A 6-month follow-up case report of regional cerebral blood flow changes in treatment-resistant depression after successful treatment with bilateral transcranial magnetic stimulation.

: We report a patient with treatment-resistant depression who responded dramatically to bilateral transcranial magnetic stimulation (TMS) and present a 6-month follow-up of changes in regional cerebral blood flow. A 59-year-old man with 4 recurrences of depression came to our outpatient clinic. His current episode had persisted for at least 10 months, although he received several antidepressants. After successful TMS treatment, as compared with normal comparisons, the areas of hypoperfusion in the anterior and subgenual cingulate cortices were almost unchanged but were normalized at month 6. The areas of hyperperfusion in the orbitofrontal cortex were reduced considerably at week 4 and disappeared at month 6. Although there are limitations of a case report, the findings of this case suggest that treatment response to bilateral TMS may be associated with the anterior cingulate, subgenual cingulate, and orbitofrontal cortices.