Vojnosanitetski pregled 2014 Volume 71, Issue 2, Pages: 207-210
https://doi.org/10.2298/VSP1402207K
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Switch to hypomania induced by repetitive transcranial magnetic stimulation and partial sleep deprivation added to antidepressant: A case report
Krstić Jelena (Clinical Hospital Center “Dr Dragiša Mišović”-Dedinje, Psychiatric Hospital, Belgrade + Faculty of Biology, Belgrade)
Ilić Tihomir V. (Military Medical Academy, Clinic of Neurology, Department of Clinical Neurophysiology, Belgrade + University of Defence, Military Medical Academy, Faculty of Medicine, Belgrade)
Introduction. Bipolar depression is often unrecognized and difficult to treat
because of two opposite problems: treatment resistance and risk of manic
switch. Case report. A 53-year-old female was suffering from unipolar
depressive disorder since the age of 36. During a recent major depressive
episode pervasive feelings of sadness, lost of interest in activities, severe
insomnia and highly expressed somatic anxiety dominated 7 months. After
unsuccessful tries with two different antidepressants of adequate doses and
duration, slow rate repetitive trascranial magnetic stimulation (rTMS) was
started, but the patient stayed at the fixed dose of antidepressant. Partial
sleep deprivation (PSD) was additionally applied twice during these 2 weeks
with the idea to boost up, or enhance rTMS treatment response. At the last
two rTMS sessions depression obviously meliorated, but the patient also
expressed symptoms of hypomania. The therapy of rTMS was stopped, hypomanic
symptoms gradually vanished and two weeks after the rTMS treatment the
patient was euthymic. Antidepressant was kept on. In a follow-up period of 2
years the diagnose of bipolar affective disorder was definitely established.
Conclusion. This case report shows that a combination of slow rate rTMS and
partial sleep deprivation in the patient at the fixed dose of
antidepressants, have strong synergistic effect even with potential to induce
hypomanic switch, that is the first description in the literature to our
knowledge.
Keywords: bipolar disorder, diagnosis, differential, depression, antidepressive agents, sleep deprivation, transcranial magnetic stimulation
Projekat Ministarstva nauke Republike Srbije, br. 41014