Pridmore S, Turnier-Shea Y: Rapid transcranial magnetic stimulation (rTMS)
German J Psychiatry 2000;3
We report the treatment of major depressive disorder with a longer than usual course of rapid transcranial magnetic stimulation (rTMS). We have elsewhere reported the successful treatment of depression with five treatments per week for 4 weeks .
This was a 60 year old farm owner and operator. He had suffered major depressive episodes for a decade. We treated him with rTMS one year previously with 10 treatments over two weeks, with produced modest improvement.
On this occasion he was referred by his treating psychiatrist with a one month history of increasing depression. He was on venlafaxine 300 mg per day, and there had been no changes in the previous six months. At assessment there was depressed mood, psychomotor retardation and suicidal thoughts. The Hamilton Depression Rating Scale (HDRS) score was 26. On a Likert scale  of 0=the worst imaginable depression, to 10=no depression, he scored 3.
No change was made to his medication. He was treated with rTMS via a figure-of-eight coil to the left prefrontal cortex at 100% of motor threshold. Stimulation was at 20 Hz, trains were 2 seconds long and 25 to 30 trains were given daily, depending on the ambient temperature and the heating of the coil.
The patient was given five daily treatments during the first and second weeks and the two daily treatments during the third through sixth weeks (18 treatments in total). The Likert score at the end of these weeks was 4, 6, 7, 8, 9, 10. The final HDRS score was 3.
Thus, improvements continued over six weeks, and interestingly, improvement continued during the two treatments per week phase. This was a sensible, solid citizen and his gradual improvement suggested the investigation of longer courses of rTMS.
Department of Psychological Medicine
Royal Hobart Hospital
1. Pridmore S, Poxon M, Chan C. Longer than expected course of transcranial magnetic stimulation. Australian and New Zealand Journal of Psychiatry 1998, 32, 140.
2. Likert R. A technique for the measurement of attitudes. Archives of Psychology 1932, 22, 1-54.