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Updated: Sep 13, 2025
MRI-guided dmPFC-rTMS as a Treatment for Treatment-resistant Major Depressive Disorder
Published on: August 11, 2015
Efficacy and Safety of Accelerated Intermittent Theta Burst Stimulation for Adolescents With Major Depressive
Xiaoli Liu1, Ziyang Peng1, Fang Cheng1
1Department of Psychiatry, Affiliated Kangning Hospital of Ningbo University (Ningbo Kangning Hospital), Ningbo, Zhejiang, China.
Background:
Developing safe and rapid treatments is crucial for adolescent major depressive disorder (MDD). While 10-session daily accelerated intermittent theta burst stimulation (a-iTBS) is effective in adults, its duration and safety limit its use in adolescents. In this study, we evaluated a 5-session daily a-iTBS protocol for adolescents with non-treatment-resistant MDD.
Methods:
Seventy-four adolescents with non-treatment-resistant MDD were randomly assigned to a-iTBS or a sham group. The a-iTBS group underwent 5 sessions of 1800-pulse iTBS per day targeting the left dorsolateral prefrontal cortex (Montreal Neurological Institute [MNI] coordinates: -44, 40, 29) using neuronavigation for 10 consecutive days, while the sham group received intervention with a sham coil that provided haptic sensations and audible sounds. The 17-item Hamilton Depression Rating Scale (HAMD-17), Hamilton Anxiety Rating Scale, and Children's Depression Inventory were rated at baseline, the first day after the innervation (day 11), and the 1-month and 3-month follow-ups.
Results:
The a-iTBS group showed a significantly greater reduction in HAMD-17 scores than the sham group at day 11 (p < .001, Cohen's d = 0.86 [95% CI, 0.38 to 1.33]) and the 1-month follow-up (Cohen's d = 0.72 [95% CI, 0.24 to 1.18]). However, there was no statistically significant difference between the 2 groups at the 3-month follow-up (p = .17, Cohen's d = 0.33 [95% CI, -0.13 to 0.79]). The a-iTBS group showed significantly greater improvements in anxiety and self-reported depression than the sham group at all time points (all p values < .05).
Conclusions:
a-iTBS was a safe and effective treatment for adolescents with non-treatment-resistant MDD, but the therapeutic effect diminished at the 3-month follow-up. Although the study was blinded, clinician identification exceeded random chance in the a-iTBS group, which suggests that blinding might have been partially compromised.
