Methods: A 52-year-old man with MDD, GAD, and ADHD presented with severe depression/anxiety while taking lorazepam, duloxetine, and adderall XR.Lorazepam was tapered and adderall switched to Azstarys before rTMS.He completed 36 sessions of 10-Hz left DLPFC rTMS (120% resting motor threshold, 3,000 pulses/ session).Results: rTMS produced marked improvement (PHQ-9 17 to 3).During the rTMS course, tirzepatide was titrated from 5 mg to 15 mg (reached after treatment).Within 1 month of rTMS completion, depressive symptoms worsened (PHQ-9 11) and involuntary movements emerged (jaw clenching, lip puckering, tongue movements, repetitive blinking, and leg twitching; AIMS 20).Holding vortioxetine and Azstarys had no effect.Lumateperone and cariprazine trials were ineffective.A second rTMS course was initiated while continuing high-dose tirzepatide and starting deutetrabenazine, resulting in near-complete remission (AIMS 5).Discussion: GLP-1 RA up-titration during/after rTMS was temporally associated with depressive relapse and dyskinesias.Clinicians should monitor for worsening of depression and new abnormal movements during GLP-1 RA dose escalation in patients receiving psychotropics.Further study is needed to clarify causality and the potential adjunctive role of rTMS in TD.
Aslam et al. (Mon,) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: