Parkinson’s disease (PD) is commonly associated with motor symptoms like tremors, rigidity, and slowed movement. However, one of its most overlooked and life-altering symptoms is depression. Studies suggest that up to 40% of people living with Parkinson’s experience moderate to severe depressive symptoms during the course of the disease.
Depression in PD is more than just a psychological response to physical limitations—it is now understood to stem from the same neurological and neurochemical imbalances that cause the motor symptoms.
Treating depression in PD is particularly complex. Standard antidepressant medications can interact with dopamine-based Parkinson’s treatments and, in some cases, even worsen motor symptoms. Moreover, many patients do not respond fully to these medications. As a result, there is a growing interest in safe and effective non-pharmacological interventions, such as Repetitive Transcranial Magnetic Stimulation (rTMS).
Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive brain stimulation technique that uses magnetic pulses to modulate the activity of specific areas of the brain. In the treatment of depression, the main target is the left dorsolateral prefrontal cortex (DLPFC)—a region known to regulate emotion, mood, and executive function. In patients with depression, this area often shows reduced activity, and restoring its function through stimulation can lead to significant improvement in mood.
The procedure involves placing a magnetic coil gently over the scalp. Through this coil, short bursts of magnetic energy are delivered to the brain. These pulses are painless and precisely controlled. Unlike medication, rTMS does not alter brain chemistry directly—it instead modulates the underlying neural activity, improving communication within the mood-regulation network of the brain.
Depending on the frequency used, rTMS can either enhance or reduce activity in targeted brain regions. High-frequency stimulation (typically 5–10 Hz) is used to increase activity in underactive areas like the DLPFC. This approach has proven particularly effective for Parkinson’s patients suffering from treatment-resistant depression.
Multiple meta-analyses and randomized controlled trials have demonstrated the effectiveness of rTMS in treating depression among individuals with Parkinson’s disease. A meta-analysis published in 2015, which included eight randomized controlled trials, found that rTMS led to significant improvements in depression symptoms compared to sham (placebo) treatment. These improvements were consistently reflected in widely used clinical tools, such as the Hamilton Depression Rating Scale (HAMD) and the Beck Depression Inventory (BDI).
Beyond its measurable effects on mood, rTMS has also been shown to perform equally well or even better than traditional antidepressant medications. Importantly, rTMS achieves these results without the risk of aggravating motor symptoms, a common side effect of many pharmacological treatments in Parkinson’s disease. In fact, in some studies, patients treated with rTMS reported not only mood improvements but also enhancements in motor function and cognitive clarity, suggesting a broader neurological benefit.
Further reinforcing these clinical outcomes, functional MRI (fMRI) imaging studies have documented neurological changes following rTMS sessions. These studies observed increased activation in the left dorsolateral prefrontal cortex (DLPFC) and the anterior cingulate cortex, two regions that play a key role in emotion regulation, decision-making, and stress response. These neural changes provide compelling physiological evidence for rTMS’s antidepressant mechanism and underscore its potential as a targeted, brain-based therapy for depression in Parkinson’s disease.
Repetitive Transcranial Magnetic Stimulation (rTMS) has an excellent safety profile. Across multiple clinical trials, patients tolerated the treatment well, with only mild side effects such as temporary scalp discomfort or light headaches.
Sessions are typically conducted over a course of several weeks, with each session lasting around 20–30 minutes. Patients are able to return to their normal activities immediately afterward, making rTMS a convenient and low-disruption option for many.
Repetitive Transcranial Magnetic Stimulation (Rtms) is particularly suitable for patients with Parkinson’s disease who suffer from moderate to severe depression, especially when standard treatments like antidepressants or psychotherapy have failed. It is also ideal for those who are sensitive to medication side effects or wish to avoid additional drug therapies due to already complex treatment regimens. Furthermore, patients who have comorbid conditions such as anxiety or sleep disturbances may also experience improvements in these symptoms through rTMS.