Is accelerated, high-dose theta burst stimulation a panacea for treatment-resistant depression?
Open accessAbstract
A recent study by Williams et al. (Williams NR, Sudheimer KD, Bentzley BS, Pannu J, Stimpson KH, Duvio D, Cherian K, Hawkins J, Scherrer KH, Vyssoki B, DeSouza D, Raj KS, Keller J, Schatzberg AF. Brain 141: e18, 2018) used accelerated, high-dose intermittent theta burst stimulation (iTBS) to treat highly treatment-resistant depression patients. Remarkably, most patients remitted, but the durability of therapeutic response was weak and all patients relapsed within 2 wk posttreatment. This mini-review examines the “fast on, fast off” effects of accelerated, high-dose iTBS for depression and suggests a new treatment that would combine the strengths of multiple extant iTBS protocols.
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The SAINT/SNT TMS paradigm shows rapid and significant antidepressant effects with remission rates up to 78.6% in randomized controlled trials.
“Notably, the SAINT/SNT paradigm, shows rapid and significant effects with remission rates up to 78.6% in randomized controlled trials [108,109,110,111].”
From The Heart’s Electromagnetic Field in Emotions, Empathy and Human Connection: Biosensor-Derived Insights into Heart–Brain Axis Mechanisms and a Basis for Novel BioMagnetoTherapies (2026) · cites this paper as [109]
In “A Second Benefit of TBS: Accelerated, High-Dose Treatment Protocols” (page not specified), the paper reports rapid remission with accelerated iTBS in five of six patients. It gives a remission rate of 83.3%, not 78.6%, and does not identify that six-patient study as a randomized controlled trial or call its protocol SAINT/SNT. (LLM, conf=0.88)
Experimental — accuracy not yet measuredSingle-pulse TMS reduces monthly headache days in migraines, especially with aura, sustained up to 12 months in difficult-to-treat cohorts, but results for chronic migraine remain inconclusive.
“In migraines, especially with aura, single-pulse TMS studies report significant reductions in monthly headache days, sustained up to 12 months in difficult-to-treat cohorts [107,108,109,110,111,119,120,121,122], while results for chronic migraine remain inconclusive [117,122].”
From The Heart’s Electromagnetic Field in Emotions, Empathy and Human Connection: Biosensor-Derived Insights into Heart–Brain Axis Mechanisms and a Basis for Novel BioMagnetoTherapies (2026) · cites this paper as [109]
The section “A Brief Background on Transcranial Magnetic Stimulation” says that an FDA-approved treatment for migraine with aura uses a single TMS pulse. It does not report reductions in monthly headache days, effects sustained for 12 months in difficult-to-treat cohorts, or inconclusive results for chronic migraine. Page numbers are not available in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measured
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Cites
Theta Burst Stimulation of the Human Motor Cortex
Huang, Y.-Z., Edwards, M. J., Rounis, E., Bhatia, K. P., & Rothwell, J. C. (2005) · Neuron · doi:10.1016/j.neuron.2004.12.033 · Cited by 4,158 · see citing works
J Neuropsychiatry Clin Neurosci
Yudofsky, S. C., & Hales, R. E. (1992) · The Journal of Neuropsychiatry and Clinical Neurosciences · doi:10.1176/jnp.4.4.359 · Cited by 3,818 · see citing works
O’Reardon, J. P., Solvason, H. B., Janicak, P. G., Sampson, S., Isenberg, K. E., Nahas, Z., McDonald, W. M., Avery, D., Fitzgerald, P. B., Loo, C., et al. (2007) · Biological Psychiatry · doi:10.1016/j.biopsych.2007.01.018 · Cited by 1,910 · see citing works
Transcranial magnetic stimulation: a primer.
Hallett, M. (2007) · Neuron · doi:10.1016/j.neuron.2007.06.026 · Cited by 1,886 · see citing works
Blumberger, D. M., Vila-Rodriguez, F., Thorpe, K. E., Feffer, K., Noda, Y., Giacobbe, P., Knyahnytska, Y., Kennedy, S. H., Lam, R. W., Daskalakis, Z. J., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(18)30295-2 · Cited by 1,363 · see citing works
Daily repetitive transcranial magnetic stimulation (rTMS) improves mood in depression
George, M. S., Wassermann, E. M., Williams, W. A., Callahan, A., Ketter, T. A., Basser, P., Hallett, M., & Post, R. M. (1995) · NeuroReport · doi:10.1097/00001756-199510020-00008 · Cited by 954 · see citing works
Default mode network mechanisms of transcranial magnetic stimulation in depression
Liston, C., Chen, A. C., Zebley, B. D., Drysdale, A. T., Gordon, R., Leuchter, B., Voss, H. U., Casey, B. J., Etkin, A., & Dubin, M. J. (2014) · Biological Psychiatry · doi:10.1016/j.biopsych.2014.01.023 · Cited by 763 · see citing works
Brain activity during transient sadness and happiness in healthy women
(1995) · American Journal of Psychiatry · doi:10.1176/ajp.152.3.341 · Cited by 737 · see citing works
Carpenter, L. L., Janicak, P. G., Aaronson, S. T., Boyadjis, T. A., Brock, D. G., Cook, I. A., Dünner, D. L., Lanocha, K. I., Solvason, H. B., & Demitrack, M. A. (2012) · Depression and Anxiety · doi:10.1002/da.21969 · Cited by 371 · see citing works
Tenebäck, C. C., Nahas, Z. H., Speer, A. M., Molloy, M. A., Stallings, L. E., SPICER, K. M., Risch, S. C., & George, M. S. (1999) · Journal of Neuropsychiatry · doi:10.1176/jnp.11.4.426 · Cited by 249 · see citing works
High-dose spaced Theta-burst TMS as a rapid-acting antidepressant in highly refractory depression
Williams, N. R., Sudheimer, K. D., Bentzley, B. S., Pannu, J., Stimpson, K. H., Duvio, D., Cherian, K., Hawkins, J., Scherrer, K. H., Vyssoki, B., et al. (2018) · Brain · doi:10.1093/brain/awx379 · Cited by 215 · see citing works
Neurostimulation for Treatment of Migraine and Cluster Headache
Schwedt, T. J., & Vargas, B. B. (2015) · Pain Medicine · doi:10.1111/pme.12792 · Cited by 93 · see citing works
Response to deep TMS in depressive patients with previous electroconvulsive treatment
Rosenberg, O., Zangen, A., Stryjer, R., Kotler, M., & Dannon, P. N. (2009) · Brain stimulation · doi:10.1016/j.brs.2009.12.001 · Cited by 35 · see citing works
George, M. S. (2010) · Brain stimulation · doi:10.1016/j.brs.2010.08.002 · Cited by 2 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Bulteau, S., Laurin, A., Péré, M., Fayet, G., Thomas-Ollivier, V., Deschamps, T., Auffray-Calvier, E., Bukowski, N., Vanelle, J., Sebille, V., et al. (2022) · Brain stimulation · doi:10.1016/j.brs.2022.05.011 · Cited by 100 · see citing works
Caulfield, K. A., Fleischmann, H. H., George, M. S., & McTeague, L. M. (2022) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2022.06.038 · Cited by 99 · see citing works
Self-citationOptimization Strategies of Transcranial Magnetic Stimulation in Major Depressive Disorder
Wen, K.-S., & Zheng, W. (2024) · ALPHA PSYCHIATRY · doi:10.5152/alphapsychiatry.2023.231401 · Cited by 45 · see citing works
Lenze, E. J., Nicol, G. E., Barbour, D. L., Kannampallil, T., Wong, A. W. K., Piccirillo, J., Drysdale, A. T., Sylvester, C. M., Haddad, R., Miller, J. P., et al. (2021) · Journal of Psychiatry and Neuroscience · doi:10.1503/jpn.200042 · Cited by 43 · see citing works
Dose-response of intermittent theta burst stimulation of the prefrontal cortex: A TMS-EEG study
Desforges, M., Hadas, I., Mihov, B., Morin, Y., Braün, M. R., Lioumis, P., Zomorrodi, R., Théoret, H., Lepage, M., Daskalakis, Z. J., et al. (2022) · Clinical Neurophysiology · doi:10.1016/j.clinph.2021.12.018 · Cited by 42 · see citing works
Caulfield, K. A., Li, X., & George, M. S. (2021) · Clinical Neurophysiology · doi:10.1016/j.clinph.2021.06.015 · Cited by 36 · see citing works
Self-citationLan, X.-J., Yang, X.-H., Qin, Z.-J., Cai, D.-B., Liu, Q.-M., Mai, J.-X., Deng, C.-J., Huang, X., & Zheng, W. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1244289 · Cited by 35 · see citing works
Gonsalves, M. A., White, T. L., Barredo, J., Fukuda, A. M., Joyce, H. E., Harris, A. D., & Carpenter, L. L. (2022) · NeuroImage Clinical · doi:10.1016/j.nicl.2022.103049 · Cited by 29 · see citing works
Lin, H., Liang, J., Wang, Q., Shao, Y., Song, P., Li, S., & Bai, Y. (2024) · Cerebral Cortex · doi:10.1093/cercor/bhae106 · Cited by 26 · see citing works
Self-sustainable intermittent deep brain stimulator
Elsanadidy, E., Mosa, I. M., Hou, B., Schmid, T., El‐Kady, M. F., Khan, R. S., Haeberlin, A., Tzingounis, A. V., & Rusling, J. F. (2022) · Cell Reports Physical Science · doi:10.1016/j.xcrp.2022.101099 · Cited by 23 · see citing works
Miron, J., Voetterl, H., Fox, L., Hyde, M., Mansouri, F., Dees, S., Zhou, R., Sheen, J., Jodoin, V. D., Mir-Moghtadaei, A., et al. (2021) · Psychiatry Research · doi:10.1016/j.psychres.2021.113790 · Cited by 22 · see citing works
Geoly, A. D., Stimpson, K. H., Espil, F. M., Bentzley, B. S., & Williams, N. (2025) · Brain stimulation · doi:10.1016/j.brs.2025.04.006 · Cited by 18 · see citing works
Konstantinou, G., Downar, J. H., Daskalakis, Z. J., & Blumberger, D. M. (2020) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2020.07.007 · Cited by 18 · see citing works
Synchronized cervical VNS with accelerated theta burst TMS for treatment resistant depression
George, M. S., Caulfield, K. A., O’Leary, K., Badran, B. W., Short, E. B., Huffman, S. M., Li, X., Kerns, S. E., & Williams, N. (2020) · Brain stimulation · doi:10.1016/j.brs.2020.08.002 · Cited by 12 · see citing works
Self-citationGeorge, M. S., Caulfield, K. A., & Wiley, M. (2022) · Handbook of clinical neurology · doi:10.1016/b978-0-12-819410-2.00028-x · Cited by 9 · see citing works
Self-citationKonstantinou, G., Trevizol, A. P., Goldbloom, D. S., Downar, J. H., Daskalakis, Z. J., & Blumberger, D. M. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.09.114 · Cited by 9 · see citing works
Accelerated transcranial magnetic stimulation for major depressive disorder: A quick path to relief?
Tang, N., Shu, W., & Wang, H. (2023) · Wiley Interdisciplinary Reviews Cognitive Science · doi:10.1002/wcs.1666 · Cited by 5 · see citing works
Effects of brain estrogen receptor on depression and its mechanism of action
Wen, Y., Gao, K., Tong, G., Meng, X., Pan, M., Wang, Y., Meng, D., Zheng, Y., & Yue, G.-X. (2024) · Guidelines and Standards of Chinese Medicine · doi:10.1097/gscm.0000000000000026 · Cited by 4 · see citing works
Acupuncture intervening depressive disorder: research progress in its neurobiological mechanism
Li, P., Xiao, M., Ma, X., Yan, X., & Ma, C.-B. (2023) · Journal of Acupuncture and Tuina Science · doi:10.1007/s11726-023-1381-5 · Cited by 4 · see citing works
Wen, K.-S., Yang, X.-H., Zhang, N., Lin, S., Huang, X., Jackson, T., Xiang, Y., & Zheng, W. (2024) · ALPHA PSYCHIATRY · doi:10.5152/alphapsychiatry.2024.241799 · Cited by 4 · see citing works
Caulfield, K. A., Lopez, J. W., Cox, C. E., Roberts, D. R., & McTeague, L. M. (2020) · Brain stimulation · doi:10.1016/j.brs.2020.02.003 · Cited by 3 · see citing works
Self-citationLi, S. M., Xiao, M., Ma, C.-B., & Yan, X. (2025) · 世界针灸杂志：英文版 · doi:10.1016/j.wjam.2025.06.004 · Cited by 2 · see citing works
Palantzas, A., & Anagnostouli, M. (2026) · Sensors · doi:10.3390/s26051738 · Cited by 1 · see citing works
Unlocking the potential of psychedelics as medicine: Past obstacles and future outlooks
Kim, S. Y., Collins, R.-N., Teng, J., & Kalinowski, L. (2023) · MIT Science Policy Review · doi:10.38105/spr.osqbpecncp · Cited by 1 · see citing works
Modirrousta, M., Meek, B. P., & Aoun, M. A. (2021) · Advances in Psychiatry and Behavioral Health · doi:10.1016/j.ypsc.2021.05.002
Marques, R. C., Marques, D., & Vieira, L. (2022) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2022.100449
- Authors
- Caulfield, K. A.
- Affiliations
- Medical University of South Carolina (US)
- Corresponding author
- Caulfield, Kevin A.
- ORCID
- Caulfield, Kevin A.
- Venue
- Journal of Neurophysiology
- Publisher
- American Physiological Society
- Published
- 2020-01-01
- Volume
- 123
- Issue
- 1
- Pages
- 1-3
- ISSN
- 0022-3077 (ISSN-L)
- 1522-1598
- OpenAlex
- W2975161579
- Cited by
- 26
- References
- 14
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 4 · 2023: 4 · 2022: 7 · 2021: 4 · 2020: 4
- FWCI
- 1.65
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Neurophysiology (publishedVersion)
- PubMed (publishedVersion)
- 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
- intermittent theta burst stimulation, treatment-resistant depression, remission, relapse, non-invasive brain stimulation
- MeSH terms
- Humans, Outcome Assessment, Health Care, Transcranial Magnetic Stimulation, Depressive Disorder, Treatment-Resistant
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