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Despite advances in pharmacology and neuromodulation, major depression in large numbers of patients remains treatment-resistant. These investigators introduced three modifications to improve upon the FDA-approved protocol for noninvasive intermittent theta-burst stimulation (iTMS) in a study of 21 treatment-resistant, severely depressed patients (57% women; mean age, 45; mean illness duration, 23 years).
The participants had nonpsychotic depression associated with bipolar II or major depressive disorder and a mean of six prior adequate antidepressant trials. Treatments were guided by functional-connectivity MRI to precisely target a region of the left dorsolateral prefrontal cortex that was anticorrelated to the subgenual anterior cingulate …