Mitochondrial myopathy and comorbid major depressive disorder: effectiveness of dTMS on gait and mood symptoms

Chiara Rapinesi; Delfina Janiri; Georgios D Kotzalidis; Daniele Serata; Antonio Del Casale; Paola Scatena; Claudia Dacquino; Giovanna Gentile; Giovanni Manfredi; Emanuela Danese; Ruggero Nessim Raccah; Roberto Brugnoli; Gemma Callovini; Vittoria Rachele Ferri; Stefano Ferracuti; Abraham Zangen; Maurizio Simmaco; Gloria Angeletti; Paolo Girardi

doi:10.1016/j.genhosppsych.2015.03.002

Mitochondrial myopathy and comorbid major depressive disorder: effectiveness of dTMS on gait and mood symptoms

Gen Hosp Psychiatry. 2015 May-Jun;37(3):274.e7-9. doi: 10.1016/j.genhosppsych.2015.03.002. Epub 2015 Mar 13.

Authors

Chiara Rapinesi¹, Delfina Janiri², Georgios D Kotzalidis³, Daniele Serata¹, Antonio Del Casale⁴, Paola Scatena⁵, Claudia Dacquino², Giovanna Gentile⁶, Giovanni Manfredi², Emanuela Danese², Ruggero Nessim Raccah⁷, Roberto Brugnoli², Gemma Callovini², Vittoria Rachele Ferri², Stefano Ferracuti², Abraham Zangen⁸, Maurizio Simmaco⁶, Gloria Angeletti², Paolo Girardi¹

Affiliations

¹ NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy; Villa Rosa, Suore Hospitaliere of the Sacred Heart of Jesus, Viterbo, Italy.
² NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy.
³ NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy. Electronic address: giorgio.kotzalidis@uniroma1.it.
⁴ NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome School of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy; Department of Psychiatric Rehabilitation, Fondazione Padre Alberto Mileno Onlus, Vasto, Chieti, Italy.
⁵ Villa Rosa, Suore Hospitaliere of the Sacred Heart of Jesus, Viterbo, Italy.
⁶ DiMA Department (Advanced Molecular Diagnosis), School of Medicine and Psychology, Sapienza University, Rome, Italy.
⁷ ATID Ltd Advanced Technology Innovation Distribution, Rome, Italy.
⁸ Department of Life Sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel.

PMID: 25799088
DOI: 10.1016/j.genhosppsych.2015.03.002

Abstract

Background: Mitochondrial myopathies (MMs) often present with leukoencephalopathy and psychiatric symptoms, which do not respond to or worsen with psychiatric drugs.

Case report: A 67-year-old woman with a 10-year history of probable chronic progressive external ophthalmoplegia, an MM, had drug-resistant, anxious-depressive symptoms. Since she had never had seizures, we proposed 20 sessions of deep transcranial magnetic stimulation (dTMS) for her depression. Surprisingly, besides the expected improvement of depression, we observed marked improvement of movement disorder that lasted as long as the patient was undergoing dTMS. She also improved her performance on neuropsychological tests of executive function and cognitive speed. Depressive symptom improvement was persistent, while anxiety symptoms recurred after the end of the sessions.

Conclusions: dTMS may be an alternative antidepressant strategy in patients with MMs, provided that they are free from seizures. The mechanism of improvement of motor disturbance may relate to dorsolateral prefrontal cortex stimulation and improved executive function and needs further investigation.

Keywords: Comorbidity; Deep transcranial magnetic stimulation (dTMS); Dorsolateral prefrontal cortex (DLPFC); Major depressive disorder; Mitochondrial myopathy.

Publication types

Case Reports

MeSH terms

Aged
Comorbidity
Depressive Disorder, Major / epidemiology
Depressive Disorder, Major / therapy*
Female
Gait / physiology*
Humans
Mitochondrial Myopathies / complications
Mitochondrial Myopathies / therapy*
Transcranial Magnetic Stimulation / methods*