Table 1.
Summary of cases
| Case | HAM-D score | Medication during rTMS | Psychiatric family history | History of bipolarity | TMS application procedure | Session when hypomania was observed | Hypomania treatment |
|---|---|---|---|---|---|---|---|
| I |
27 |
Escitalopram 10 mg/day |
Grandfather had a psychotic disorder |
None |
25 Hz, 1,000 pulses, LDLPFC, 100% MT, one session daily |
9 |
Escitalopram stopped. Valproic acid added. Eleven sessions of 1 Hz, 250 pulses, RDLPFC rTMS applied |
| II |
24 |
Venlafaxine 150 mg/day |
None |
None |
25 Hz, 1,000 pulses, LDLPFC, 100% MT, one session daily |
14 |
Venlafaxine stopped. Valproic acid added. Six sessions of 1 Hz, 250 pulses, RDLPFC rTMS applied |
| III |
22 |
Fluoxetine 60 mg/day |
None |
None |
25 Hz, 1,000 pulses, LDLPFC, 100% MT, one session daily |
12 |
Fluoxetine stopped. Valproic acid added. Eight sessions of 1 Hz, 250 pulses, RDLPFC rTMS applied |
| IV | 26 | Escitalopram 20 mg/day, mirtazapine 30 mg/day | None | None | 25 Hz, 1000 pulses, LDLPFC, 1,00% MT, one session daily | 12 | Escitalopram and mirtazapine stopped. Valproic acid added. Eight sessions of 1 Hz, 250 pulses, RDLPFC rTMS applied |