Patients with treatment-resistant depression receiving three weeks of accelerated theta burst stimulation (aTBS)—a form of transcranial magnetic stimulation (TMS) using short, targeted bursts—experienced greater reduction in depression scores than did those who received a sham procedure, according to a report in JAMA Psychiatry.
“Our study introduced a pragmatic aTBS approach for clinical practice,” wrote Matheus Rossi F. Ramos, M.D., of the University of Sao Paulo Medical School, and colleagues. “The 78-minute daily treatment duration can likely fit into most outpatient participants’ routines, allowing them to maintain daily functionality.” Further, their protocol does not require neuroimaging equipment to identify where the TMS bursts should be directed.
From July 2022 to June 2024, 89 outpatients with treatment-resistant depression (average age of 41.7) were randomized to receive either 45 sessions of active aTBS over 15 weekdays or a sham procedure. All participants had scores of greater than 16 on the Hamilton Depression Rating Scale (HDRS), were considered at low risk of suicide, and had not responded to more than one antidepressant trial. The active aTBS involved three magnetic pulse sessions (each for six minutes and 18 seconds) interspersed with two 30-minute breaks. The magnetic pulses were directed to the brain's left dorsolateral prefrontal cortex.
Those patients receiving the active procedure experienced an average reduction in HDRS scores of 9.68 (a 55% decrease from baseline) compared with 5.57 in the sham group, indicating a medium-to-large effect size. A total of 17 patients (34%) in the active treatment arm experienced remission—defined as an HDRS score of eight or less—compared with eight participants (16%) receiving the sham procedure. The treatment was well tolerated, although those receiving active aTBS experienced scalp pain.
“Further research offers promising directions for future advancements in this field, including clinical trials comparing new aTBS protocols with standard ones and studies exploring the optimal parameters for these protocols,” the researchers concluded.
For related information, see the Psychiatric News article “FDA Clears Accelerated TMS Protocol for Depression.”
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