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Accelerated theta burst stimulation for the treatment of depression: A randomised controlled trial
Open accessAbstract
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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“A recent trial suggested similar outcomes for TBS at 80% vs 120% RMT.40”
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Bracht, T., Borel, P., Dendorfer, S., Soravia, L. M., Adorjan, K., Walther, S., Federspiel, A., Wiest, R., Florineth, G. A., & Denier, N. (2026) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-026-02355-2
Wass, C., Geiger, F., Aiff, H., Hieronymus, F., & Hagsäter, M. (2026) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2026.101175
Abdelnaim, M. A., Reißmann, A., Kerkel, K., Aamer, M., Hüebner, J., Poeppl, T. B., Schoisswohl, S., & Langguth, B. (2026) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-026-02384-x
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Self-citationCoomans, A. C., de Roij, L. V., Oostra, E., Hoogendoorn, A. W., van der Werf, Y. D., van den Heuvel, O. A., & van Exel, E. R. (2026) · Transcranial magnetic stimulation . · doi:10.1016/j.transm.2026.100337
Metadata
- 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
- ORCID
- 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
- gold
- doi.org
- Licence
- 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 (medical) › 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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