Prolonged intermittent theta burst stimulation in the treatment of major depressive disorder: a case series

Maxime Richard; Clémence Noiseux; Véronique Desbeaumes Jodoin; Daniel M Blumberger; Jack Sheen; Farrokh Mansouri; Laurent Elkrief; Christophe Longpré-Poirier; Paul Lespérance; Jean-Philippe Miron

doi:10.1016/j.psychres.2022.114709

Prolonged intermittent theta burst stimulation in the treatment of major depressive disorder: a case series

Psychiatry Res. 2022 Sep:315:114709. doi: 10.1016/j.psychres.2022.114709. Epub 2022 Jul 3.

Affiliations

¹ Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada; Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, QC, Canada. Electronic address: m.richard@umontreal.ca.
² Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada.
³ Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute at the Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, ON, Canada.
⁴ Institute of Medical Science, Faculty of Medicine, University of Toronto, ON, Canada.
⁵ Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada; Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, QC, Canada.
⁶ Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada; Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, QC, Canada. Electronic address: jean-philippe.miron@umontreal.ca.

PMID: 35816923
DOI: 10.1016/j.psychres.2022.114709

Abstract

Intermittent theta burst stimulation (iTBS) using 600 pulses is an effective and FDA-cleared transcranial magnetic stimulation (TMS) protocol for major depressive disorder (MDD). Prolonged iTBS (piTBS) using 1,800 pulses could increase the effectiveness of TMS for MDD, but its real-world effectiveness is still debated. We assessed the safety, tolerability, and preliminary effectiveness of a 3x daily piTBS 1,800 pulses protocol delivered over 2 weeks in 27 participants. Only four participants (18.2%) achieved response, two of them achieving remission (9.1%). Five participants (18.5%) experienced tolerability issues. Future studies should focus on the neurophysiological effects of TBS protocols to determine optimal parameters.

Keywords: Major depressive disorder (MDD); Prolonged intermittent theta burst stimulation (piTBS); Repetitive transcranial magnetic stimulation (rTMS).

MeSH terms

Depressive Disorder, Major* / therapy
Humans
Prefrontal Cortex / physiology
Research
Theta Rhythm / physiology
Transcranial Magnetic Stimulation / methods
Treatment Outcome