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Updated: Jul 12, 2026
MRI-guided dmPFC-rTMS as a Treatment for Treatment-resistant Major Depressive Disorder
Published on: August 11, 2015
Rectangular Pulse Three-Hour Repetitive Transcranial Magnetic Stimulation Treatment for Major Depressive Disorder: A
Michelle S Goodman1, Daniel M Blumberger2, Mehran Talebinejad3
1Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada.
Background:
Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for major depressive disorder (MDD). There has been recent growth in rTMS research focusing on parameter optimization, including accelerated treatment schedules and controllable pulse parameter stimulation; these advancements have the potential to improve accessibility and clinical outcomes. As such, the aim of this pilot study was to assess the safety and preliminary clinical efficacy of a rapid, one-day treatment protocol of rectangular pulse rTMS, in adults with MDD.
Materials And Methods:
Patients with MDD aged between 22 and 85 years presenting to a community rTMS clinic were enrolled in an open-label trial. A one-day treatment using rectangular pulse 10 Hz rTMS was offered. The treatment course consisted of three sessions of a biphasic rectangular pulse 19-minute rTMS protocol, delivering a total of 9000 pulses with a 60-minute interval between sessions. Clinical scales were administered at baseline, at the end of the treatment day, after 24 hours, and seven days later. Clinic data were used to report on additional outcomes from 30, 60, and 90 days post treatment.
Results:
A total of 55 patients were enrolled in the trial and 53 started treatment. Results revealed a decrease in score on the Montgomery Åsberg Depression Rating Scale of 25.5 ± 5.4 (representing a percentage reduction of 72.0% ± 13.4%) from baseline to seven days post treatment. In addition, 32 of 53 (60.4%) patients met the criteria for clinical remission, whereas 47 of 53 (88.7%) patients met the criteria for clinical response, seven days post treatment. Naturalistic clinic data showed that the antidepressant effect may persist for up to 90 days post treatment, with 41 of 53 (77.4%) patients maintaining a clinically significant response and 20 of 53 (37.7%) patients remaining in clinical remission.
Conclusions:
Our preliminary findings suggest that a brief, one-day course of rectangular pulse rTMS may produce meaningful and sustained reductions in clinical depressive symptoms. Larger, blinded, randomized control trials with trained and impartial raters are needed to confirm these findings.
