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TITLE:
[Transcranial magnetic stimulation as an
alternative to electroshock therapy in treatment resistant depressions. A literature
review]
AUTHOR:
Markwort S; Cordes P; Aldenhoff J
AUTHOR AFFILIATION:
Klinik fur Psychiatrie und Psychotherapie der
Christian-Albrechts-Universitat zu Kiel.
SOURCE:
Fortschr Neurol Psychiatr 1997 Dec;65(12):540-9
NLM CIT. ID:
98113535
ABSTRACT:
Transcranial magnet stimulation (TMS) is a
low-risk method for direct and localised stimulation of the cerebral cortex. For several
years it has played an important part in measurements of the central motor conduction time
(magnetically evoked potentials/MEP). Further technical and methodological developments,
such as high-frequency (rapid rate TMS/rTMS) or triggered stimulation have led to broad
scientific application of this method. Electric convulsive therapy (ECT) has proved its
value in the treatment of various psychiatric disorders, especially in pharmaco-resistant
depression. The therapeutic mechanism is actually unclear. However, the generalised
convulsive fit appears to be the precondition for the therapeutic effect. A disadvantage
lies in the risk inherent in the necessary general anaesthesia and the possible side
effects, such as transitory states of confusion and transient mnestic deficits. Bearing in
mind the possibility that TMS could have the same effects as ECT due to stimulations below
the convulsion threshold or to the direct or indirect stimulations of so-called
disorder-specific key regions, several pilot studies and some controlled studies have been
published during the past three years on its efficacy in depressive disorders. The results
were reported on and critically evaluated. The results of this survey of the literature on
the subject is that (r)TMS does not represent an alternative to ECT in the therapy of
pharmaco-resistant depressions. Due to its slight and only transient antidepressive
effect, (r)TMS is also, in our opinion, not suitable as so-called add-on therapy as a
complement to antidepressant medication.
When my office
lease expired at the end of 2004, I decided to turn it into a
"sabbatical" from my private practice. Many years ago, in my
grandfather's 89th year of life, he told me, "John, it is important
to smell the roses while you can still smell them." His life
gave living a very good reputation. It is also true that the
pursuit of that philosophy required my grandfather to to re-open his
assay office/ore market in Wickenburg, Arizona as a 75-year-old because
he had run a little short of retirement money. Thus, if blessed with his
luck and health, I'll be back.. --jjh
