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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
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 (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
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Chapter 4. The Pre-ECT Medical Workup
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Metadata
- 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 (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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