Brief Brain Stimulation Helps Treatment-Resistant Depression

May 21, 2018

A 3-minute form of repetitive transcranial magnetic stimulation (rTMS) was just as effective as standard 37-minute rTMS in patients with treatment-resistant major depressive disorder, according to a Canadian multisite study published in The Lancet.

“These findings will have a significant impact on our ability to treat patients,” said study senior author Jonathan Downar, MD, University Health Network’s Krembil Research Institute, Toronto. “This will allow every device in Canada to treat several times more people per day, meaning shorter wait lists and better access to this treatment.”

For the study, researchers recruited 414 adults with treatment-resistant depression from 3 neurostimulation centers and randomized them to standard rTMS, which lasts 37.5 minutes, or a 3-minute version of rTMS called intermittent theta burst stimulation (iTBS). Treatment was administered to the left dorsolateral prefrontal cortex 5 days a week for 4 to 6 weeks.

Repetitive TMS Shows Promise for Treating Depression in BPD

Some 49% of participants who received iTBS had significantly reduced symptoms of depression by the study’s end, researchers reported, with 32% of those participants experiencing remission. In comparison, 27% of patients who received standard rTMS experienced remission of depressive symptoms.

“In patients with treatment-resistant depression, iTBS was noninferior to 10 Hz rTMS for the treatment of depression,” researchers concluded. “Both treatments had low numbers of dropouts and similar side-effects, safety, and tolerability profiles.”

Meanwhile, a study published online in The Journal of Clinical Psychiatry found 3 to 6 weeks of bilateral rTMS administered 5 days a week resolved suicidal ideation in 40.4% of patients with treatment-resistant major depressive disorder. Just 18.8% of participants randomized to sham rTMS and 26.8% who received left unilateral rTMS had their suicidal ideation resolved.

Study Supports Efficacy and Safety of Shorter TMS Treatments

“This is one of the first large studies showing rTMS is effective in treating suicidal ideation,” said study senior author Jeff Daskalakis, MD, PhD, Centre for Addiction and Mental Health, Toronto. “The effects on suicidal ideation were independent of effects on depressive symptoms.”

—Jolynn Tumolo


Blumberger DM, Vila-Rodriguez F, Thorpe KE, et al. Effectiveness of theta burst versus high-frequency repetitive transcranial magnetic stimulation in patients with depression (THREE-D): a randomised non-inferiority trial. The Lancet. 2018;391:1683-1692.

Weissman CR, Blumberger DM, Brown PE, et al. Bilateral repetitive transcranial magnetic stimulation decreases suicidal ideation in depression. The Journal of Clinical Psychiatry. 2018 April 17;[Epub ahead of print].

Three-minute version of brain stimulation therapy effective for hard-to-treat depression, according to landmark Canadian study [press release]. Toronto, Canada: Centre for Addiction and Mental Health; April 26, 2018.

Brain stimulation reduces suicidal thinking in people with hard-to-treat depression, new CAMH study shows [press release]. Toronto, Canada: Centre for Addiction and Mental Health; May 3, 2018.

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