Author: Martijn Arns. 

rTMS or magnetic Brain stimulation is a new method to treat depression as an alternative to antidepressants. After more then 20 years of research and the first results from the clinic, this treatment seems very efficacious without any adverse side effects. Transcranial Magnetic Stimulation (rTMS) is part of a new development in the treatment of psychiatric disorders, where more often treatments are more focal, localised and personalized. Besides rTMS other treatments such as Deep Brain Stimulation and EEG Biofeedback are also part of this new development; also referred to as Personalized Medicine. The primary goal of Personalized Medicine is to get the right treatment to the right person at the right time, leading to higher efficacies and fewer side effects.

Last month the results from a large-scale controlled study were published on the effects of rTMS treatment for depression in 300 patients. These were all treatment-resistive patients who did not respond to antidepressant medication. This study - published in Biological Psychiatry by O'Reardon and colleagues -  demonstrated that rTMS is a safe and efficacious treatment for treatment resistive depression.

In the Brainclinics Treatment clinic in Nijmegen (The Netherlands) rTMS has been applied over the last year in a practical setting and combined with psychotherapy. In this setting any client with depression is treated (so not only treatment resistive patients). The rTMS treatment is personalized for every client using their individual QEEG on the basis of which the stimulation site is chosen. Furthermore, the EEG is used to rule out contra-indications - such as paroxysmal activity and the presence of beta spindles.

The figure below shows the first results of the first 10 depressive clients treated with QEEG based rTMS. The graph shows the Beck's Depression Inventory (BDI) score, which is a very often used questionnaire to assess the severity of depressive symptoms. This questionnaire was assessed every 5^th session. The cut-off score is 13 (red line), so a score below 13 indicates the client is formally not depressed anymore. The graph below clearly shows that on average clients showed a ‘normal' BDI score after 15 sessions.

The First preliminary conclusions can summarized as follows:

1) After 20 sessions 9 out of 10 patients - 90% showed a full remission, meaning they had a BDI score lower then 13.
2) Within 15 sessions of rTMS treatment patients showed a more then 65% reduction in depressive symptomatology (BDI score).
3) During these sessions no adverse side effects were reported.
4) Forty percent of these patients were free of medication and 60% was on antidepressant medication before the treatment was initiated. Some clients were even able to lower their medication doses during treatment.
5) In addition to these 10 patients, 1 was excluded due to contra-indications and there was 1 drop-out.
6) At this moment more data is being collected and we envision the complete data-set will be available in the 2nd quarter of 2008. However, these preliminary results look most promising!

In comparison, Antidepressants such as Citalopram show full remission in maximum 33% of patients (Trivedie et al., 2006; STAR*D trial) and only 30-50% of clients respond well to Antidepressant medication.

For more information on this topic, results and a demo movie visit www.brainclinics.com/index.php?pId=94&language_id=2