Occurrence of delusions during repetitive transcranial magnetic stimulation (rTMS) in major depression

Background: Repetitive transcranial magnetic stimulation (rTMS) has been suggested as a potentially useful treatment for major depression. Nonpsychotic depressed patients appear to have a better outcome than those with psychotic symptoms. Methods: We report findings in a patient suffering from recurrent, nonpsychotic major depression (DSM-IV) who had 13 daily sessions of rTMS monotherapy within a 3 week period. Results: During rTMS treatment, the patient developed recurrent severe delusions, which he had never experienced before. Psychotic symptoms remitted quickly with neuroleptic medication. Conclusions: In light of preclinical findings showing increased dopaminergic activity after rTMS treatment, occurrence of psychotic symptoms should be considered a potential side effect of rTMS treatment.