Once daily versus twice daily theta-burst stimulation in the treatment of major depression disorder

Abstract

Introduction Intermittent theta-burst stimulation (iTBS) is a well-tolerated, time efficient yet not inferior [1] alternative to conventional repetitive transcranial magnetic stimulation (rTMS) protocols in the treatment of major depression disorder (MDD). While the consensus recommendation is 15–30 treatment sessions over a course of 3–6 weeks [2] , the ideal stimulation parameters (e.g., number and frequency of stimulation sessions) have yet to be determined. Methods In this double-blind randomized trial, 26 inpatients diagnosed with MDD were treated with neuronavigated iTBS over the left dorsolateral prefrontal cortex on 15 weekdays over the course of three weeks. On each treatment day, patients received either two active iTBS sessions (‘twice-daily’ group, n = 17) or one active and one sham iTBS session (‘once-daily’ group, n = 9). Results While patients in both groups showed a significant reduction of Hamilton Depression rating scores (HDRS-17), preliminary analyses show a significantly larger decrease in depressive symptoms among patients in the ‘twice-daily’ group (mean = 53%) compared to the ‘once-daily’ group (mean = 37%; F(1,24) = 5.17, P = .032). No increase in side effects was observed in the ‘twice-daily’ compared to the ‘once-daily’ group. Conclusion These findings suggest that two daily iTBS sessions increase the therapeutic effect of iTBS while being just as well tolerated as one daily session. Future studies should consider whether a twice-daily treatment regimen might be a feasible alternative to a conventional six-week treatment course.