Feasibility of home-based accelerated intermittent theta-burst stimulation (aiTBS) for depression: a case series

Transcranial magnetic stimulation (TMS) is an established treatment option for major depressive disorder (MDD) but is currently limited to clinical settings such as hospitals or doctors' offices. Technical and logistical challenges have so far prevented its application in patients' homes.

In this pilot study, five outpatients with MDD (aged 29-65 years), living up to 120 km from a tertiary care hospital (Regensburg, Germany), received home-based TMS treatment using an accelerated intermittent theta burst stimulation protocol (aiTBS; 5 sessions per day, 1800 pulses per session). Treatment was delivered using a conventional DuoMAG XT-100 device (Deymed Diagnostics, Hronov, Czech Republic). Feasibility was evaluated through assessment of logistical challenges, device handling, safety, treatment tolerability and patient satisfaction. Depressive symptoms were measured before and after treatment using the 21-item Hamilton Depression Rating Scale (HAMD-21) and the Major Depression Inventory (MDI).

Home-based TMS treatment was feasible with no serious adverse events reported. A reduction in depressive symptom scores was observed. Major logistical challenges included device transport, space requirements and the need for trained personnel on site.

Our pilot data demonstrate the feasibility of home-based TMS using a conventional clinical device, while highlighting substantial technical and logistical limitations. These limitations underscore the urgent need for the development of lightweight, portable and patient-friendly TMS devices to facilitate the delivery of neurostimulation therapies beyond clinical settings. Further studies with larger samples are warranted, using randomized controlled designs comparing home-based and clinic-based TMS to evaluate not only feasibility, but also efficacy under standardized conditions.