Abstract
Current efforts to improve clinical effectiveness and utility of repetitive transcranial magnetic stimulation (rTMS) in the treatment of major depression (MD) include theta burst stimulation (TBS), a patterned form of rTMS. This study was performed to investigate the efficacy of bilateral TBS to the dorsolateral prefrontal cortex (dlPFC) in patients with major depressive disorder in addition to ongoing medication and psychotherapy. In this randomized-controlled trial, thirty-two patients with MD were treated for six weeks (thirty sessions) with either successively intermittent, activity enhancing TBS to the left and continuous, inhibiting TBS to the right dlPFC or with bilateral sham stimulation. Primary outcome measure was the proportion of treatment response defined as a Montgomery-Asberg Depression Rating Scale (MADRS) <50% compared to baseline. Secondary outcomes comprised response and remission rates of the Hamilton Depression Rating Scale (HAMD) and the Beck Depression Inventory (BDI). Logistic regression analysis with the factors treatment condition, duration of the current episode age and therapy resistance revealed a significantly larger number of responders in the cTBS ( n = 9) compared to the sham-stimulation ( n = 4) group (Wald χ 2 = 3.9, p = 0.048). Response to cTBS was predicted by a shorter duration of the current episode (Wald χ 2 = 3.77, p = 0.052). Patient-reported outcome as assessed by the BDI indicated a higher rate of remitters in the cTBS ( n = 6) than in the sham ( n = 1) group (Wald χ 2 = 3.6, p = 0.058). These findings indicate that a six weeks treatment of MDD with iTBS to the left and cTBS to the right dlPFC for six weeks is safe, feasible and superior to sham stimulation applied add-on to pharmacological and psychotherapeutic treatment.
Published Version
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