Depression and anxiety outcomes of adults undergoing intermittent theta burst stimulation (iTBS) treatment for major depressive disorder: A naturalistic study

Background

Standard repetitive transcranial magnetic stimulation (rTMS) and intermittent theta burst stimulation (iTBS) are approved treatments for major depressive disorder (MDD). iTBS offers shorter treatment durations and increased accessibility. This study examines the clinical outcomes of iTBS for MDD in a tertiary medical center.

Methods

Patients who underwent iTBS for MDD at Mayo Clinic Rochester between March 2021 and January 2023 were included. Baseline and endpoint scores of the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder 7-item (GAD-7) were compared using t-tests. Response, remission, and a single question patient-reported outcome (PRO) of "Did the treatment help?" were reported. Outcomes of patients with anxious depression (GAD-7 ≥10) were also reported.

Results

Forty-two patients (mean age 41.7 years, 59.5% female) were analyzed. iTBS resulted in a significant reduction in depression symptoms (PHQ-9: baseline mean 19.9, endpoint mean 13.0, p < 0.001). The response rate was 38.1%, remission rate was 9.5%, and PRO was 57.1%. Anxiety symptoms also significantly improved (GAD-7: baseline mean 13.0, endpoint mean 9.1, p < 0.001). The response rate for anxiety was 33.3%, and remission rate was 28.6%. Our response rate for depression was comparable to existing literature, while the remission rate was lower.

Conclusion

iTBS demonstrated significant reductions in depression and anxiety symptoms among patients with MDD, and in the subset of patients with anxious depression. The single question PRO can be a practical aid in patient discussions. These findings contribute to the growing body of literature on iTBS for MDD.