A pilot investigation of an intensive theta burst stimulation protocol for patients with treatment resistant depression

Abstract

Introduction: Accelerated or intensive forms of repetitive transcranial magnetic stimulation (rTMS) are increasingly being explored for their potential to produce more efficient and rapid treatment benefits in major depressive disorder (MDD). However, accelerated or intensive protocols using standard forms of rTMS are still quite time-consuming to apply. Theta burst stimulation (TBS) is a novel form of magnetic stimulation with the potential to produce similar anti-depressant effects but in a much abbreviated period of time. The aim of this study was to investigate the comparative efficacy of an intensive TBS protocol compared to standard rTMS treatment. Methods: 74 outpatients (36 female, mean age 44.36 ± 12.1 years) with MDD received either intensive TBS (3 intermittent TBS treatments per day for 3 days in week 1, 3 treatments a day for 2 days in week 2, and 3 treatments in 1 day in week 3 and in week 4, or standard rTMS (5 daily sessions per week for 4 weeks). Patients were assessed weekly throughout the treatment course, and at 4 weeks after treatment end. Results: There were no significant differences in the degree of reduction in depressive symptoms, the rate of reduction in depressive symptoms, remission or response rates (response rates ¼ 27.8% for intensive group, 26.3% for the standard group, p > 0.05 for all analyses) between the intensive TBS and standard rTMS treatment groups. However, the overall response and remission rates were limited in both groups. There was no difference in rates of side effects, no serious adverse events and no alterations in cognitive performance. Conclusion: Intensively applied TBS appears to have similar efficacy to standard rTMS when these were applied as delivered in this study but does not produce more rapid clinical benefits. The overall response rates in both groups in this study were limited, most likely by the total doses provided in both study arms. Clinical trials registration: Australian New Zealand Clinical Trials Registry: ACTRN12616000443493.

A Systematic Review of Neuromodulation Treatment Effects on Suicidality

“…Two studies comparing the efficacy of accelerated TMS to standard TMS also showed the significant improvement in suicidal ideation from baseline even though groups did not differ in terms of improvement. Fitzgerald et al (2020) compared the accelerated rTMS treatment and standard rTMS treatment in terms of clinical efficacy in patients with TRD. In a 2group, single-blind, randomized, controlled trial, they enrolled 36 patients in an accelerated intermittent TBS group and 38 patients in a standard rTMS treatment group.…”

Treatment‐resistant depression: An overview for psychiatric advanced practice nurses

“…Classifications of rTMS are generally equally efficacious. 63 Accelerated or intensive forms of rTMS, such as theta burst stimulation, may improve depressive symptoms over a shorter duration of time, 64 by providing a similar number of treatment sessions as routine protocol over a shorter period of time. rTMS has been found effective in managing TRD, with those receiving rTMS more than five times likely to achieve remission compared with their counterparts.…”

The Role of Gut Mucins in the Etiology of Depression

“…Similarly, ketamine, which is believed to correct depressive symptoms by increasing neurogenesis and dendritic spine formation, can act within hours of infusion-before changes in neuronal plasticity have been observed (Soumier et al, 2016). While many people have been treated successfully with these methods, as many as 30% of patients diagnosed with depression remain resistant to treatment (Fitzgerald et al, 2020). Furthermore, as the heritability of depression is only thought to account for 40-50% of cases, environmental factors that influence mood disorders must be considered as potential therapeutic targets (Levinson, 2006).…”