Cited by 105Transcranial Magnetic Stimulation StudiesElectroconvulsive Therapy StudiesTreatment of Major Depression

Accelerated theta burst stimulation for the treatment of depression: a randomised controlled trial

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Chen, Leo, Thomas, Elizabeth H.X., Kaewpijit, Pakin, Miljevic, Aleksandra, Hughes, Rachel, Hahn, Lisa, Kato, Yuko, Gill, Shane +8 more·2021·Brain Stimulation

Abstract

INTRODUCTION: Theta burst pattern repetitive transcranial magnetic stimulation (TBS) is increasingly applied to treat depression. TBS's brevity is well-suited to application in accelerated schedules. Sizeable trials of accelerated TBS are lacking; and optimal TBS parameters such as stimulation intensity are not established. METHODS: We conducted a three arm, single blind, randomised, controlled, multi-site trial comparing accelerated bilateral TBS applied at 80 % or 120 % of the resting motor threshold and left unilateral 10 Hz rTMS. 300 patients with treatment-resistant depression (TRD) were recruited. TBS arms applied 20 bilateral prefrontal TBS sessions over 10 days, while the rTMS arm applied 20 daily sessions of 10 Hz rTMS to the left prefrontal cortex over 4 weeks. Primary outcome was depression treatment response at week 4. RESULTS: The overall treatment response rate was 43.7 % and the remission rate was 28.2 %. There were no significant differences for response (p = 0.180) or remission (p = 0.316) across the three groups. Response rates between accelerated bilateral TBS applied at sub- and supra-threshold intensities were not significantly different (p = 0.319). Linear mixed model analysis showed a significant effect of time (p < 0.01), but not rTMS type (p = 0.680). CONCLUSION: This is the largest accelerated bilateral TBS study to date and provides evidence that it is effective and safe in treating TRD. The accelerated application of TBS was not associated with more rapid antidepressant effects. Bilateral sequential TBS did not have superior antidepressant effect to unilateral 10 Hz rTMS. There was no significant difference in antidepressant efficacy between sub- and supra-threshold accelerated bilateral TBS.

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  1. [78]78. Gorman, J.M. Comorbid depression and anxiety spectrum disorders Depress Anxiety. 1996; 4(4):160-168 Crossref Scopus (469) PubMed Google Scholar
  2. [89]89. Ziemann, U.T.M.S. drugs Clin Neurophysiol. 2004; 115(8):1717-1729 Crossref Scopus (547) PubMed Google Scholar

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Authors
Chen, L., Thomas, E. H. X., Kaewpijit, P., Miljevic, A., Hughes, R., Hahn, L., Kato, Y., Gill, S., Clarke, P., Ng, F., Paterson, T., Giam, A., Sarma, S., Hoy, K. E., Galletly, C., & Fitzgerald, P. B.
Affiliations
  • Epworth Hospital (AU)
  • Monash Alfred Psychiatry Research centre (AU)
  • SA Health (AU)
  • Central Adelaide Local Health Network (AU)
  • Gold Coast Hospital (AU)
Corresponding author
Chen, Leo
Venue
Brain Stimulation
Publisher
Elsevier BV
Published
2021-09
Volume
14
Issue
5
Pages
1095-1105
ISSN
  • 1876-4754 (ISSN-L)
  • 1935-861X
OpenAlex
W3188020264
Cited by
105
References
94
Citations by year
2026: 23 · 2025: 31 · 2024: 19 · 2023: 18 · 2022: 11 · 2021: 3
FWCI
5.11
Type
journal article
Language
en
Update notices
erratum (2021-09-01)
Open access
Locations
  • Brain stimulation (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion, cc-by-nc-nd)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
NHMRC
Topics
  • Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
  • Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Keywords
theta burst stimulation, repetitive transcranial magnetic stimulation, treatment-resistant depression, 10 Hz rTMS, stimulation intensity, resting motor threshold, antidepressant efficacy, remission
MeSH terms
Antidepressive Agents, Depression, Humans, Single-Blind Method, Treatment Outcome, Prefrontal Cortex, Transcranial Magnetic Stimulation, Depressive Disorder, Treatment-Resistant

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