Related Experiment Video
Updated: Jan 16, 2026
10:54
Conventional Repetitive Transcranial Magnetic Stimulation for Depression: A Step-by-Step Protocol
Published on: November 21, 2025
287
Stepwise interventional psychiatry approach for major depression: A case series
Véronique Desbeaumes Jodoin1, Emma Bousseau1, François Trottier-Duclos2
1Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, QC, Canada.
Journal of Psychiatric Research
|September 30, 2025
Summary
A stepwise treatment combining transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), and ketamine shows promise for treatment-resistant depression (TRD). This sequential approach may improve overall response rates by addressing diverse patient needs.
Area of Science:
- Neuroscience
- Psychiatry
- Clinical Research
Background:
- Treatment-resistant depression (TRD) often necessitates multiple interventions for symptom management.
- A real-world, stepwise protocol combining neuromodulation and pharmacotherapy was investigated.
Purpose of the Study:
- To evaluate the efficacy of a sequential treatment strategy for TRD.
- To explore outcomes of combining transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), and intravenous ketamine.
Main Methods:
- Twenty-eight adults with major depressive disorder underwent a 50-session tDCS protocol.
- Non-responders were sequentially offered iTBS (rTMS) followed by intravenous ketamine.
- Response was defined as a ≥50% reduction in MADRS scores.
Main Results:
- tDCS achieved a 46.4% response rate and 32.1% remission rate.
- Subsequent rTMS and ketamine yielded additional responders.
- Cumulative response and remission rates reached 67.9% and 53.6%, respectively.
Conclusions:
- A sequential neuromodulation strategy may enhance overall response rates in TRD.
- This pragmatic, stepwise approach appears feasible for managing TRD.
- Further controlled studies are needed to personalize treatment sequencing.
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