rTMS of the dorsomedial prefrontal cortex for major depression: Safety, tolerability, effectiveness, and outcome predictors for 10 Hz versus intermittent theta-burst stimulation
Open accessAbstract
BACKGROUND: Conventional rTMS protocols for major depression commonly employ stimulation sessions lasting >30 min. However, recent studies have sought to improve costs, capacities, and outcomes by employing briefer protocols such as theta burst stimulation (iTBS). OBJECTIVE: To compare safety, effectiveness, and outcome predictors for DMPFC-rTMS with 10 Hz (30 min) versus iTBS (6 min) protocols, in a large, naturalistic, retrospective case series. METHODS: A chart review identified 185 patients with a medication-resistant major depressive episode who underwent 20-30 sessions of DMPFC-rTMS (10 Hz, n = 98; iTBS, n = 87) at a single Canadian clinic from 2011 to 2014. RESULTS: Clinical characteristics of 10 Hz and iTBS patients did not differ prior to treatment, aside from significantly higher age in iTBS patients. A total 7912 runs of DMPFC-rTMS (10 Hz, 4274; iTBS, 3638) were administered, without any seizures or other serious adverse events, and no significant differences in rates of premature discontinuation between groups. Dichotomous outcomes did not differ significantly between groups (Response/remission rates: Beck Depression Inventory-II: 10 Hz, 40.6%/29.2%; iTBS, 43.0%/31.0%. 17-item Hamilton Rating Scale for Depression: 10 Hz, 50.6%/38.5%; iTBS, 48.5%/27.9%). On continuous outcomes, there was no significant difference between groups in pre-treatment or post-treatment scores, or percent improvement on either measure. Mixed-effects modeling revealed no significant group-by-time interaction on either measure. CONCLUSIONS: Both 10 Hz and iTBS DMPFC-rTMS appear safe and tolerable at 120% resting motor threshold. The effectiveness of 6 min iTBS and 30 min 10 Hz protocols appears comparable. Randomized trials comparing 10 Hz to iTBS may be warranted.
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Numerous studies of TBS for TRD have been published, but studies tend to report reduction in depressive symptoms as the sole outcome measure, focus on neuroimaging, or report other clinical outcomes.
“Numerous studies of TBS for TRD have been published, but studies tend to report reduction in depressive symptoms as the sole outcome measure (e.g., Bakker et al., 2015;Blumberger et al., 2018;Blumberger et al., 2021;Bouaziz et al., 2023;Bulteau et al., 2022;Caeyenberghs et al., 2018;Chen et al., 2021;Lee et al., 2021;Mehta et al., 2022;Spitz et al., 2022;Spurny-Dworak et al., 2022;Stöhrmann et al.”
From Neurocognitive effects of theta burst stimulation for treatment-resistant depression in adults: A systematic review and recommendations for future research (2025) · cites this paper as Bakker et al., 2015
The Results (page unavailable) report reduced depressive symptoms in the iTBS group on the HamD17 and BDI-II scales. But the Results also report safety and tolerability outcomes, including adverse events and premature discontinuation, so symptom reduction was not the sole outcome reported by this study. (LLM, conf=0.87)
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Self-citationCurrent Updates on Newer Forms of Transcranial Magnetic Stimulation in Major Depression
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Is theta burst stimulation ready as a clinical treatment for depression?
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- Authors
- Bakker, N., Shahab, S., Giacobbe, P., Blumberger, D. M., Daskalakis, Z. J., Kennedy, S. H., & Downar, J.
- Affiliations
- University Health Network (CA)
- Centre for Addiction and Mental Health (CA)
- University of Toronto (CA)
- ORCID
- Venue
- Brain Stimulation
- Publisher
- Elsevier BV
- Published
- 2015-03
- Volume
- 8
- Issue
- 2
- Pages
- 208-215
- ISSN
- 1876-4754 (ISSN-L)
- 1935-861X
- OpenAlex
- W2052249755
- Cited by
- 306
- References
- 35
- Citations by year
- 2026: 17 · 2025: 33 · 2024: 23 · 2023: 29 · 2022: 25 · 2021: 24 · 2020: 25 · 2019: 43 · 2018: 26 · 2017: 31 · 2016: 25 · 2015: 5
- FWCI
- 10.59
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Brain stimulation (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Keywords
- repetitive transcranial magnetic stimulation, dorsomedial prefrontal cortex, major depressive disorder, treatment-resistant depression, intermittent theta burst stimulation, 10 Hz stimulation, safety and tolerability, prognostic factors
- MeSH terms
- Adult, Depressive Disorder, Major, Major Depressive Disorder, Female, Humans, Male, Middle Aged, Personality Inventory, Psychiatric Status Rating Scales, Retrospective Studies, Theta Rhythm, Treatment Outcome, Prefrontal Cortex, Transcranial Magnetic Stimulation, Young Adult
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