A pilot investigation of rTMS for post-traumatic brain injury depression: Safety, tolerability and efficacy.

Depression following a Traumatic Brain Injury (TBI) is common and difficult to treat using standard approaches. The current study investigated, for the first time, Transcranial Magnetic Stimulation for the treatment of post TBI depression. We specifically assessed the safety, tolerability and efficacy of TMS in this patient population. We also explored cognitive outcomes. 21 patients with a current episode of major depression subsequent to a TBI participated in a randomized double blind placebo controlled trial of rTMS. Sequential bilateral rTMS (to the left and right dorsolateral prefrontal cortex) was provided in 20 treatments over a period of 4 weeks. Patients were randomly allocated to receive either active or sham stimulation. There were no adverse effects and treatment was well tolerated. There was no significant effect of rTMS on post-TBI depression, with all patients showing a significant improvement in depressive symptoms irrespective of their treatment group (p =0.002). There were significant improvements in cognition following active rTMS in the areas of working memory (p=0.021) and executive function (p =0.029). rTMS was shown to be safe and well tolerated in patients who had developed depression post a traumatic brain injury. We did not find a therapeutic effect for post-TBI depression, however this approach may have some utility in improving cognitive function. Future research should focus on alternative rTMS treatment approaches for post-TBI depression and the direct investigation of rTMS as a treatment for cognitive impairment in TBI. Key Words: Post-traumatic brain injury depression, Transcranial Magnetic Stimulation, Clinical Trial.