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