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Published on: August 11, 2015
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.
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.
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.
