Related Experiment Video
Updated: Jun 7, 2026
Conventional Repetitive Transcranial Magnetic Stimulation for Depression: A Step-by-Step Protocol
Published on: November 21, 2025
Combining Behavioral Activation and repetitive Transcranial magnetic stimulation in Late-Life Depression (COMBAT-LLD
Imke de Wijs1, Indira Tendolkar1, Maria H C T van Beek1
1Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands; Donders Institute for Brain Cognition and Behavior, Center for Medical Neuroscience, Nijmegen, the Netherlands.
Combining repetitive transcranial magnetic stimulation (rTMS) with behavioral activation (BA) may improve treatment outcomes for late-life depression (LLD). This study investigates if rTMS plus BA is more effective and cost-effective than rTMS alone for older adults.
Area of Science:
- Geriatric Psychiatry
- Neuroscience
- Clinical Psychology
Background:
- Late-life depression (LLD) affects many older adults, leading to poor quality of life and increased mortality.
- Current treatments for LLD are often insufficient, with many patients not achieving full remission.
- Repetitive transcranial magnetic stimulation (rTMS) shows promise for LLD, but combining it with psychotherapy, like behavioral activation (BA), may enhance effectiveness.
Purpose of the Study:
- To assess the (cost-)effectiveness of combining low-frequency rTMS with BA in older adults with treatment-resistant LLD.
- To compare the efficacy of rTMS with BA versus rTMS with neutral conversations.
- To evaluate secondary outcomes including quality of life, treatment acceptability, behavioral engagement, and cognitive functioning.
Main Methods:
- A multicenter, assessor-blind, randomized controlled trial involving 148 participants aged 60 years and older.
- Participants randomized to receive six weeks of rTMS with either BA or neutral conversations.
- Follow-up assessments at 3, 6, and 12 months to measure symptom reduction and cost-effectiveness.
Main Results:
- The study hypothesizes that rTMS combined with BA will demonstrate greater symptom reduction and superior cost-effectiveness compared to rTMS alone.
- Results will indicate the effectiveness of BA-assisted rTMS in treating late-life depression.
- Secondary outcome data will provide insights into quality of life, behavioral changes, and cognitive function.
Conclusions:
- The findings are expected to confirm the enhanced (cost-)effectiveness of rTMS with BA for treatment-resistant LLD in older adults.
- This research will provide practical guidance for integrating BA into standard rTMS care for geriatric depression.
- The study aims to improve treatment outcomes and quality of life for elderly individuals suffering from depression.
