Left intermittent theta burst stimulation combined with right low-frequency rTMS as an additional treatment for major depression: A retrospective study

Yuwei Mi; Yunxin Ji; Zhongze Lou; Yanbin Hou; Liemin Ruan

doi:10.4103/indianjpsychiatry.indianjpsychiatry_905_21

Left intermittent theta burst stimulation combined with right low-frequency rTMS as an additional treatment for major depression: A retrospective study

Indian J Psychiatry. 2022 Jul-Aug;64(4):364-369. doi: 10.4103/indianjpsychiatry.indianjpsychiatry_905_21. Epub 2022 Jul 13.

Authors

Yuwei Mi^{1

2}, Yunxin Ji², Zhongze Lou^{2

3}, Yanbin Hou², Liemin Ruan²

Affiliations

¹ School of Medicine, Ningbo University, Ningbo, Zhejiang, P.R. China.
² Department of Psychosomatic Medicine, Ningbo First Hospital, Ningbo, Zhejiang, P.R. China.
³ Medical Research Center, Ningbo First Hospital, Ningbo, Zhejiang, P.R. China.

PMID: 36060727
PMCID: PMC9435624
DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_905_21

Abstract

Background: Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for major depression (MD). We retrospectively analyzed the efficacy of intermittent theta burst stimulation (iTBS) on the left dorsolateral prefrontal cortex (DLPFC) combined with low-frequency rTMS (LF-rTMS) on the right DLPFC as an additional therapy to standard medication treatment.

Materials and methods: The study included 54 patients with MD who completed 10 courses (5 days per week) of rTMS as an add-on therapy. Thirty patients were treated in the combination group (120% resting motor threshold; left DLPFC, iTBS, 600 stimuli + right DLPFC, 1-Hz rTMS, 600 stimuli), while 24 patients were in the high-frequency rTMS (HF-rTMS) group (120% resting motor threshold; left DLPFC, 10-Hz rTMS, 3000 stimuli). The outcome was assessed based on the changes in scores of 24-item Hamilton Depression Scale (HAMD-24) and 14-item Hamilton Anxiety Scale (HAMA-14).

Results: Both depression and anxiety were significantly improved after 2 weeks of treatment by rTMS combined with medication. The combination of iTBS and LF-rTMS was significantly superior to HF-rTMS in improving the scores of HAMD-24 (P = 0.041) and HAMA-14 (P = 0.0095), and the response rate (P = 0.027).

Conclusion: The pilot study showed that the combination of iTBS and LF-rTMS may hold promise as a potentially effective alternative therapy for MD due to its efficacy and time-saving benefit. The preliminary results shed light on the study of the efficacy and acceptability of the combination of iTBS and LF-rTMS for MD.

Keywords: Additional Treatment; brain stimulation; depression; dorsolateral prefrontal cortex (DLPFC); intermittent theta burst (iTBS); repetitive transcranial magnetic stimulation (rTMS).