Combination of electroconvulsive therapy and repetitive transcranial magnetic stimulation can lead to rapid remission

Background: Several methods have been developed to augment Electroconvulsive Therapy (ECT) in not or not fully responding patients. A promising approach combines repetitive Transcranial Magnetic Stimulation (rTMS) and ECT. This study shows the case of a 79-year-old female patient with depression and a pronounced psychomotor slowing, who remitted under an inhibitory rTMS of the left Supplementary Motor Area (SMA). Methods/Case report: Our study’s patient is a 79-year-old woman presented with treatment-resistant depression and a pronounced psychomotor slowing. After no response to nine ECT-sessions with maximized energy (200%), an alternating inhibitory rTMS of left SMA was applied: 1 Hz, pulse width 25 ms, 25 series of 40 pulses each (1000 pulses) at 110% of motor stimulus threshold. Results: After five rTMS augmented ECT sessions, we achieved a rapid response and substantial reduction of depressive symptoms. At the end of therapy, our patient even clinically met remission criteria. Conclusions: In addition to pharmacological add-on therapy, neurostimulation techniques could be further used in augmenting ECT. In summary, a particular future focus should be placed on powerful combinations of neurostimulation therapies, especially rTMS. Mainly because of the promising results from our described case, the expected augmentation effects of combining ECT and rTMS should be evaluated in future controlled clinical trials. Conflicts of Interests: No conflicts to declare Funding: No funding provided

Abstract licence: CC BY-NC

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