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Chawanun Charnsil, Sirijit Suttajit, Vudhichai Boonyanaruthee, Samornsri LeelarphatDepartment of Psychiatry, Chiang Mai University, Sriphum, Amphur Muang, Chiang Mai, ThailandBackground: The purpose of this study was to evaluate the long-term effect of repetitive transcranial magnetic stimulation (rTMS) as adjunctive treatment in patients with partial remission of major depressive disorder.Methods: This was a 12-month, prospective, open-label study in patients meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria for nonpsychotic major depressive disorder who responded to 8 weeks of medication treatment but did not reach remission. All patients were assigned to receive 10 sessions of rTMS applied at the left dorsolateral prefrontal cortex. During the course of rTMS, the patients were still taking their usual medication. Patients were followed up for 12 months to determine the long-term antidepressant effect.Results: There were nine patients (seven women and two men) who met the inclusion criteria and agreed to receive rTMS. The mean Hamilton rating scale for depression (HAM-D) score prior to treatment with rTMS was 12.89 ± 2.15. At 12 months after treatment, the mean HAM-D score was 6.45 ± 1.67 using a Friedman test, and in patients with partial remission of major depressive disorder, the HAM-D score significantly decreased after treatment with rTMS at 12 months (P = 0.001). Seven patients (77.78%) had reached the stage of remission (HAM-D < 8) after treating with rTMS at 12 months. There were no serious adverse events. One patient had vertigo after the first session of treatment and one patient felt scalp contractions during treatment, and both fully recovered within half an hour with no medical intervention.Conclusion: For patients with major depressive disorder in partial remission, high frequency rTMS at the left dorsolateral prefrontal cortex may provide benefits in adjunctive treatment with well tolerability. Also, follow-up findings show a long duration of benefit.Keywords: depression, remission, magnetic stimulation, adjunctive, long term

Objective: This study aimed to evaluate the effect of adjunctive treatment with rTMS in patients with partial remission major depressive disorder., Method: Subjects were patients meeting DSM-IV-TR criteria for non-psychotic major depressive disorder who responded to 8 weeks of medication treatment but still had residual symptoms (HAM-D score between 7 and 18). All patients were assigned to receive 10 daily sessions (total of 12,500 magnetic pulses) of rTMS applied at the left dorsolateral prefrontal cortex as adjunctive treatment. The antidepressant effect was measured repeatedly at 6 days, and at 4 and 8 weeks after treatment with the Thai version of HAM-D scale as a primary outcome scale., Results: Seven of nine patients (78%) reached the stage of remission (HAM-D < 8) after being treated with adjunctive rTMS. There was a statistically significant difference in decreasing of the HAM-D score during the treatment, χ(2) (df 3) = 17.929, P < 0.001. There was no severe adverse event. One patient had vertigo after the first session of treatment and one patient had a scalp contraction feeling during treatment but full recovered in half an hour with no medical intervention., Conclusion: For patients with a major depressive disorder in partial remission, high frequency rTMS may provide benefits in adjunctive treatment which are tolerated well. However, the long term effects should be observed.