Efficacy of Accelerated iTBS in Treatment-Resistant Depression: A Randomized Controlled Trial

This study investigates the growing clinical interest in accelerated TMS protocols , which aim to achieve therapeutic results in days rather than weeks. By delivering multiple sessions of intermittent Theta Burst Stimulation (iTBS) per day, researchers sought to determine if higher dose density translates to faster and more robust remission in patients who have failed multiple antidepressant trials. Study Methodology & Parameters:. Target Area: Left Dorsolateral Prefrontal Cortex (L-DLPFC), a key node in the executive control network., Stimulation Protocol: iTBS (3 pulses at 50 Hz, repeated at 5 Hz; 2 seconds on, 8 seconds off)., Dose Density: Multiple sessions per day (accelerated) vs. the standard once-daily protocol., Objective Metrics: Primary outcomes measured via the Montgomery-Åsberg Depression Rating Scale (MADRS) and secondary assessments of cognitive function and safety. Key Clinical Findings:. Rapid Response: Accelerated iTBS demonstrated a significantly faster onset of antidepressant effects compared to sham or standard protocols., Safety & Tolerability: The higher dose density was well-tolerated, with no significant increase in adverse events such as headaches or fatigue compared to standard TMS., Neuroplasticity Implications: The findings support the hypothesis that concentrated stimulation may better induce long-term potentiation (LTP)-like changes in neural circuitry.