Augmenting DLPFC rTMS with Treatment at the Supplementary Motor Area: A Case Series

Background: Repetitive Transcranial Magnetic stimulation (rTMS) is commonly targeted at the dorsolateral prefrontal cortex (dlPFC) for treatment-resistant depression (TRD). For nonresponders, providers may augment treatment with alternative targets. Sagittal midline targets including dorsomedial (dmPFC), and supplementary motor area (SMA) are preeminent obsessive compulsive disorder (OCD) also treat TRD. We present a retrospective clinical case series of patients without OCD whose depressive symptoms exhibited little-to-no improvement in response to rTMS dlPFC but responded after introduction SMA treatment. Methods: Adult (n = 4) who had not bilateral within first 20 treatments received additional during their remaining sessions. was located via 35% Nasion-Inion distance heuristic. The primary outcome percent Patient Health Questionnaire (PHQ-9) score. Results: Mean pre-intervention on PHQ-9 11 percent, post-intervention 63 percent. total before intervention 27.5. session count score decreased least 5 points below baseline 8. Verbal reports from all indicated coinciding initiation intervention. Conclusions: Additional improve outcomes therapy TRD nonresponders. comorbidities implicate neural correlates post-traumatic stress as mechanism. Conflicts Interests: None Funding: This work supported by NeuroStim TMS Centers, LLC. Disclosures: