Theta-burst stimulation shows promise for late-life depression

Older patients with major depressive disorder (MDD) treated with active theta-burst stimulation (TBS) show no significantly greater reduction in Hamilton Depression Rating Scale (HAM-D) scores than those who received sham stimulation at week 6, according to a study.

However, by week 12, active TBS demonstrates superiority to sham stimulation in reducing depressive symptoms, suggesting TBS as a potential treatment option for late-life depression.

A total of 108 older adults (mean age 67 years) underwent either active or sham TBS. At week 6, the intention-to-treat analysis revealed no significant between-group difference in mean reduction in HAM-D score (mean difference, ‒1.65, 95 percent confidence interval [CI], ‒3.38 to 0.08).

By week 12, however, active TBS correlated with a significantly higher decrease in HAM-D score than sham stimulation (mean difference, ‒1.89, 95 percent CI, ‒3.75 to ‒0.03), with response rates of 52 percent in the active group and 33 percent in the sham group.

In linear mixed models, the active TBS group did not demonstrate a statistically significant greater reduction in HAM-D score compared with the sham group at week 6 (Cohen’s d, ‒0.36, 95 percent CI, ‒0.74 to 0.01).

This triple-blind, sham-controlled randomized clinical trial included participants aged 60 years and above with a diagnosis of moderate-to-severe MDD who were not using antidepressants. Those with other psychiatric disorders, neurological disorders, and contraindications to TBS were excluded.

TBS was administered bilaterally, with intermittent TBS on the left dorsolateral prefrontal cortex (DLPFC) and continuous TBS on the right DLPFC, with a total of 1,800 pulses at each side. Participants underwent 20 daily sessions of active or sham TBS over 20 consecutive weekdays and one additional session during weeks 6, 8, and 12, for a total of 23 sessions.