Dragon Katharina, Janthur Carina, Hebel Tobias, Abdelnaim Mohamed A, Reißmann Andreas, Langguth Berthold, Schecklmann Martin
Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.
University Medical Center, University of Regensburg, Regensburg, Germany.
Behav Brain Res. 2025 Feb 28;479:115361. doi: 10.1016/j.bbr.2024.115361. Epub 2024 Nov 27.
Intermittent Theta Burst Stimulation (iTBS), a specific form of repetitive transcranial magnetic stimulation (rTMS) is increasingly used for treating affective disorders. Accelerated iTBS protocols (aiTBS) with shorter treatment duration may lead to equal but faster response rates compared to standard protocols.
Here, we retrospectively analyzed the records of 66 rTMS in- and out-patients with major depressive disorder in a tertiary care hospital between April 2023 and September 2023. All patients received left prefrontal iTBS with 1200 pulses, either one session/workday over 4 weeks (n = 34) or left prefrontal aiTBS on five sessions/workday for one week (n = 32). Depressive symptoms were assessed with the 21-item Hamilton Depression Rating Scale (HAMD-21) and the Major Depression Inventory (MDI) before and at the end of the respective treatment.
With both treatments, iTBS and aiTBS, the severity of depression improved significantly according to HAMD-21 and MDI. Response rates for iTBS were 38 % (HAMD-21) and 35 % (MDI), for aiTBS 19 % (HAMD-21) and 16 % (MDI), respectively. Remission rates showed a similar pattern. Effect sizes for group differences were small to medium. No serious adverse events occurred in any group. Tolerability was lower in aiTBS. Overall satisfaction was low for aiTBS on a qualitative and subjective level.
aiTBS with 1200 pulses and five daily sessions lead to amelioration of symptoms within one week. But benefit, satisfaction, tolerability was slightly lower in contrast to four weeks of iTBS. For everyday clinical practice, aiTBS protocols can be considered after weighing up the logistical disadvantages, such as possible longer waiting time for new patients that want to start a therapy with TMS. Future studies should explore the optimal dosage regime (number of sessions per day, number of pulses per session) for fast and effective symptom reduction.
间歇性θ波爆发刺激（iTBS）是重复经颅磁刺激（rTMS）的一种特殊形式，越来越多地用于治疗情感障碍。与标准方案相比，治疗时间较短的加速iTBS方案（aiTBS）可能会带来同等但更快的反应率。
在此，我们回顾性分析了2023年4月至2023年9月期间一家三级医院66例重度抑郁症rTMS门诊和住院患者的记录。所有患者均接受1200次脉冲的左前额叶iTBS，要么在4周内每天1次（n = 34），要么在1周内每天5次进行左前额叶aiTBS（n = 32）。在各自治疗开始前和结束时，使用21项汉密尔顿抑郁量表（HAMD - 21）和重度抑郁量表（MDI）评估抑郁症状。
iTBS和aiTBS两种治疗方法均使HAMD - 21和MDI评估的抑郁严重程度显著改善。iTBS的反应率分别为38%（HAMD - 21）和35%（MDI），aiTBS的反应率分别为19%（HAMD - 21）和16%（MDI）。缓解率呈现类似模式。组间差异的效应大小为小到中等。任何一组均未发生严重不良事件。aiTBS的耐受性较低。从定性和主观层面来看，aiTBS的总体满意度较低。
1200次脉冲且每天5次的aiTBS可在1周内改善症状。但与4周的iTBS相比，益处、满意度和耐受性略低。对于日常临床实践，在权衡诸如可能使想要开始TMS治疗的新患者等待时间更长等后勤方面的不利因素后，可考虑使用aiTBS方案。未来研究应探索快速有效减轻症状的最佳剂量方案（每天治疗次数、每次脉冲数）。
