Accelerated Theta Burst Stimulation Transcranial Magnetic Stimulation (iTBS-TMS) Pururauka program for severe...

The Pururauka protocol is an accelerated intermittent theta burst stimulation (iTBS) paradigm designed to rapidly reduce depressive symptoms and suicidal ideation in individuals with severe major depressive episodes. This study evaluated its clinical effects in patients presenting with insufficient response to at least two prior pharmacological treatments, current suicidal ideation, and more than two previous suicide attempts.

Thirty-six adults with non-psychotic major depressive disorder (ICD-11) and HAM-D-17 scores >20 received a five-day accelerated iTBS intervention (180,000 pulses total) targeting the left dorsolateral prefrontal cortex. Depressive symptoms were assessed using the HAM-D and MADRS at baseline, daily during treatment, and at 1-, 3-, and 6-month follow-ups. Suicidal ideation was evaluated with HAM-D item 3 across the same time points. Satisfaction was measured with a visual analogue scale (VAS). Safety assessments included EEG screening and neuropsychiatric evaluations. Ethical approval was obtained from the Andean University of Cusco Ethics Committee (INFORME 023-2024-CIEI-UAC).

Mean HAM-D scores decreased from 38.89 at baseline to 13.61 at day 5 and 12.36 at six months (p < 0.001). Suicidal ideation resolved in most participants by day 3 and remained minimal or absent during follow-up. MADRS scores showed similar patterns, with 68 % of participants presenting no depressive symptoms immediately after treatment. No serious adverse events occurred, and satisfaction scores remained high throughout the protocol.

The Pururauka accelerated iTBS protocol was associated with rapid and sustained reductions in depressive symptoms and suicidal ideation in individuals with severe depressive episodes and insufficient response to previous medications. These preliminary findings warrant confirmation in future randomized controlled trials.