Effect of prior pharmacotherapy on remission with sequential bilateral theta-burst versus standard bilateral repetitive transcranial magnetic stimulation in treatment-resistant late-life depression

Rafae A Wathra; Benoit H Mulsant; Zafiris J Daskalakis; Jonathan Downar; Shawn M McClintock; Sean M Nestor; Tarek K Rajji; Alisson P Trevizol; Daniel M Blumberger

doi:10.1192/bjp.2023.81

Effect of prior pharmacotherapy on remission with sequential bilateral theta-burst versus standard bilateral repetitive transcranial magnetic stimulation in treatment-resistant late-life depression

Br J Psychiatry. 2023 Nov;223(5):504-506. doi: 10.1192/bjp.2023.81.

Authors

Rafae A Wathra¹, Benoit H Mulsant¹, Zafiris J Daskalakis², Jonathan Downar¹, Shawn M McClintock³, Sean M Nestor⁴, Tarek K Rajji⁵, Alisson P Trevizol¹, Daniel M Blumberger¹

Affiliations

¹ Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
² Department of Psychiatry, University of California, San Diego Health, San Diego, California, USA.
³ Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
⁴ Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; and Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.
⁵ Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto Dementia Research Alliance, University of Toronto, Toronto, Ontario, Canada.

Abstract

Repetitive transcranial magnetic stimulation (rTMS) is used for treatment of late-life depression. In the FOUR-D study, sequential bilateral theta-burst stimulation (TBS) had comparable remission rates to standard bilateral rTMS. Data were analysed from the FOUR-D trial to compare remission rates between two types of rTMS based on the number and class of prior medication trials. The remission rate was higher in participants with ≤1 previous trial (43.9%) than in participants with 2 previous trials (26.5%) or ≥3 previous trials (24.6%; χ² = 6.36, d.f. = 2, P = 0.04). Utilising rTMS earlier in late-life depression may lead to better outcomes.

Keywords: Depression; geriatric; neurostimulation.; rTMS; theta burst.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Clinical Trials as Topic
Depression* / therapy
Depressive Disorder, Treatment-Resistant* / drug therapy
Humans
Transcranial Magnetic Stimulation
Treatment Outcome

Grants and funding

PJT-148840/CIHR/Canada