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In patients with treatment-resistant depression, repetitive transcranial magnetic stimulation (rTMS) to the left dorsolateral prefrontal cortex, given daily for 4 to 6 weeks, is effective, perhaps even more so than additional medication trials. However, its average session length of 37.5 minutes limits access. In a Canadian noninferiority trial, 414 patients with treatment-resistant depression were randomized to a form of rTMS called intermittent theta burst stimulation (iTBS), which only takes 3 minutes, or standard 10-Hz rTMS.
Patients had experienced two or three antidepressant failures or intolerance, were stabilized for ≥4 weeks on their current antidepressant, and had Hamilton Rating Scale for Depression scores (HRSD) of ≥18. Investiga…