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Cited by 106Transcranial Magnetic Stimulation StudiesTreatment of Major DepressionElectroconvulsive Therapy Studies

Unilateral and bilateral MRI-targeted repetitive transcranial magnetic stimulation for treatment-resistant depression: a randomized controlled study

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Blumberger, Daniel M., Maller, Jerome J., Thomson, Lauren, Mulsant, Benoit H., Rajji, Tarek K., Maher, Missy, Brown, Patrick E., Downar, Jonathan +3 more·2016·Journal of Psychiatry and Neuroscience
DOI 10.1503/jpn.150265PMC PMC4915938
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Abstract

Background: Several factors may mitigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) over sham rTMS in patients with treatment-resistant depression (TRD). These factors include unilateral stimulation (i.e., treatment of only the left dorsolateral prefrontal cortex [DLPFC]), suboptimal methods of targeting the DLPFC and insufficient stimulation intensity (based on coil-to-cortex distance). Methods: We recruited patients with TRD between the ages of 18 and 85 years from a university hospital, and participants were randomized to receive sequential bilateral rTMS (600 pulses at 1 Hz followed by 1500 pulses at 10 Hz), unilateral high-frequency left (HFL)-rTMS (2100 pulses at 10 Hz) or sham rTMS for 3 or 6 weeks depending on treatment response. Stimulation was targeted with MRI localization over the junction of the middle and anterior thirds of the middle frontal gyrus, using 120% of the coil-to-cortex adjusted motor threshold. Our primary outcome of interest was the remission rate. Results: A total of 121 patients participated in this study. The remission rate was significantly higher in the bilateral group than the sham group. The remission rate in the HFL-rTMS group was intermediate and did not differ statistically from the rate in the 2 other groups. There were no significant differences in reduction of depression scores among the 3 groups. Limitations: The number of pulses used per session in the unilateral group was somewhat lower in our trial than in more recent trials, and the sham condition did not involve active stimulation. Conclusion: Our findings suggest that sequential bilateral rTMS is superior to sham rTMS; however, adjusting for coil-to-cortex distance did not yield enhanced efficacy rates.

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  • Prior research has indicated that the sequential bilateral approach involving inhibitory stimulation (1 Hz) to the right DLPFC and excitatory stimulation (10 Hz) to the left DLPFC has exhibited efficacy with standard rTMS and cTBS on the right and iTBS on the left, and has recently demonstrated effectiveness in older individuals.

    “Prior research has indicated that the sequential bilateral approach involving inhibitory stimulation (1 Hz) to the right DLPFC and excitatory stimulation (10 Hz) to the left DLPFC has exhibited efficacy with standard rTMS18,19 and continuous theta-burst stimulation (cTBS) on the right and iTBS on the left,20 and has recently demonstrated effectiveness in older individuals.21”

    From Can Intermittent Theta-Burst Stimulation of Dorsolateral Prefrontal Cortex Relieve Executive Dysfunction in Patients With Late-Life Depression? (2024) · cites this paper as [19]

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Authors
Blumberger, D. M., Maller, J. J., Thomson, L., Mulsant, B. H., Rajji, T. K., Maher, M., Brown, P. E., Downar, J., Vila-Rodriguez, F., Fitzgerald, P. B., & Daskalakis, Z. J.
Affiliations
  • University Health Network (CA)
  • the Non-Invasive Neurostimulation Therapies laboratory, Department of Psychiatry, University of British Columbia, Vancouver, B.C., Canada
ORCID
Venue
Journal of Psychiatry and Neuroscience
Publisher
Canadian Science Publishing
Published
2016-07
Volume
41
Issue
4
Pages
E58-E66
ISSN
  • 1180-4882 (ISSN-L)
  • 1488-2434
DOI
10.1503/jpn.150265
PMC
PMC4915938
OpenAlex
W2416745659
Cited by
106
References
5
Citations by year
2026: 8 · 2025: 7 · 2024: 14 · 2023: 15 · 2022: 10 · 2021: 18 · 2020: 12 · 2019: 9 · 2018: 8 · 2017: 3 · 2016: 2
FWCI
4.02
Type
journal article
Language
en
Open access
Licence
www.nrcresearchpress.com/page/about/CorporateTextAndDataMining (tdm)
Locations
  • Journal of Psychiatry and Neuroscience (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
Canadian Institutes of Health Research
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
treatment-resistant depression, repetitive transcranial magnetic stimulation, high-frequency rTMS, dorsolateral prefrontal cortex, motor threshold, remission rate, sham rTMS
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Analysis of Variance, Female, Humans, Male, Middle Aged, Patient Dropouts, Treatment Outcome, Transcranial Magnetic Stimulation, Magnetic Resonance Imaging, Interventional, Young Adult, Depressive Disorder, Treatment-Resistant

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