Search

Several studies demonstrated that repetitive transcranial magnetic stimulation (rTMS) is an efficacious treatment for treatment-resistant major depressive disorder (TRD). Recent metaanalyses and more recent large multicentre studies provided evidence suggesting that rTMS is indeed a promising treatment; however, its efficacy has often been shown to be modest, compared with sham stimulation. We review these lines of evidence and discuss several reasons that may explain the modest therapeutic efficacy in most of these studies, including: most involved left-sided treatment alone to the dorsolateral prefrontal cortex (DLPFC) only, which may be less optimal than applying bilateral stimulation; suboptimal methods were used to target the DLPFC (that is, the 5-cm anterior method), limiting the treatment potential of inherently a targeted form of treatment; some treatment durations were short (that is, 2 to 4 weeks); and stimulation intensity might have been insufficient by not considering coil-to-cortex distance, which has been linked to rTMS-induced antidepressant response. Future studies attempting to address the above-mentioned limitations are necessary to potentially optimize the efficacy of this already promising treatment option in TRD. Finally, it is also essential that research investigate the mechanisms of therapeutic efficacy, thus increases in understanding can be translated into enhanced treatment. For several reasons that will be reviewed, cortical excitability may represent an important mechanism, linked to the therapeutic efficacy of this disorder. [ABSTRACT FROM AUTHOR]

Patients with schizophrenia often fail to respond to standard antipsychotic medications or have a partial treatment response. Few treatment options are available for these patients. Repetitive transcranial magnetic stimulation (rTMS) was developed and investigated over the last 10 years as a potential treatment option for various psychiatric conditions. Increasingly, studies are focusing on potential applications of rTMS in schizophrenia. To date, most of these studies were symptom-specific rather than focused on the treatment of the disorder in general. The most extensive literature focuses on the use of low-frequency stimulation to attempt to disrupt or reduce the intensity of persistent refractory auditory hallucinations. This research tends to suggest that rTMS could have a role in this subset of patients. There is also preliminary but limited evidence that rTMS could have a role in reducing the negative symptoms of schizophrenia and perhaps in augmenting cognitive function. These findings also highlight the pressing need for further research including multisite studies to confirm the value of these options. [ABSTRACT FROM AUTHOR]

Background: The efficacy of repetitive transcranial magnetic stimulation (rTMS) in the treatment of depression has been assessed in a number of acute treatment trials during the last 10 years. Little is known about the long-term impact of the treatment on the disorder and its effectiveness when applied for repeated relapses of depression over time. Method: Nineteen patients who had previously responded to rTMS in clinical trials received treatment with rTMS for a total of 30 episodes of depressive relapse. Results: Approximately 10 months elapsed between treatment episodes. The majority of patients achieved a significant improvement in each treatment course with significant improvements achieved in patients treated with both low-frequency right-sided rTMS and high-frequency left-sided rTMS. Conclusions: The study suggests that rTMS may have value in the treatment of episodes of depressive relapse with little reduction in efficacy over time. [ABSTRACT FROM AUTHOR]