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Electroconvulsive Therapy01:30

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Electroconvulsive therapy (ECT), or shock therapy, remains a critical biomedical intervention for severe, treatment-resistant depression. While its origins can be traced back to Hippocrates' observations that malaria-induced convulsions alleviated mental illness, modern ECT has evolved significantly from its earlier, more primitive applications. First introduced in 1938 by Ugo Cerletti and his colleagues, ECT involves inducing controlled seizures using electrical currents. In its early...
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Accelerated sequential bilateral theta-burst stimulation in major depression: an open trial.

Rajamannar Ramasubbu1, Elliot C Brown2, Ben Selby3

  • 1Department of Psychiatry/Clinical Neurosciences Cumming School of Medicine, Mathison Centre for Mental Health Research and Education, Non-Invasive Neurostimulation Network, Hotchkiss Brain Institute, University of Calgary, TRW Building, Room 4D64, 3280 Hospital Drive NW, Calgary, AB, T2N4Z6, Canada. rramasub@ucalgary.ca.

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Summary

Accelerated bilateral theta burst stimulation (TBS) shows promise for treatment-resistant depression, with significant symptom reduction observed. However, high intensity limits tolerability, necessitating further research.

Keywords:
Accelerated rTMSClinical trialMajor depressive disorderTheta burst stimulation

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Area of Science:

  • Neuroscience
  • Psychiatry
  • Clinical Medicine

Background:

  • Theta burst stimulation (TBS) is an established treatment for major depressive disorder (MDD).
  • Accelerated and bilateral protocols are emerging strategies to potentially improve TBS efficacy.
  • Treatment-resistant MDD (TRD) requires novel therapeutic approaches.

Purpose of the Study:

  • To evaluate the efficacy and safety of an accelerated bilateral TBS protocol in patients with TRD.
  • To assess symptom reduction, response, and remission rates following daily accelerated bilateral TBS.

Main Methods:

  • An open-label pilot study involving 25 patients with TRD.
  • Daily administration of 5 sequential bilateral intermittent and continuous TBS treatments to the dorsolateral prefrontal cortex (DLPFC) for 5 days.
  • High-intensity stimulation (120% resting motor threshold) was used.

Main Results:

  • Significant reduction in Hamilton Depression Rating Scale (HDRS-17) scores at day 5 and 2 weeks post-treatment (p < 0.001).
  • Response rates increased from 20% at day 5 to 32% at 2 weeks, indicating delayed effects.
  • High intensity stimulation was not tolerated by 60% of patients; no major adverse events were reported.

Conclusions:

  • Accelerated bilateral TBS may be a clinically effective and safe option for TRD.
  • The high intensity of the protocol poses tolerability challenges.
  • Further randomized sham-controlled trials are necessary to confirm the therapeutic role of this protocol in depression.