Cited by 308Transcranial Magnetic Stimulation StudiesTreatment of Major DepressionElectroconvulsive Therapy Studies

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rTMS of the Dorsomedial Prefrontal Cortex for Major Depression: Safety, Tolerability, Effectiveness, and Outcome Predictors for 10 Hz Versus Intermittent Theta-burst Stimulation

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Bakker, Nathan, Shahab, Saba, Giacobbe, Peter, Blumberger, Daniel M., Daskalakis, Zafiris J., Kennedy, Sidney H., Downar, Jonathan·2015·Brain Stimulation

DOI 10.1016/j.brs.2014.11.002

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Abstract

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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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: Shahab, Saba
Giacobbe, Peter
Blumberger, Daniel M.
Daskalakis, Zafiris J.
Kennedy, Sidney H.
Downar, Jonathan
Venue: Brain Stimulation
Publisher: Elsevier BV
Published: 2015-03
Volume: 8
Issue: 2
Pages: 208-215
ISSN: 1876-4754 (ISSN-L)
1935-861X
DOI: 10.1016/j.brs.2014.11.002
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: cc-by-nc-nd
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
creativecommons.org/licenses/by-nc-nd/3.0/ (vor)
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 (medical) › 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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rTMS of the Dorsomedial Prefrontal Cortex for Major Depression: Safety, Tolerability, Effectiveness, and Outcome Predictors for 10 Hz Versus Intermittent Theta-burst Stimulation

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