Bilateral neuronavigated 20Hz theta burst TMS for treatment refractory depression: An open label study.

Background: Current medication and transcranial magnetic stimulation (TMS) treatments for depression bring only approximately one-third of patients to remission. Newer TMS techniques such as bilateral treatment, neuronavigation, and theta burst stimulation (TBS) show promise in improving remission rates. However, it is unclear whether newer off-label techniques improve outcomes enough to justify widespread implementation.

Methods: An IRB approved retrospective chart review examined 58 primarily treatment-resistant (79%) depressed patients who received bilateral neuronavigated TBS-20Hz in a private outpatient clinic.

Results: 72% (42/58) of patients remitted (Beck Depression Inventory-II (BDI-II) < 13) with an 81% decrease in BDI-II scores. 83% (48/58) of patients responded (BDI-II ≤ 50%). Average time to remission was 7.3 treatment weeks (SD = 4.5, Range 0.6-21.2). Overall, 40% (17/42) of remitters also successfully discontinued one or more pretreatment medications.

Conclusions: Bilateral Neuronavigated TBS-20Hz TMS brought more than two-thirds of treatment refractory depressed patients to remission. TBS-20Hz may be critical for obtaining higher remission rates. Controlled trials are warranted.