| Paper authors: | Daniel M. Blumberger, Benoit H. Mulsant, Kevin E. Thorpe, Shawn M. McClintock, Gerasimos N. Konstantinou, Hyewon H. Lee, Sean M. Nestor, Yoshihiro Noda, Tarek K. Rajji, Alisson P. Trevizol, Fidel Vila-Rodriguez, Zafiris J. Daskalakis, Jonathan Downar |
| Year of paper publication: | 2022 |
| Post authors: | Caleb Pozdnikoff, Lisa Ridgway, Fidel Vila-Rodriguez |
| Download the research article: | Blumberger et al. (2022) Effectiveness of standard sequential bilateral repetitive transcranial magnetic stimulation vs bilateral theta burst stimulation in older adults with depression |
Introduction
For a number of adults 60 years and older, the struggle with major depressive disorder is made worse by its persistence. Between 55% and 81% of older adults do not respond to initial antidepressant treatments. When depression persists despite multiple treatments, it is classified as treatment-resistant depression (TRD). For these challenging cases, repetitive transcranial magnetic stimulation (rTMS) offers a well-tolerated and evidence-based treatment option.
rTMS involves direct stimulation of brain areas like the dorsolateral prefrontal cortex (DLPFC). Bilateral rTMS (rTMS on both sides of the brain) results in higher remission rates in older patients with TRD compared to other methods. However, bilateral rTMS takes longer, typically lasting 47.5 minutes. These lengthy sessions can make it hard for people to attend appointments, decreasing access to rTMS.
To address the challenge of long treatment times, theta burst stimulation (TBS) has been developed. TBS uses patterned bursts of stimulation that may achieve similar effects to standard rTMS in about 4 minutes. The shorter appointment time may increase the number of older adults with TRD who can access this treatment.
This study was designed to assess if this quicker bilateral TBS protocol was as effective as the standard, longer bilateral rTMS in reducing depressive symptoms in older adults with TRD.
Methods
This study involved 164 older adults with TRD, who were randomly split into two groups. One group received traditional bilateral rTMS (47.5 minutes per treatment), and the other group received TBS (4 minutes per treatment). The treatment was applied to the DLPFC, which is a common brain area to stimulate for TRD.
The people in the study received four weeks of treatment, and if they had not experienced a decrease in depressive symptoms, they could do 2 more weeks of treatment. To monitor depressive symptoms, participants did three separate questionnaires before they started treatment, after every 5th treatment, and after all of the treatment weeks were finished.
Results
- The researchers found that for older adults, the shorter protocol (TBS) was just as effective as the longer protocol (traditional rTMS)
- Both TBS and standard rTMS demonstrated cognitive safety, meaning no significant impairment in thinking skills was found
- Pain levels were well tolerated in both groups
Conclusion
This study found that 4-minute bilateral TBS was as effective as the 47.5-minute standard bilateral rTMS in reducing depressive symptoms among older adults with TRD. Crucially, the significantly shorter session duration of TBS may substantially increase treatment capacity and access to effective brain stimulation for older adults with TRD.