Can Bilateral Prefrontal Repetitive Transcranial Magnetic Stimulation (rTMS) Induce Mania?A Case Report

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Sir: Bilateral repetitive transcranial magnetic stimulation(rTMS) using high-frequency (hf-rTMS) and low-frequency (lf-rTMS) stimulation over the left and right dorsolateral prefrontal cortex (DLPFC), respectively, was theorized to enhance antidepressant outcome.1 Although efficacy is discussed controversially, 2,3 this stimulation paradigm at least did not induce nocuous cognitive impairments.2,4 Cases of affective side effects have been reported with use of hf-rTMS over the left DLPFC5,6 and with use of lf-rTMS over the right DLPFC.7

J Clin Psychiatry 2004;65(11):1575-1576