Prolonged intermittent theta burst stimulation in the treatment of major depressive disorder
Bibliographic record
Abstract
Background: Intermittent theta burst stimulation (iTBS) is effective for major depressive disorder (MDD).Prolonged iTBS (piTBS) using 1800 pulses was shown to be better than placebo (Li et al. 2014 , but not superior to standard repetitive transcranial magnetic stimulation (rTMS) (Li et al. 2020) for MDD.In a recent study by Cole et al. (2019), remission rates of up to 90% were reported using a 10x daily accelerated piTBS protocol.Still, the real-world effectiveness of piTBS is still debated.Objective: We conducted a retrospective analysis assessing the safety, tolerability, and preliminary effectiveness of a 3x daily piTBS protocol.Methods: 27 MDD patients (43.5 years; 66.7% female) received at least one session of piTBS.Treatment consisted of 3x daily sessions, 50 min intersession intervals, total of 30 sessions over 10 days.Stimulation was delivered over the left dorsolateral prefrontal cortex (DLPFC) at 120% of the resting motor threshold (MT) using R30/X100 stimulators with B70 coils (MagVenture, Farum, Denmark).Outcomes were assessed using the Montgomery-Asberg Depression Rating Scale (MADRS).Primary endpoints were response rates (score reductions of 50% from baseline) and remission rates (score <10) following treatment.Results: Four participants (18.2%) responded, with two of those having reached remission (9.1%).Six (22.2%) participants did not complete the treatment: four (14.8%) because of tolerability issues (three because of pain and one because of increased anxiety) and two (9.1%) due to lack of significant improvement.Conclusion: Our results raise questions about the clinical utility of piTBS for MDD.This is in line with recent work from McCalley et al. (2021) that did not find a statistically significant increase in cortical excitability following iTBS 1800 vs. sham in healthy controls.The treatment period might also have been too short.More work is required to understand the effects of piTBS in MDD.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".