Description

ABSTRACT

Objective:In addition to repetitive transcranial magnetic stimulation (rTMS), deep transcranial magnetic stimulation (dTMS) has also been shown to be effective in treatment of various neuropsychiatric disorders including depression. The objective of this case study is to demonstrate differential and rapid improvement of Insomnia comorbid with MDD with dTMS.

Methods: Brainsway deep TMS device was used with an H1-coil.The usual procedure for dTMS stimulation for MDD was followed. After determining MT the coil was located 6 cm anterior to the MT location.  dTMS sessions were given daily on week days for 5 weeks. The primary outcome was clinical response of depression as seen on clinical assessment, self-report, Hamilton Depression Rating scale (HDRS-21) and Montgomery Asberg Depression Rating scale (MADRS). Insomnia severity index (ISI), Patient Health Questionnaire (PHQ-9) and Global assessment of functioning (GAF) were used as secondary outcomes.

Results:  Improvement in insomnia symptoms was seen first as early as day 2 of treatment that was reflected on ISI. Improvement in insomnia was followed by gradual improvement in depressive symptoms.

Conclusion:  This case with insomnia and co-morbid treatment resistant depression is the first report of rapid improvement in insomnia with co-morbid MDD with dTMS. While dTMS is a treatment option for major depressive disorder, its role in insomnia and insomnia co-morbid with depression merits further study.

Key words: Insomnia, Treatment resistant depression, Transcranial magnetic stimulation, Brain stimulation.