Comparing theta burst stimulation with standard left high frequency transcranial magnetic stimulation in the treatment of depression in a randomized controlled study: A preliminary comparison study

Background: Theta Burst stimulation (TBS) is a promising alternative to standard repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant depression (TRD). TBS treatment is delivered over a much shorter time than rTMS, enabling more patients to be treated with the same resources. The aim of this preliminary study was to explore the efficacy of an intensive bilateral TBS protocol (BL TBS) compared to a standard rTMS protocol. Methods: Thirty-two outpatients with TRD were randomized to a standard rTMS protocol and 34 outpatients were randomized to a TBS protocol. Treatment was delivered over two week or four weeks. Both treatment groups received twenty treatments in total. Patients were assessed at baseline, week 1, week 2 and week 4. Results: There were no major differences in baseline depression severity between the randomized treatment groups. There was no significant difference in response and remission rates between the two groups. In the standard rTMS group, 40.6% met criteria for response and 25% met criteria for remission. These rates were 20.6% and 25.5% respectively for the TBS group. There was a significant reduction in mean depression scores for both treatment groups (p<0.05); and suicidal ideation decreased significantly in the standard rTMS group. Limitations: This was not a sham-controlled study, so placebo response rates are not known. Conclusion: TBS provided clinical benefit, which on most outcome measures did not differ significantly from outcomes with a standard course of rTMS treatment, and could be advantageous from a clinical, service and patient perspective.