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Updated: Jan 8, 2026
MRI-guided dmPFC-rTMS as a Treatment for Treatment-resistant Major Depressive Disorder
Published on: August 11, 2015
Prolonged intermittent theta burst stimulation as an alternative to standard rTMS: Real-world data from patients with
Cheng-Ta Li1, Chih-Ming Cheng1, Hui-Ching Lin2
1Precision Depression Intervention Center (PreDIC), Department of Psychiatry, Taipei Veterans General Hospital, Taipei 112, Taiwan; Department of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Brain Science and Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Background:
While standard repetitive transcranial magnetic stimulation (rTMS) requires 20-30 sessions when treating patients with major depressive disorders (MDD), subthreshold prolonged intermittent theta burst stimulation (piTBS) may yield comparable effects in fewer visits-critical for self-paid treatment settings. piTBS has been reported to result in antidepressant response in as few as 10 sessions. However, most of them used small to moderate sample sizes.
Methods:
We conducted a retrospective cohort study to examine the antidepressant effects of left prefrontal piTBS in clinical scenarios and to compare responses between piTBS and 10 Hz rTMS in patients who completed their treatments at distinct sessions in a large medical center. A total of 273 adult non-psychotic MDD patients were included in the analysis (120 piTBS and 153 rTMS). Patients received treatment in a private pay model on a daily basis and were encouraged to undergo at least 10-15 sessions, with the option of extending to 20 or more if a clinically meaningful response was not achieved.
Results:
There were no significant differences in age, sex distribution, or baseline clinical variables between groups. Antidepressant effects were also comparable (piTBS vs. rTMS, responders= 49.2 % vs. 39.9 %; remitters= 34.2 % vs. 29.4 %). Notably, the piTBS group had a significantly lower stimulation intensity than the rTMS group (p < 0.001) and required fewer total sessions (12.4 ± 3.3 vs. 14.5 ± 5.9)(p = 0.001). The piTBS group reported less local pain. Using piTBS treatment may yield a savings of US$750 to US$3000 per treatment course, which is a 25-66.7 % reduction in medical expenses.
Conclusion:
In a real-world private pay model, subthreshold piTBS achieved comparable antidepressant effects to 10 Hz rTMS and resulted in cost and travel savings for patients.
