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Updated: Dec 10, 2025
Conventional Repetitive Transcranial Magnetic Stimulation for Depression: A Step-by-Step Protocol
Published on: November 21, 2025
Bilateral sequential theta burst stimulation for multiple-therapy-resistant depression: A naturalistic observation
Amer M Burhan1, James A Patience2, Johannes G P Teselink3
1Therapeutic Brain Stimulation Clinic, Parkwood Institute-Mental Health Building, 550 Wellington Road, N6C 0A7, London, Ontario, Canada; Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Bilateral sequential theta-burst repetitive transcranial magnetic stimulation (bsTBS) shows promise for treatment-resistant depression (TRD). This faster rTMS approach achieved significant response and remission rates in patients with multiple treatment failures.
Area of Science:
- Neuroscience
- Psychiatry
- Medical Technology
Background:
- Treatment-resistant depression (TRD) affects one-third of patients, causing significant disability and reduced quality of life.
- Repetitive transcranial magnetic stimulation (rTMS) is an option for TRD, with faster theta-burst protocols showing preliminary promise.
- Existing treatments often fail, necessitating novel therapeutic approaches for severe depression.
Purpose of the Study:
- To evaluate the efficacy and tolerability of bilateral sequential theta-burst rTMS (bsTBS) in a real-world setting for patients with multiple-treatment-resistant depression.
- To determine response and remission rates using a standardized depression rating scale.
- To assess the safety profile of the bsTBS treatment in this patient population.
Main Methods:
- A naturalistic study involving 50 patients diagnosed with TRD, assessed over 36 months at an academic TMS clinic.
- Patients received 20 sessions of bsTBS, targeting prefrontal cortex locations (F4/F3), with 600 pulses per session at 100% or 80% of resting motor threshold.
- Data collection included demographic information, treatment history (multiple antidepressant failures, ECT, therapy), and depression severity scores (HAMD-17) to measure response and remission.
Main Results:
- A 52% response rate (≥50% reduction in HAMD-17) and a 28% remission rate (HAMD-17 score ≤7) were observed.
- The average depression severity score decreased by 42% across the patient cohort.
- The bsTBS treatment was generally well-tolerated, with occasional mild adverse events like headache and scalp discomfort; syncope occurred in 0.22% of treatments.
Conclusions:
- Bilateral sequential theta-burst rTMS (bsTBS) is a promising treatment option for patients with multiple-treatment-resistant depression.
- The study demonstrates significant response and remission rates in a challenging patient population, supporting the clinical utility of bsTBS.
- bsTBS offers a potentially effective and tolerable neuromodulation strategy for severe, refractory depression.
