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

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


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.

Original languageEnglish
Pages (from-to)274.e7-274.e9
JournalGeneral Hospital Psychiatry
Issue number3
StatePublished - 1 May 2015


  • Comorbidity
  • Deep transcranial magnetic stimulation (dTMS)
  • Dorsolateral prefrontal cortex (DLPFC)
  • Major depressive disorder
  • Mitochondrial myopathy

ASJC Scopus subject areas

  • Psychiatry and Mental health


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