Background: Repetitive transcranial magnetic stimulation (rTMS) is a method of noninvasively modulating focal brain activity and may be an effective treatment for Treatment Resistant Depression (TRD). Psychostimulants are frequently prescribed off-label for adults with major depressive disorder or bipolar disorder as an adjunctive antidepressant treatment. Here, we present a case where high-interval rTMS is being used to replace an adjunctive psychostimulant.
Methods: A middle-aged male patient achieved depression remission with 20 high-frequency left dlPFC rTMS treatments. We continued high frequency left dlPFC rTMS for 16 more treatments at increasing intervals while adjunctive antidepressant treatment was tapered. Progress was assessed using Quick Inventory of Depressive Symptomatology (QIDS).
Results: The patient initially reported a 24 in the QIDS. After 20 treatments delivered five days per week, the reported QIDS decreased to 2. After continuing rTMS at an interval tapered to one per week and tapering Dextroamphetamine-Amphetamine extended-release 30mg QD to 20mg QD, QIDS increased slightly to 7. We plan to continue this taper with once weekly or biweekly rTMS.
Conclusions: The patient had a slight recurrence of symptoms severity after tapering adjunctive medication and continuing weekly rTMS. The degree of recurrence in this case was not clinically relevant enough to warrant a change in treatment plan. rTMS may be used safely to replace the effect of adjunctive medication with full efficacy to be determined.