Feasibility and clinical effects of accelerated sequential bilateral theta burst stimulation in late-life depression (ACCELDER Trial)
Bibliographic record
Abstract
Background Difficult-to-treat depression (DTD) in older adults is associated with high rates of disability, hospitalization, and mortality. As the effectiveness of once daily theta burst stimulation (TBS) has been demonstrated in older adults, we aimed to explore the feasibility and clinical effects of an accelerated bilateral TBS protocol. Methods This single arm, open-label trial enrolled outpatients aged 60 years and over with a current major depressive episode and nonresponse to at least one antidepressant. Participants received continuous TBS (600 pulses) to the right dorsolateral prefrontal cortex (DLFPC) followed by intermittent TBS (600 pulses) to the left DLPFC, 8 times daily for 5 consecutive days. The primary outcome measures were proportion of participants retained in the study and change in Montgomery-Åsberg Depression Rating Scale (MADRS). Secondary outcomes included rates of remission defined by MADRS ≤ 10, changes in measures of anxiety and suicidality, and measures of tolerability including number of serious adverse events. Results 79 participants enrolled in the study over a period of 2.5 years, 78 (67.7 ± 5.9 yrs, 75.6 % female) of whom received majority of TBS sessions. MADRS scores decreased a mean ( ± SD) 8.5 ± 6.7 points following treatment completion (F (2,154) = 61.6, p < 0.0001) and this improvement persisted 4 weeks later ( p < 0.0001). The remission rate was 18 % at treatment end and increased to 24 % 4 weeks later. Symptoms of anxiety ( p < 0.01) and suicidal ideation ( p = 0.03) also improved at treatment end. Treatment was well-tolerated and no serious adverse events were reported. Conclusions Accelerated TBS is feasible in older patients with DTD; its efficacy is comparable to once daily TBS; and it is well-tolerated. If these results are confirmed in a larger randomized trial, accelerated TBS may become a preferred treatment option for older depressed patients. Clinicaltrials.gov Identifier NCT05119699
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| 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) | 0.000 | 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 teacher head, 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".