Comparisons of Accelerated Continuous and Intermittent Theta Burst Stimulation for Treatment-Resistant Depression and Suicidal Ideation

Haoyang Zhao; Chaonan Jiang; Miaomiao Zhao; Yang Ye; Liang Yu; Ying Li; Honglin Luan; Shiyi Zhang; Pengfeng Xu; Xuanqiang Chen; Fen Pan; Desheng Shang; Xiaohan Hu; Kangyu Jin; Jingkai Chen; Tingting Mou; Shaohua Hu; Bernadette M Fitzgibbon; Paul B Fitzgerald; Robin F H Cash; Xianwei Che; Manli Huang

doi:10.1016/j.biopsych.2023.12.013

Comparisons of Accelerated Continuous and Intermittent Theta Burst Stimulation for Treatment-Resistant Depression and Suicidal Ideation

Biol Psychiatry. 2023 Dec 22:S0006-3223(23)01788-2. doi: 10.1016/j.biopsych.2023.12.013. Online ahead of print.

Authors

Haoyang Zhao¹, Chaonan Jiang¹, Miaomiao Zhao¹, Yang Ye², Liang Yu³, Ying Li¹, Honglin Luan⁴, Shiyi Zhang¹, Pengfeng Xu¹, Xuanqiang Chen¹, Fen Pan¹, Desheng Shang⁵, Xiaohan Hu⁴, Kangyu Jin¹, Jingkai Chen¹, Tingting Mou¹, Shaohua Hu¹, Bernadette M Fitzgibbon⁶, Paul B Fitzgerald⁷, Robin F H Cash⁸, Xianwei Che⁹, Manli Huang¹⁰

Affiliations

¹ Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou, China; Brain Research Institute of Zhejiang University, Hangzhou, China; Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, China.
² Centre for Cognition and Brain Disorders, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; TMS Centre, Deqing Hospital of Hangzhou Normal University, Hangzhou, China.
³ Department of Anesthesiology and Pain, Hang Zhou First People's Hospital, Hangzhou, China.
⁴ Department of Psychiatry, Wen Zhou Seventh People's Hospital, Wenzhou, China.
⁵ Department of Radiology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
⁶ Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Department of Psychiatry, Monash University, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
⁷ Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Department of Psychiatry, Monash University, Melbourne, Victoria, Australia; School of Medicine and Psychology, Australian National University, Canberra, Australian Capital Territory, Australia.
⁸ Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Victoria, Australia; Department of Biomedical Engineering, The University of Melbourne, Melbourne, Victoria, Australia.
⁹ Centre for Cognition and Brain Disorders, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; TMS Centre, Deqing Hospital of Hangzhou Normal University, Hangzhou, China. Electronic address: xwcheswu@gmail.com.
¹⁰ Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Mental Disorder Management in Zhejiang Province, Hangzhou, China; Brain Research Institute of Zhejiang University, Hangzhou, China; Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, China. Electronic address: huangmanli@zju.edu.cn.

PMID: 38142717
DOI: 10.1016/j.biopsych.2023.12.013

Abstract

Background: Suicidal ideation is a substantial clinical challenge in treatment-resistant depression (TRD). Recent work demonstrated promising antidepressant effects in TRD patients with no or mild suicidal ideation using a specific protocol termed intermittent theta burst stimulation (iTBS). Here, we examined the clinical effects of accelerated schedules of iTBS and continuous TBS (cTBS) in patients with moderate to severe suicidal ideation.

Methods: Patients with TRD and moderate to severe suicidal ideation (n = 44) were randomly assigned to receive accelerated iTBS or cTBS treatment. Treatments were delivered in 10 daily TBS sessions (1800 pulses/session) for 5 consecutive days (total of 90,000 pulses). Neuronavigation was employed to target accelerated iTBS and cTBS to the left and right dorsolateral prefrontal cortex (DLPFC), respectively. Clinical outcomes were evaluated in a 4-week follow-up period.

Results: Accelerated cTBS was superior to iTBS in the management of suicidal ideation (p_{week 1} = .027) and anxiety symptoms (p_{week 1} = .01). Accelerated iTBS and cTBS were comparable in antidepressant effects (p < .001; accelerated cTBS: mean change at weeks 1, 3, 5 = 49.55%, 54.99%, 53.11%; accelerated iTBS: mean change at weeks 1, 3, 5 = 44.52%, 48.04%, 51.74%). No serious adverse events occurred during the trial. One patient withdrew due to hypomania. The most common adverse event was discomfort at the treatment site (22.73% in both groups).

Conclusions: These findings provide the first evidence that accelerated schedules of left DLPFC iTBS and right DLPFC cTBS are comparably effective in managing antidepressant symptoms and indicate that right DLPFC cTBS is potentially superior in reducing suicidal ideation and anxiety symptoms.

Keywords: DLPFC; Suicidal ideation; Theta burst stimulation; Treatment-resistant depression.