Objectives: Although high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) over the left dorsolateral prefrontal cortex (DLPFC) has been reported to improve mood symptoms in major depressive disorder (MDD), research on its impact on psychomotor symptoms is scarce. This study assessed the psychomotor effects of 1 and 10 sessions, respectively, of HF-rTMS over the left DLPFC. Methods: Ten HF-rTMS sessions were applied in 21 medication-free MDD patients over a 2-week period. At the beginning, one placebo (sham)-controlled rTMS session was also applied in a cross-over, single-blind design. Psychomotor variables were digitally recorded during completion of a Fitts’ task, at baseline, after the first and second real/sham session and at the end point. Results: The total 10-session treatment period resulted in a decrease of depression severity. One HF-rTMS session resulted in improvements on the Fitts’ task, without a difference between active and sham stimulation, however. No further improvements occurred from session 2 to session 10. Conclusions: No evidence was provided to link the observed psychomotor improvements to HF-rTMS stimulation, as a practice effect could have impacted the significant psychomotor outcomes.

Keywords:
Transcranial magnetic stimulation, High-frequency repetitive transcranial magnetic stimulation, Psychomotor symptoms, Retardation, Major depressive disorder
1.
Mitchell PB, Loo CK: Transcranial magnetic stimulation for depression. Aust NZ J Psychiatry 2006;40:406–413.
2.
Daskalakis ZJ, Levinson AJ, Fitzgerald PB: Repetitive transcranial magnetic stimulation for major depressive disorder: a review. Can J Psychiatry 2008;53:555–566.
3.
Dell’osso B, Camuri G, Castellano F, Vecchi V, Benedetti M, Bortolussi S, Altamura AC: Meta-review of meta-analytic studies with repetitive transcranial magnetic stimulation (rTMS) for the treatment of major depression. Clin Pract Epidemiol Ment Health 2011;7:167–177.
4.
Gershon AA, Dannon PN, Grunhaus L: Transcranial magnetic stimulation in the treatment of depression. Am J Psychiatry 2003;160:835–845.
5.
Schutter DJ: Antidepressant efficacy of high-frequency transcranial magnetic stimulation over the left dorsolateral prefrontal cortex in double-blind sham-controlled designs: a meta-analysis. Psychol Med 2009;39:65–75.
6.
Fitzgerald PB, Daskalakis ZJ: A practical guide to the use of repetitive transcranial magnetic stimulation in the treatment of depression. Brain Stimul 2012;5:287–296.
7.
Sobin C, Sackeim HA: Psychomotor symptoms of depression. Am J Psychiatry 1997;154:4–17.
8.
Dantchev N, Widlöcher DJ: The measurement of retardation in depression. J Clin Psychiatry 1998;59(suppl)14:19–25.
9.
Schrijvers D, Hulstijn W, Sabbe BGC: Psychomotor symptoms in depression: a diagnostic, pathophysiological and therapeutic tool. J Affect Disord 2008;109:1–20.
10.
Keck ME, Welt T, Mueller MB, Erhardt A, Ohl F, Toschi N, et al: Repetitive transcranial magnetic stimulation increases the release of dopamine in the mesolimbic and mesostriatal system. Neuropharmacol 2002;43:101–109.
11.
Pogarell O, Koch W, Pöpperl G, Tatsch K, Jakob F, Zwanzger P, et al: Striatal dopamine release after prefrontal repetitive transcranial magnetic stimulation in major depression: preliminary results of a dynamic [123I] IBZM SPECT study. J Psychiatr Res 2006;40:307–314.
12.
Vanderhasselt MA, De Raedt R, Leyman L, Baeken C: Acute effects of repetitive transcranial magnetic stimulation on attentional control are related to antidepressant outcomes. J Psychiatry Neurosci 2009;34:119–126.
13.
Vanderhasselt MA, De Raedt R, Baeken C, Leyman L, D’Haenen H: A single session of rTMS over the left dorsolateral prefrontal cortex influences attentional control in depressed patients. World J Biol Psychiatry 2009;10:34–42.
14.
Hoeppner J, Schulz M, Irmisch G, Mau R, Schläfke D, Richter J: Antidepressant efficacy of two different rTMS procedures. High frequency over left versus low frequency over right prefrontal cortex compared with sham stimulation. Eur Arch Psychiatry Clin Neurosci 2003;253:103–109.
15.
Hoeppner J, Padberg F, Domes G, Zinke A, Herpertz SC, Grossheinrich N, et al: Influence of repetitive transcranial magnetic stimulation on psychomotor symptoms in major depression. Eur Arch Psychiatry Clin Neurosci 2010;260:197–202.
16.
Baeken C, De Raedt R, Santermans L, Zeeuws D, Vanderhasselt MA, Meers M, et al: HF-rTMS treatment decreases psychomotor retardation in medication-resistant melancholic depression. Prog Neuropsychopharmacol Biol Psychiatry 2010;30:684–687.
17.
Sabbe B, Hulstijn W, Van Hoof J, Zitman F: Fine motor retardation and depression. J Psychiatr Res 1996;30:295–306.
18.
Sabbe B, Hulstijn W, van Hoof J, Tuynman-Qua HG, Zitman F: Retardation in depression: assessment by means of simple motor tasks. J Affect Disord 1999;55:39–44.
19.
Pier MP, Hulstijn W, Sabbe BG: Differential patterns of psychomotor functioning in unmedicated melancholic and nonmelancholic depressed patients. J Psychiatr Res 2004a;38:425–435.
20.
Baeken C, Schrijvers DL, Sabbe BG, Vanderhasselt MA, De Raedt R: Impact of one HF-rTMS session on fine motor function in right-handed healthy female subjects: a comparison of stimulation over the left versus the right dorsolateral prefrontal cortex. Neuropsychobiology 2012;65:96–102.
21.
Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al: The Mini- International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998;20:22–57.
22.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J: An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–571.
23.
Hamilton M: A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56–62.
24.
Thase ME, Rush AJ: Treatment-resistant depression; in Bloom FE, Kupfer DJ (eds): Psychopharmacology: the Fourth Generation of Progress. Raven Press, New York, 1995, pp 1081–1097.
25.
Rush AJ, Thase ME, Dube S: Research issues in the study of difficult-to-treat depression. Biol Psychiatry 2003;53:743–753.
26.
Schrijvers D, De Bruijn ERA, Maas Y, De Grave C, Sabbe BGC, Hulstijn W: Action monitoring in major depressive disorder with psychomotor retardation. Cortex 2008;44:569–579.
27.
Van Strien JW: Handvoorkeur en taaldominantie. Neuropraxis 2001b; 2:10–15.
28.
Peleman K, Van Schuerbeek P, Luypaert R, Stadnik T, De Raedt R, De Mey J, et al: Using 3D-MRI to localize the dorsolateral prefrontal cortex in TMS research. World J Biol Psychiatry 2010;11:425–430.
29.
Wassermann EM: Risk and safety of repetitive transcranial magnetic stimulation: report and suggested guidelines presented at the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation, June 5–7, 1996. Electroencephalogr Clin Neurophysiol 1998;108:1–16.
30.
Rossi S, Hallett M, Rossini PM, Pascual-Leone A, Safety of TMS Consensus Group: Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol 2009;120:2008–2039.
31.
Pridmore S, Bruno R, Turnier-Shea Y, Reid P, Rybak M: Comparison of unlimited numbers of rapid transcranial magnetic stimulation and ECT treatment sessions in major depressive episode. Int J Neuropsychopharmacol 2000;3:129–134.
32.
Kaptchuk TJ, Goldman P, Stone DA, Stason WB: Do medical devices have enhanced placebo effects? J Clin Epidemiol 2000;53:786–792.
33.
Loo C, Sachdev P, Elsayed H, McDarmont B, Mitchell P, Wilkinson M, et al: Effects of a 2- to 4-week course of repetitive transcranial magnetic stimulation (rTMS) on neuropsychologic functioning, electroencephalogram, and auditory threshold in depressed patients. Biol Psychiatry 2001;49:615–623.
34.
McDonald WM, Durkalski V, Ball ER, Holtzheimer PE, Pavlicova M, Lisanby SH, Avery D, Anderson BS, Nahas Z, Zarkowski P, Sackeim HA, George MS: Improving the antidepressant efficacy of transcranial magnetic stimulation: maximizing the number of stimulations and treatment location in treatment-resistant depression. Depress Anxiety 2011;28:973–980.
35.
George MS, Post RM: Daily left prefrontal repetitive transcranial magnetic stimulation for acute treatment of medication-resistant depression. Am J Psychiatry 2011;168:356–364.
© 2012 S. Karger AG, Basel
2012
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.