• Home
  • Store
    • Newsletter Subscriptions
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN SA Courses
  • CME Center
  • Multimedia
    • Podcast
    • Webinars
    • Blog
  • Newsletters
    • General Psychiatry
    • Child Psychiatry
    • Addiction Treatment
    • Hospital Psychiatry
    • Geriatric Psychiatry
    • Psychotherapy and Social Work
  • Log In
  • Register
  • Welcome
  • Sign Out
  • Subscribe
Home » The Role of rTMS in Poststroke Depression

The Role of rTMS in Poststroke Depression

January 7, 2022
Susan L. Siegfreid, MD
From The Carlat Hospital Psychiatry Report
Issue Links: Learning Objectives | Editorial Information | PDF of Issue
Susan L. Siegfreid, MD Dr. Siegfreid has disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.
REVIEW OF: Hordacre B et al, J Neurol 2021;268(4):1474–1484

STUDY TYPE: Randomized controlled trial

Poststroke depression is common, disabling, and often treatment refractory. We know repetitive transcranial magnetic stimulation (rTMS) is effective for treatment-resistant depression. Might it offer a safe and effective treatment for poststroke depression? Two previous small randomized controlled trials of rTMS (using high-frequency [10 Hz] delivery of 1,000 pulses per session to the left dorsolateral prefrontal cortex for 10 sessions) demonstrated both safety and efficacy in poststroke depression (Gu SY and Chang MC, Brain Stimul 2017;10(2):270–274; Jorge RE et al, Biol Psychiatry 2004;55(4):398–405). Researchers in the current study hypothesized that delivery of a higher dose—3,000 pulses per session—would increase clinical benefit without compromising safety.

The study recruited 11 patients with moderate (baseline PHQ-9 score > 5) poststroke depression and no change in antidepressant medication for the prior six months. Most of the patients (n = 9) were male, ages 44–78 years, with predominantly right hemispheric strokes occurring one to 11 years prior to enrollment. Participants were randomized to either active (n = 6) or sham (n = 5) rTMS groups using an identical figure-8 coil. They received 10 treatment sessions, occurring over five weekdays for two consecutive weeks. The primary outcome measure for depression severity was the Beck Depression Inventory-II (BDI), which was assessed at baseline, immediately after treatment, and at one month follow-up.

From baseline to one-month follow-up, the BDI scores in the treatment group decreased significantly more than in the sham group, with an average change of 12 points (p = 0.04). Adverse effects were transient and comparable between the treatment and sham groups.

CHPR’S TAKE
This study was small and only followed moderately depressed patients for one month after treatment, but it provides additional evidence that higher-dose rTMS is a safe and effective treatment option for poststroke depression in patients who do not fully respond to antidepressant medication.
Hospital Psychiatry
KEYWORDS depression post-stroke-depression rtms stroke tms transcranial-magnetic-stimulation treatment
    Susan L. Siegfreid, MD

    Can Physical Activity Offset Cognitive Decline?

    More from this author
    www.thecarlatreport.com
    Issue Date: January 7, 2022
    SUBSCRIBE NOW
    Table Of Contents
    CME Post-Test - Testifying, CHPR, January/February/March 2022
    A Primer for Psychiatrists on Court Hearings
    Borderline Personality Disorder in the ED
    Tarasoff: Making Sense of the Duty to Warn or Protect
    Principles of Verbal De-Escalation
    Minimizing PTSD From Workplace Trauma
    The Role of rTMS in Poststroke Depression
    DOWNLOAD NOW
    Featured Book
    • PB4e_Cover2.png

      Psychiatry Practice Boosters, Fourth Edition (2023)

      Teaches you the key points of 63 of the most clinically relevant studies in psychiatry.
      READ MORE
    Featured Video
    • therapist_canstockphoto9201097.jpg
      General Psychiatry

      Using SAMe In Clinical Practice with Garrett Rossi, MD

      Read More
    Featured Podcast
    • canstockphoto60629555.jpg
      Hospital Psychiatry

      QT Intervals in Psychiatric Practice

      Several psychiatric medications prolong the QTc interval and place patients at risk of the dreaded torsade de pointes. Some patients are particularly vulnerable to QTc...

      Listen now
    Recommended
    • Approaches to Autism Intervention

      January 31, 2022
      canstockphoto2240982_child-bubbles_thumb.jpg
    • Currently Available Cannabis Products

      September 1, 2022
    • Interpreting Assessment Discrepancies from Multiple Sources

      October 17, 2022
      ChildAssessment.png
    • Approaches to Autism Intervention

      January 31, 2022
      canstockphoto2240982_child-bubbles_thumb.jpg
    • Currently Available Cannabis Products

      September 1, 2022
    • Interpreting Assessment Discrepancies from Multiple Sources

      October 17, 2022
      ChildAssessment.png
    • Approaches to Autism Intervention

      January 31, 2022
      canstockphoto2240982_child-bubbles_thumb.jpg
    • Currently Available Cannabis Products

      September 1, 2022
    • Interpreting Assessment Discrepancies from Multiple Sources

      October 17, 2022
      ChildAssessment.png

    About

    • About Us
    • CME Center
    • FAQ
    • Contact Us

    Shop Online

    • Newsletters
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN Self-Assessment Courses

    Newsletters

    • The Carlat Psychiatry Report
    • The Carlat Child Psychiatry Report
    • The Carlat Addiction Treatment Report
    • The Carlat Hospital Psychiatry Report
    • The Carlat Geriatric Psychiatry Report
    • The Carlat Psychotherapy Report

    Contact

    info@thecarlatreport.com

    866-348-9279

    PO Box 626, Newburyport MA 01950

    Follow Us

    Please see our Terms and Conditions, Privacy Policy, Subscription Agreement, Use of Cookies, and Hardware/Software Requirements to view our website.

    © 2023 Carlat Publishing, LLC and Affiliates, All Rights Reserved.