Brugada syndrome (BrS) is a common occult cause of sudden cardiac arrest in otherwise healthy-appearing adults. The pathognomonic electrocardiographic pattern may be unmasked only by certain medications, many of which are unknown. We report a case of a depressed but otherwise healthy man with an asymptomatic right bundle branch block on electrocardiography who experienced antidepressant-induced BrS and ultimately recovered with transcranial magnetic stimulation (TMS). After an initial trial of nortriptyline, the patient's depressive symptoms improved; however, he experienced a syncopal event and was subsequently diagnosed as having BrS. Cross titration to bupropion, which had not previously been known to exacerbate BrS, was followed by another cardiac event. As a result, the patient was referred for TMS as a substitute for pharmacotherapy. After 31 TMS sessions over 8 weeks, the patient demonstrated significant improvement by subjective report and objective reduction in his Patient Health Questionnaire-9 scores from 10 (moderate) to 1 (minimal). Transcranial magnetic stimulation is a Food and Drug Administration-approved nonpharmacologic treatment for depression. Given the potential lethality of BrS with known and unknown psychopharmacologic agents, providers should consider TMS as first-line therapy in this patient population. Bupropion should be added to the list of agents known to exacerbate this disease.

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Repetitive transcranial magnetic stimulation (rTMS) offers a noninvasive, safe, and well-toleratedmethodofneuromodulation.WereviewedexistingliteraturecoveringrTMStreatment of posttraumatic stress disorder (PTSD), schizophrenia, dementia, bipolar disorder, obsessive-compulsive disorder (OCD), autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD). Data for PTSD suggest the right dorsolateral prefrontal cortex may be a potential treatment site. rTMS in schizophrenia suggests high-frequency stimulation of the left DLPFC may have some benefit for negative symptoms, and low-frequency stimulation of the primary auditory cortex may assist with auditory hallucinations. The role of rTMS in the diagnosis and treatment of dementia is promising, but further studies are needed. Data for bipolar disorder are inconsistent across the spectrum of mood states. Treatment of OCD by stimulation of the supplementary motor area may have promise. Data are lacking regarding use of rTMS for ASD or ADHD to draw definitive conclusions. [ Psychiatr Ann . 2014; 44(6):293–298.]