Possible replacement of augmenting medication in treatment-resistant depression by transcranial magnetic stimulation: a case report

Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for depression. As the left prefrontal cortex activity is linked to depression, rTMS induces blood flow in the left dorsolateral prefrontal cortex. We used rTMS in a middle-aged male patient with depression who had discontinued psychostimulant medication over a 12-month period. He had been consistently taking dextroamphetamine-amphetamine extended release 30 mg once daily prior to the onset of rTMS treatment. The patient achieved depression remission through 39 sessions of high-frequency left dorsolateral prefrontal cortex rTMS treatments. We assessed disease progression using the Quick Inventory of Depressive Symptomatology, and we measured blood pressure before each session of rTMS. After tapering the dextroamphetamine-amphetamine extended release from 30 mg to 10 mg, the patient’s score on the Quick Inventory of Depressive Symptomatology increased slightly to 7 and then dropped to 0. The results indicate that interval rTMS can lower blood pressure and may be an alternative to adjunctive psychostimulants.