Effects of bilateral sequential theta-burst stimulation on functional connectivity in treatment-resistant depression: First results

Stöhrmann, Peter; Godbersen, Godber Mathis; Reed, Murray Bruce; Unterholzner, Jakob; Klöbl, Manfred; Baldinger-Melich, Pia; Vanicek, Thomas; Hahn, Andreas; Lanzenberger, Rupert; Kasper, S.; Kranz, Georg S.

doi:10.1016/j.jad.2022.12.088

Cited by 16 publications

(2 citation statements)

References 53 publications

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“…29 Notably, analyses of the impact of bsTBS on the cognitive control network 30 and on executive functioning 31 appeared to yield negative results. In contrast, other studies suggested that bsTBS significantly modulates the salience network 32 and that the distribution of 5HT1A receptors could partially explain the variance of bsTBS outcomes. 33 Nonetheless, some of those studies, while negative, provide additional support for the safety of bilateral stimulation in an array of brain regions.…”

Section: Discussionmentioning

confidence: 75%

Unilateral and Bilateral Theta Burst Stimulation for Treatment-Resistant Depression: Follow up on a Naturalistic Observation Study

Elnazali,

Veerakumar,

Blair

et al. 2024

Preprint

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Background: Theta burst stimulation (TBS) is a novel and faster modality of transcranial magnetic stimulation, which is showing promise as a treatment-resistant depression (TRD) treatment. Though TBS can be applied unilaterally or bilaterally, few studies have compared the effectiveness of both approaches in a naturalistic clinical sample. Objectives: In this retrospective chart review, we aimed to: (1) replicate previous bilateral sequential TBS effectiveness in a larger cohort of patients at a single centre, (2) present treatment outcome data between unilateral and bilateral TBS approaches, (3) investigate baseline factors associated with our observed outcomes, and (4) examine the sustainability of response, with follow-up data up to 6 months from patients. Methods: We included 161 patients who received TBS (unilateral: n = 64 (40%), 45.55 ± 14.25 years old, 55% females; bilateral: n = 97 (60%), 47.67 ± 15.11 years old, 58% females). Results: Firstly, we observed 47% response and 34% remission in the bilateral group, replicating findings from a smaller naturalistic study from our group; patients receiving unilateral TBS displayed 36% response and 26% remission, with no significant differences found between unilateral and bilateral TBS in remission and response rates. Secondly, bilaterally stimulated patients needed fewer treatments than those stimulated unilaterally (27 vs 29 on average respectively, t [159] = 3.31, p = .001), and had significantly lower anxiety symptoms post treatment (GAD-7) relative to patients receiving unilateral stimulation, F (1,148) = 3.95, p =0.049. Thirdly, no baseline factors were found to predict treatment outcomes. Lastly, after six months, 69% of patients who met the response criteria did not require additional treatment or a change in medication. Conclusions: Our findings support the efficacy and tolerability of TBS in TRD and indicate that bilateral TBS may have a superior anxiolytic effect and offer a slightly faster time to response.

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Section: Discussionmentioning

confidence: 75%

Unilateral and Bilateral Theta Burst Stimulation for Treatment-Resistant Depression: Follow up on a Naturalistic Observation Study

Elnazali,

Veerakumar,

Blair

et al. 2024

Preprint

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“…A randomized sham-controlled study enrolling 60 treatment-refractory patients with recurrent major depressive disorder revealed that the mean antidepressant effect was highest in a combination of iTBS and cTBS ( 14 ). A three-week treatment of iTBS over left DLPFC and cTBS of the right DLPFC (DLPFC) in patients with treatment-resistant depression (TRD) reported that significantly reduced functional connectivity between the left stimulation target and bilateral anterior insula ( 30 ). Third, our patient underwent accelerated iTBS over the left DLPFC with a 20 min interval, whereas the patients in the study by Philip et al received iTBS over the right DLPFC without interval.…”

Section: Discussionmentioning

confidence: 99%

Accelerated theta-burst transcranial magnetic stimulation of the bilateral dorsolateral prefrontal cortex in a patient with post-traumatic stress disorder and major depressive disorder: Case report

Chang

Liu²,

Chen³

et al. 2023

Front. Psychiatry

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BackgroundTheta-burst transcranial magnetic stimulation has demonstrated promising effectiveness as treatment for post-traumatic stress disorder (PTSD) and depression. However, the effect of accelerated theta-burst stimulation (TBS) in comorbid with PTSD and depression remains unknown.Case presentationWe report a case of a 25-year-old woman with PTSD and depression whose symptoms markedly improved after continuous TBS of the right dorsolateral prefrontal cortex (DLPFC) and intermittent TBS (iTBS) over the left DLPFC, and then with 20 min break before the 2nd iTBS session.ConclusionsAccelerated TBS over the bilateral DLPFC may improve severe PTSD and depression. Accelerated TBS may have more improvement of depression symptoms than PTSD symptoms. Further trials are warranted to investigate the effect and safety for patients with complicated PTSD and depression.

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Comparative antidepressant effects and safety of intravenous racemic ketamine, psilocybin and theta burst stimulation for major depressive disorder: A systematic review and network meta‐analyses of randomized controlled trials

Terao,

Kodama

2024

PCN Reports

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The individual efficacy and safety of intravenous racemic (IV) ketamine, psilocybin, and theta burst stimulation (TBS) for major depressive disorder have been demonstrated through meta‐analyses of randomized controlled trials (RCTs), but the comparative usefulness of these novel treatments has not yet been fully examined. We systematically searched the CENTRAL, Medline, CINHAL, and ClinicalTrials.gov databases for randomized controlled trials up to July 4, 2024. Random‐effects network meta‐analyses were conducted to compare the Comparative antidepressant effects and safety of intravenous racemic ketamine, psilocybin and theta burst stimulation for major depressive disorderantidepressant efficacy, tolerability, and acceptability of IV ketamine, psilocybin, and TBS. Twenty‐eight RCTs were included. All treatments were superior to placebo, with IV ketamine and psilocybin showing significantly greater antidepressant efficacy than TBS. No significant differences were detected between all treatments and placebo in tolerability and acceptability. In a subgroup analysis focusing on short periods of 1 week or less, only IV ketamine was significantly more effective than placebo. In another subgroup analysis focusing on periods of 4 weeks or longer, IV ketamine and psilocybin showed significantly better antidepressant effects than placebo. The confidence in the evidence ranged from very low to moderate. Specifically, there is a scarcity of studies on psilocybin and a lack of direct comparison trials. The findings suggest that IV ketamine and psilocybin may be more effective treatments compared to TBS. Additionally, IV ketamine may have an advantage in terms of rapid onset of action. The number of included studies is limited, especially for psilocybin, and therefore the current findings are preliminary, necessitating further accumulation of direct‐comparison RCTs.

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Effects of bilateral sequential theta-burst stimulation on functional connectivity in treatment-resistant depression: First results

Cited by 16 publications

References 53 publications

Unilateral and Bilateral Theta Burst Stimulation for Treatment-Resistant Depression: Follow up on a Naturalistic Observation Study

Unilateral and Bilateral Theta Burst Stimulation for Treatment-Resistant Depression: Follow up on a Naturalistic Observation Study

Accelerated theta-burst transcranial magnetic stimulation of the bilateral dorsolateral prefrontal cortex in a patient with post-traumatic stress disorder and major depressive disorder: Case report

Comparative antidepressant effects and safety of intravenous racemic ketamine, psilocybin and theta burst stimulation for major depressive disorder: A systematic review and network meta‐analyses of randomized controlled trials

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