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High-dose spaced theta-burst TMS as a rapid-acting antidepressant in highly refractory depression.

(2014) that describes how a course of intermittent theta-burst stimulation (iTBS) over the left dorsolateral prefrontal cortex (L-DLPFC) produced robust antidepressant re-sponses compared to sham stimulation in patients with treatment-refractory depression (Li et al. , 2014). TBS, a patterned form of repetitive transcranial magnetic stimulation (rTMS) modelled after endogenous hippocampal dis-charge patterns (Larson and Lynch, 1986; Huang et al. , 2005), has been shown to be more efﬁcient than standard rTMS in modulating cortical excitability (Ca´rdenas-Morales et al. , 2009). Preliminary results indicate non-inferiority of 600 pulses/day of iTBS versus 3000 pulses/ day of conventional rTMS in treating depression (Blumberger et al. , 2017). Li et al. found that iTBS in highly refractory depression led to a mean 33% reduction in the 17-item Hamilton Depression Rating Scale (HDRS17)