Efficacy of Repetitive Transcranial Magnetic Stimulation for Improving Depressive Symptoms in Patients With Parkinson's Disease

Prior treatment

• Patients with artificial hip joint implants
• Presence of conductive, ferromagnetic, or magnetically sensitive metal near the head or treatment coil (e.g., cochlear implants, implanted electrodes/stimulators, aneurysm clips or coils)
• Use of drug infusion pumps or hearing aids
• Currently enrolled in another clinical trial or used investigational drug/device within 30 days or 5 half-lives prior to consent

Other illness

• History of epilepsy
• Parkinson's disease caused by cerebrovascular disease, CNS infection, intoxication, or traumatic brain injury
• Diagnosed with Parkinson-plus syndromes (multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, dementia with Lewy bodies etc.)
• Major psychiatric disorders other than depressive disorders (e.g., bipolar disorder, psychotic disorders) that may interfere with study participation or assessment of depressive symptoms
• Cardiac disease, especially patients with pacemakers
• Patients with acute illness
• Patients taking tricyclic antidepressants, neuroleptics, or other medications that may lower seizure threshold
• History of increased intracranial pressure or head trauma
• History of schizophrenia, bipolar disorder, or substance abuse
• History of or planned deep brain stimulation or stereotactic surgery (pallidotomy, thalamotomy)
• Any participant deemed ineligible by the investigator, including those with medical conditions that may increase risk or interfere with study evaluation

Lab values

• Clinically significant abnormal laboratory values (AST, ALT, or total bilirubin \> 2.5 x ULN)

Other

• Unable to follow instructions or communicate
• Pregnant, breastfeeding, or women of childbearing potential
• Febrile patients
• Corrected or uncorrected visual acuity less than 0.5
• Evidence of external wounds on brain or neck
• Prominent psychotic symptoms other than depression (high NPI scores for hallucinations, delusions, mania)
• Suicidal ideation (BDI-II item 9 score of 2 or 3)

• Willing and able to provide written informed consent
• Male or female aged 40 to 90 years
• Diagnosed with Parkinson's disease with depressive symptoms
• Hoehn and Yahr stage 1 to 3
• On stable Parkinson's disease medication for at least 3 months prior to screening, with no planned dose increase during the study period
• Clinically significant depressive symptoms (BDI-II score ≥14) confirmed by clinician interview, without major psychiatric conditions that may confound their assessment
• Able to read and write Korean and capable of independently completing questionnaires