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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 Theta-Burst Stimulation for Treatment-Resistant Depression: A Randomized Clinical Trial.

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Accelerated intermittent theta-burst stimulation (aTBS) is a safe and effective treatment for treatment-resistant depression (TRD). This pragmatic protocol demonstrated significant antidepressant effects, offering a promising option for patients.

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Area of Science:

  • Neuroscience
  • Psychiatry
  • Clinical Trials

Background:

  • Intermittent theta-burst stimulation (iTBS) is an established treatment for treatment-resistant depression (TRD).
  • Accelerated TBS (aTBS), involving multiple sessions daily, may enhance antidepressant effects but requires further investigation.
  • Existing protocols can be time-consuming and necessitate neuroimaging for precise targeting.

Purpose of the Study:

  • To evaluate the efficacy and safety of a pragmatic accelerated intermittent theta-burst stimulation (aTBS) protocol for treatment-resistant depression (TRD).
  • To assess a simplified aTBS protocol using a craniometric approach, avoiding neuroimaging.
  • To determine the effectiveness of a TBS protocol with 3 sessions daily over 15 weekdays.

Main Methods:

  • A triple-blinded, sham-controlled randomized clinical trial involving 100 participants with TRD.
  • Participants received 45 active or sham aTBS sessions over 15 weekdays, with 3 iTBS sessions daily.
  • The left dorsolateral prefrontal cortex was targeted using a craniometric approach; primary outcome was change in HDRS-17 score at week 5.

Main Results:

  • The active aTBS group showed a significantly greater reduction in HDRS-17 scores compared to the sham group (54.7% vs 31.87%).
  • Higher response and remission rates were observed in the active aTBS group.
  • The aTBS protocol was well-tolerated, with scalp pain being the most frequent side effect in the active group.

Conclusions:

  • A pragmatic aTBS protocol, utilizing 3 daily iTBS sessions and a non-neuronavigated approach, is safe and effective for treating TRD.
  • This simplified protocol offers a potentially more accessible and time-efficient treatment option for TRD.
  • Further research may explore long-term efficacy and broader implementation of this pragmatic aTBS approach.