27th National Clinical Education Symposium Presentation Abstracts

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29 APRIL 2025, MONDAY
13:00-14:00 POSTER PRESENTATION SESSION-2

Could accelerated transcranial magnetic stimulation be an alternative to electroconvulsive therapy in patients with severe suicidal ideation?

İbrahim Barikan1, Ömer Faruk Uygur1, Hakan Emre Babacan1

1. Department of Psychiatry, Ataturk University Faculty of Medicine, Erzurum

DOI: 10.5080/kes27.abs142 Page 168
Electroconvulsive therapy(ECT) is the most effective treatment of depression. In recent years, transcranial magnetic stimulation(TMS), which uses electrical brain stimulation, has emerged as an alternative to ECT in depression treatment and TMS applied more than once a day is called accelerated TMS(aTMS). We aim to present in this case raport a patient with depressive symptoms and suicidal thoughts who benefited from aTMS. An 31-year-old man presented to the outpatient clinic with anhedonia, feeling worthless, suicidal thoughts and insomnia for three months and we learned that he had attempted suicide before coming to us. In his history, we learned that he had a depressive episode for 14 years and used varying doses of fluoxetine, venlafaxine, risperidone(for augmentation) and quetiapine(for sleep disorders) in the past.He was currently using venlafaxine 225 mg/day, quetiapine 400 xr mg/day + 100 mg/day.However, his depressive symptoms still continued and he had serious suicidal thoughts.Since the patient did not improve with drug treatments we applied bilateral stimulation(left dorsolateral prefrontal cortex iTBS 1800 pulses and right dorsolateral prefrontal cortex cTBS 600 pulses) for 10 days with 5 sessions per day and 30-minute intervals for a total of 50 sessions without changing the current drug doses.Hamilton Depression Rating Scale-17(HDRS-17) and Montgomery-Asberg Depression Rating Scale(MADRS) scores decreased from 20 and 22 points to 6 and 2 points after treatment, respectively.Monthly follow-up was performed, at the end of 3 months, HDRS-17 and MADRS scored 1 and 0, respectively.Suicidal scores in HDRS-17 and MADRS decreased from 2 and 4 to 0, respectively.Verbal and written consent was obtained from the patient for the case report. Rapid improvement in depression is very important, especially for preventing suicide. In this article,both depressive symptoms and suicidal thoughts improved rapidly in the patient treated with aTMS. We recommend that psychiatrists consider aTMS for the rapid treatment of depression.