (rTMS) of the right Dorso-Lateral Pre-Frontal Cortex (DLPFC) in a sample of bipolar depressives. Materials and methods: 11 subjects with bipolar I or bipolar II disorder and major depressive episode who had not responded to previous pharmacological treatment were augmented with 3 weeks of open-label rTMS combined to brain navigation. Results: All subjects completed the trial showing a statistically significant improvement on the HAM-D21, MADRS and CGIs, 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 on the basis of the HAM-D21 scores, was obtained by 6 out of 11 subjects, 4 of whom were considered remitters. Partial response was obtained by 3 out of 11 patients. No manic/ hypomanic activation was detected during the treatment according to YMRS scores. Side-effects were moderate and 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 bipolar drug-resistant depressives, even though the lack of a sham controlled group limits the confidence in the results.