Dexamethasone suppression test reversal in rapid transcranial magnetic stimulation-treated depression

Objective: The aim of this paper is to report the effect of rapid transcranial magnetic stimulation (rTMS) on the mood and dexamethasone suppression test (DST) of a patient with major depressive disorder (DSM-IV). Clinical picture: A 36-year-old woman with a past history of prolactinoma and recurrent major depressive disorder presented with major depression on three separate occasions over a 3-month period. DST was positive on each occasion. Treatment: During each episode, a course of rTMS was given. Courses varied from seven to 13 once-daily treatment sessions depending on clinical response. These treatment sessions were 20 trains of 10 Hz for 5 s at 100% of motor threshold. Outcome: Remission was achieved, psychiatric rating scales improved and the DST status converted from positive to negative. There were no side effects. Conclusion: DST status in major depressive disorder can be converted from positive to negative by rTMS. This so far unreported observation increases our knowledge of rTMS.