Source: Psychoneuroendocrinology  |  Posted 9 years ago

Persistent hypothalamic-pituitary-adrenocortical (HPA) system hyperactivity after repetitive transcranial magnetic stimulation (rTMS) therapy suggests a high risk for relapse in patients with major depression.

The finding argues for immediate maintenance therapy in depression patients who respond to rTMS therapy, say German researchers.

The investigators, from Ludwig-Maximilians University of Munich, explain that research has demonstrated HPA dysregulation normalises after successful antidepressant pharmacotherapy. Normalisation is assessed by a combined dexamethasone/corticotropin-releasing hormone (DEX/CRH) test.

They investigated whether rTMS also normalises HPA system activity in 37 medication-free patients undergoing a major depressive episode. Participants had DEX/CRH tests in an open trial before and after 13 daily sessions of left prefrontal rTMS.

Results indicate there was an overshoot of CRH-induced cortical release in patients that was not affected by rTMS treatment. Post-dexamethasone cortisol levels prior to the CRH challenge decreased in patients who responded to rTMS.

No changes were observed in CRH-induced adrenocorticotropic hormone and cortisol release, in either responders or non-responders.

"The persisting HPA system hyperactivity after rTMS suggests a high risk for relapse and therefore argues for an immediate maintenance therapy in patients responding to this treatment," the investigators concluded.