Prolonged intermittent theta burst stimulation in the treatment of major depressive disorder: a case series

Psychiatry Res. 2022 Sep;315:114709. doi: 10.1016/j.psychres.2022.114709. Epub 2022 Jul 3.


Intermittent theta burst stimulation (iTBS) using 600 pulses is an effective and FDA-cleared transcranial magnetic stimulation (TMS) protocol for major depressive disorder (MDD). Prolonged iTBS (piTBS) using 1,800 pulses could increase the effectiveness of TMS for MDD, but its real-world effectiveness is still debated. We assessed the safety, tolerability, and preliminary effectiveness of a 3x daily piTBS 1,800 pulses protocol delivered over 2 weeks in 27 participants. Only four participants (18.2%) achieved response, two of them achieving remission (9.1%). Five participants (18.5%) experienced tolerability issues. Future studies should focus on the neurophysiological effects of TBS protocols to determine optimal parameters.

Keywords: Major depressive disorder (MDD); Prolonged intermittent theta burst stimulation (piTBS); Repetitive transcranial magnetic stimulation (rTMS).

MeSH terms

  • Depressive Disorder, Major* / therapy
  • Humans
  • Prefrontal Cortex / physiology
  • Research
  • Theta Rhythm / physiology
  • Transcranial Magnetic Stimulation / methods
  • Treatment Outcome