Depression is one of the most pervasive mental health conditions worldwide, affecting millions of individuals. While traditional treatments such as medication and psychotherapy work for many, there is a significant group of patients who experience treatment-resistant depression (TRD). These individuals struggle to find relief even after multiple trials of antidepressants.

A groundbreaking study has recently explored the effectiveness of accelerated theta burst stimulation (aTBS), a condensed and high-intensity form of transcranial magnetic stimulation (TMS). The results indicate that this new approach could be a game-changer for those who have not responded to conventional treatments.

TMS is a non-invasive brain stimulation technique that has been used for years to treat depression. By using magnetic pulses to stimulate nerve cells in the brain, TMS can help regulate mood, reduce anxiety and alleviate symptoms of depression.

TMS works by delivering repetitive magnetic pulses to specific brain areas, particularly the left dorsolateral prefrontal cortex, which is responsible for mood regulation. This stimulation encourages neuronal activity in underactive regions of the brain, ultimately helping to reduce symptoms of depression.

Traditional TMS requires daily sessions over a period of four to six weeks, making it a slow and time-consuming process for patients. However, aTBS condenses this timeline, delivering short bursts of magnetic stimulation that is thought to be in sync with the brain's natural wave pattern. This means patients can see significant improvement in their symptoms within three weeks instead of several months.

A third of individuals diagnosed with depression do not experience relief from traditional treatments, leading to treatment-resistant depression (TRD). This can be a frustrating and discouraging experience, but alternative treatment options like TMS and TBS provide new hope.

There are several reasons why some individuals do not respond to antidepressants:

• Genetic Factors – Some people metabolize medications differently, making them less effective.
• Neurobiological Differences – Certain brain structures and functions may contribute to depression resistance.
• Chronic Stress and Trauma – Long-term stress can alter brain chemistry, making standard treatments ineffective.

For those with TRD, there are several alternatives beyond medication, including:

• Electroconvulsive Therapy (ECT) – A procedure using electrical pulses, requires anesthesia.
• Ketamine Treatment– Shown to provide rapid relief for some patients.
• Transcranial Magnetic Stimulation (TMS) – A non-invasive and effective outpatient option.

A recent study published in JAMA Psychiatry examined the effectiveness of aTBS in treating treatment-resistant depression. The study aimed to determine whether aTBS could provide faster and more effective relief than traditional TMS.

The research focused on comparing aTBS with a sham procedure to evaluate its impact on depression symptoms. Participants underwent treatment in an outpatient setting, making it accessible and practical for real-world use.

The research focused on comparing aTBS with a sham procedure to evaluate its impact on depression symptoms. Participants underwent treatment in an outpatient setting, making it accessible and practical for real-world use.

The study took place between July 2022 and June 2024 and included 89 outpatients with TRD. The participants were randomly assigned to either:



• Active aTBS Group – Received actual TMS treatment.
• Sham Procedure Group – Received a placebo treatment that mimicked TMS but did not deliver magnetic pulses.

All participants had a Hamilton Depression Rating Scale (HDRS) score above 16 and had failed to respond to at least one antidepressant trial.

Patients in the active aTBS group underwent:

• Three daily TMS sessions, each lasting six minutes and 18 seconds.
• Two 30-minute breaks between sessions.
• Total daily treatment time of 78 minutes.
• 15 weekdays of treatment, totaling 45 sessions.

The study found that aTBS led to a significant reduction in depression symptoms:

• Patients who received active aTBS experienced a 55% reduction in their depression scores.
• 34% of the active treatment group achieved full remission (HDRS score ≤ 8), compared to only 16% in the sham group.
• The treatment was well tolerated, with only mild side effects reported.

Shorter Treatment Duration

One of the biggest benefits of aTBS is its efficiency. Traditional TMS requires six weeks of daily treatments, whereas aTBS condenses this into just three weeks.

No Need for Neuroimaging Equipment

Unlike some TMS protocols, aTBS does not require neuroimaging equipment to target the treatment area, making it more accessible for outpatient clinics.

High Success Rate in Remission

The remission rate for aTBS (34%) was more than double that of the sham group (16%), demonstrating that this condensed treatment is highly effective.

Common Side Effects

The study reported that aTBS was well tolerated, with only mild side effects, including:

• Scalp discomfort or pain during treatment.
• Mild headaches after sessions.
• Temporary discomfort in the treated area.

Who is an Ideal Candidate for aTBS?

Individuals who may benefit most from aTBS include:

• Patients diagnosed with treatment-resistant depression.
• Those who have tried at least two antidepressants with no success.
• Individuals seeking a non-invasive treatment alternative.

Expanding Accessibility to Patients

Given its shorter treatment time and high success rate, aTBS has the potential to become a leading treatment for TRD. More clinics worldwide are adopting this protocol, making it accessible to a larger population.

Ongoing Research and Potential Improvements

The study suggests further clinical trials are needed to optimize aTBS parameters and compare its effectiveness to traditional TMS. Future advancements may refine pulse frequencies, treatment durations, and individualized protocols.

The results of this study confirm that accelerated theta burst stimulation (aTBS) is a promising treatment for individuals with treatment-resistant depression. With its short treatment time, high remission rates, and minimal side effects, aTBS is paving the way for more accessible and effective depression treatments. As research in TMS and aTBS continues to evolve, the future of mental health treatment looks increasingly bright for those struggling with TRD.