Accelerated intermittent theta burst stimulation treatment in medication-resistant major depression: A fast road to remission?
Although accelerated repetitive Transcranial Magnetic Stimulation (rTMS) paradigms and intermittent Theta-burst Stimulation (iTBS) may have the potency to result in superior clinical outcomes in Treatment Resistant Depression (TRD), accelerated iTBS treatment has not yet been studied. In this registered randomized double-blind sham-controlled crossover study, spread over four successive days, 50 TRD patients received 20 iTBS sessions applied to the left dorsolateral prefrontal cortex (DLPFC). The accelerated iTBS treatment procedure was found to be safe and resulted in immediate statistically significant decreases in depressive symptoms regardless of order/type of stimulation (real/sham). While only 28% of the patients showed a 50% reduction of their initial Hamilton Depression Rating Scale score at the end of the two-week procedure, this response rate increased to 38% when assessed two weeks after the end of the sham-controlled iTBS protocol, indicating delayed clinical effects. Importantly, 30% of the responders were considered in clinical remission. We found no demographic predictors for response. Our findings indicate that only four days of accelerated iTBS treatment applied to the left DLPFC in TRD may lead to meaningful clinical responses within two weeks post stimulation.
Department of Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium.
Romain
R
Duprat
Department of Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium.
Stefanie
S
Desmyter
Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium.
De Raedt
de R
Rudi
Department of Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium.
Kees
K
van Heeringen
Department of Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium.
Dirk
D
Van den Abbeele
Department of Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium.
Hannelore
H
Tandt
Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium.
Jasmina
J
Bakic
Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium.
Gilles
G
Pourtois
Department of Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium.
Josefien
J
Dedoncker
Department of Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium.
Myriam
M
Vervaet
Department of Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium.
Sara
S
Van Autreve
Department of Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium.
Gilbert M D
GM
Lemmens
Department of Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium; Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium. Electronic address: chris.baeken@UGent.be.
Chris
C
Baeken
D000328:Adult; D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols; D018592:Cross-Over Studies; D003561:Cytarabine; D003865:Major Depressive Disorder / Q000503:physiopathology* / Q000523:psychology / Q000628:therapy*; D061218:Depressive Disorder, Treatment-Resistant / Q000503:physiopathology* / Q000523:psychology / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone; D017397:Prefrontal Cortex / Q000503:physiopathology*; D013826:Theta Rhythm / Q000502:physiology*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome
D003561:Cytarabine; D008942:Mitoxantrone
Accelerated rTMS; Intermittent theta-burst stimulation; Left DLPFC; Major depression; Treatment resistance