Four Paths of Response to rTMS in Treatment-Resistant Depression
rTMS treatment outcomes are very diverse. Some may improve almost instantly, others may require a higher number or intensity of treatments, and others may not respond at all. Understanding the diversity of rTMS treatment responses can be important in order for clinicians and patients to find the best, personalized treatment approach for their depression. The aim of this study was to describe the number and pattern of unique pathways (i.e., trajectories) of improvement to rTMS among a large group of people with treatment-resistant depression.
People are most likely to respond to rTMS if they have attempted less than 3 trials of antidepressants in the past, without success
Interestingly, the likelihood to respond (i.e., improve) with antidepressants is thought to decrease with every attempt. It is unclear whether someone’s past history with antidepressants affects the likelihood for someone to respond to rTMS or iTBS in the future. Knowing who might benefit most from neurostimulation therapies can help clinicians and patients understand the best treatment route for them.
LEFT and RIGHT-handed people with treatment-resistant depression improve equally with rTMS
Interestingly, handedness (i.e., whether an individual is right or left handed) might indicate which side of the brain/body is more dominant. Potentially, this could affect the intensity of stimulation that left or right-handed people need. Additionally, rTMS is delivered to the left side of an individual’s head. This region of the brain controls the right side of your body — raising the question as to whether rTMS is equally effective for left and right-handed people. This could have important impacts for depression treatment.
Can accelerated rTMS (iTBS) be used in place of ECT with severely depressed patients to achieve the same results?
Paper authors: Michelle Goodman, Alisson Trevizol, Gerasimos Konstantinou, David Boivin-Lafleur, Ram Brender, Jonathan Downar, Tyler Kaster, Yuliya Knyahnytska, Fidel Vila-Rodriguez, Daphne Voineskos, Zafiris Daskalakis, Daniel Blumberger Year of paper publication: 2025 Post authors: Alice Erchov, Sarah Kesler, Fidel Vila-Rodriguez Download the research article: Goodman et al. (2025) Extended course accelerated intermittent theta burst stimulation as […]
Early symptom improvement at 10 sessions as a predictor of rTMS treatment outcome in major depression
Not improving after investing time, money, and energy into a treatment for depression is, understandably, difficult. Being able to predict who will respond to what treatment would help clinicians and patients personalize treatment approaches. This could help reduce these frustrations and, hopefully, more effectively treat depression. This paper looked at whether early symptom improvement would be able to reliably predict whether someone will respond to repetitive transcranial magnetic stimulation (rTMS).
Clinical Practice Guidelines for the Management of Depression
Depression is known to cause difficulty in daily functioning, self-esteem, sleep, and emotions. With all the research we’ve done with depression, guidelines are needed to organize this information into comprehensible and universal standards of care, informed by our most up-to-date understanding of diagnosis and treatment. The guideline in question comes from India in 2017 and is a keystone because it was the first to officially recommend the use of neuromodulatory treatments (specifically, electroconvulsive therapy; ECT) in severe cases of depression.
Electroconvulsive Therapy (ECT) in Treatment-Resistant Depression
When all else fails, treatment-resistant depression can be especially debilitating: it is associated with recurring depressive episodes, higher risk of suicide, and a greater amount of hospitalizations. For those who fail ≥ 2 gold-standard antidepressants or otherwise have a need for rapid improvement, electroconvulsive therapy (ECT) may be the solution. ECT (in its modern sense) has been used for more than 90 years, but the persisting stigma and media portrayal related to treatment procedures mean it is rarely used in clinical treatments – even though it could help many recover from even persistent depression. This review article examines myths and facts about ECT, including its current use, safety, and side effects.
Differential symptom cluster responses to repetitive transcranial magnetic stimulation (rTMS) treatment in depression
Everyone experiences depression differently. Few studies have looked at how individual symptoms change across treatment, and how they might be related. Specifically, this study was interested in individuals with treatment-resistant depression and how they respond to new, effective repetitive transcranial magnetic stimulation (rTMS) treatments (or the shortened version, iTBS).
Evaluation of the effects of rTMS on self-reported quality of life and disability in treatment-resistant depression: A THREE-D study
Depression doesn’t just affect mood. It also impacts an individual’s ability to function in daily life. This study explored how the use of rTMS and iTBS as new, safe, non-invasive, and effective treatment(s) for treatment-resistant depression affected individuals’ quality of life and levels of disability.
Cognitive Impairment in Treatment-Resistant Depression
Depression is well-known to negatively impact mood, but relatively few studies have looked at how this disorder may impact cognition, or thinking ability. This is important because better cognitive ability is linked to better functioning in daily life (e.g., work or home responsibilities). This information could inform how we help people with depression. We do not know whether everyone with depression has difficulties with their cognition. We also do not know whether these difficulties span across all cognitive domains, or are specific to just a few (e.g., memory, learning). This study looked to answer these questions and identify what may predict worse cognitive impairment in those with treatment-resistant depression.