The effects of bilateral theta-burst stimulation on executive functions and affective symptoms in major depressive disorder
Open accessAbstract
Major depressive disorder (MDD) is characterized by severe affective as well as cognitive symptoms. Moreover, cognitive impairment in MDD can persist after the remission of affective symptoms. Theta-burst stimulation (TBS) is a promising tool to manage the affective symptoms of major depressive disorder (MDD); however, its cognition-enhancing effects are sparsely investigated. Here, we aimed to examine whether the administration of bilateral TBS has pro-cognitive effects in MDD. Ten daily sessions of neuronavigated active or sham TBS were delivered bilaterally over the dorsolateral prefrontal cortex to patients with MDD. The n-back task and the attention network task were administered to assess working memory and attention, respectively. Affective symptoms were measured using the 21-item Hamilton Depression Rating Scale. We observed moderate evidence that the depressive symptoms of patients receiving active TBS improved compared to participants in the sham stimulation. No effects of TBS on attention and working memory were detected, supported by a moderate-to-strong level of evidence. The effects of TBS on psychomotor processing speed should be further investigated. Bilateral TBS has a substantial antidepressive effect with no immediate adverse effects on executive functions.
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There were findings of neurocognitive enhancement in attention (Holczer et al., 2021).
“There were also findings of neurocognitive enhancement, specifically in attention (Holczer et al., 2021)”
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 Holczer et al., 2021
The Attention network task results report no significant improvement in alerting, orienting, or executive attention. The Discussion states that TBS did not produce cognitive enhancement, contrary to the cited claim of enhanced attention. Page numbers are unavailable in our copy. (LLM, conf=0.92)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredHolczer et al. (2021) found a potential effect of TBS on 1-back task performance characterized by shorter reaction times at the post-treatment timepoint compared to baseline.
“However, they found a potential effect of TBS on 1-back task performance characterized by shorter reaction times at the post-treatment timepoint compared to baseline.”
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 Holczer et al., 2021
Holczer et al. (2021) reported no significant difference in attentional processes such as alerting and orienting on the Attention Network Task or working memory on two- and three-conditions of a computerized N-back task.
“Holczer et al. (2021) reported no significant difference in attentional processes, such as alerting and orienting, on the Attention Network Task (ANT) or working memory on two-and three-conditions of a computerized Nback task.”
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 Holczer et al., 2021
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- Authors
- Holczer, A., Németh, V. L., Vékony, T., Kocsis, K., Király, A., Kincses, Z. T., Vécsei, L., Klivényi, P., & Must, A.
- Affiliations
- University of Szeged (HU)
- Lyon 1 Université (FR)
- Central European Institute of Technology (CZ)
- Corresponding author
- Must, Anita
- ORCID
- Venue
- Neuroscience
- Publisher
- Elsevier BV
- Published
- 2021-05
- Volume
- 461
- Pages
- 130-139
- ISSN
- 0306-4522 (ISSN-L)
- OpenAlex
- W3138246752
- Cited by
- 15
- References
- 84
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 8 · 2023: 3 · 2021: 1
- FWCI
- 1.20
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Neuroscience (publishedVersion, cc-by)
- PubMed (publishedVersion)
- SZTE Publicatio Repozitórium (University of Szeged) (acceptedVersion, other-oa)
- Repository of the Academy's Library (Library of the Hungarian Academy of Sciences) (acceptedVersion)
- Funders
- University of Szeged
- 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
- major depressive disorder, theta burst stimulation, executive function, working memory, attention, dorsolateral prefrontal cortex, cognitive impairment, affective symptoms, antidepressant effects, non-invasive brain stimulation, n-back task, Attention Network Task
- MeSH terms
- Affective Symptoms, Depressive Disorder, Major, Major Depressive Disorder, Humans, Treatment Outcome, Prefrontal Cortex, Transcranial Magnetic Stimulation, Executive Function
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