A Combination of Transcranial Magnetic Stimulation (TMS) and Antidepressants
There are many studies regarding the simultaneous use of repetitive TMS (rTMS), which is offered as an alternative to pharmacological treatments used in the treatment of the mood disorders like depression and anxiety, along with the drugs. The studies were mainly carried out on rats, for which a depression or anxiety model was created.
The effect of Quetiapine (QUE)’on rTMS was analyzed in a study carried out on rats. When the rTMS + Quetiapine (QUE) was administered for 1 week, a regression was observed in the depressive behavior of the rats. The simultaneous implementation of the two treatments become more effective than the implementation of just one treatment. The studies conducted concerning the pathophysiology of depression emphasized the importance of a gene named “BDNF”. Following the antidepressant treatments, BDNF increases in the hippocampus area of the brain, the significance of which regarding depression is increasing every day in recent times. The effect of the rTMS + QUE treatment, which is used in the animal study conducted, on the depressive symptoms are told be in association with the hippocampal BDNF gene.
In another study analyzing the interaction of Venlafaxine with rTMS on rats, the rTMS treatment was administered for 15 days at high frequency (15 Hz). The effects of rTMS observed on the brain continued 2 weeks after the completion of the treatment. The rTMS effect was observed to be similar to Venlafaxine, but it was seen that the simultaneous use of both treatments did not create any difference.
Paroxetin is another pharmacological agent, the simultaneous effects of which with rTMS are analyzed. In an animal study conducted in 2002, rTMS was implemented for 12 days while administering 10 mg of Paroxetin on a daily basis. A meaningful increase was observed in the performance of the rats when the post-treatment effects were analyzed with behavior tests. The results derived from the study indicate that the joint use of both treatments is more effective than their separate use.
Fluoxetine is another pharmacological drug that is commonly in use. In a study carried out on rats, for which a depression model was established, the effects of rTMS on learning were compared to Fluoxetine. The rat group subjected to the rTMS treatment for 7 days was compared to the group that received Fluoxetine treatment for 7 days. The results revealed that both methods are effective in the treatment of depression. Nevertheless, it was shown that the effect of rTMS was observed in a faster manner.
Some studies were made on the Parkinson patient group, where depression is prevalent. In the study carried out on 26 patients, one group was provided with a sham rTMS and 20 mg of Fluoxetine, while another group received active rTMS and placebo drug. In the beginning of the study, the brain images of the patients were analyzed in weeks 2 and 8 (via SPECT method). Specific brain parts of the Parkinson patients were observed to be different than the healthy ones in the beginning of the study. Following the administration of the treatment, a development was observed in the depression symptoms of the Parkinson patients in harmony with the brain images. According to the results of this study, the drug and the TMS treatment appear to have the same effect in clinical respect. When the blood flow in the brain was analyzed, it was seen that rTMS was effective than the drug.
Although positive results were obtained from the studies conducted, joint use of some drugs with rTMS may increase the risk of seizures. One must be attentive when using drugs jointly with TMS, and the dose of the drug must be adjusted by a specialist clinician.