In a recent study published in Nature Medicine, researchers conducted a randomized clinical trial (RCT) comparing resting-state functional magnetic resonance imaging (rsfMRI) connectivity-guided intermittent theta burst stimulation (cgiTBS) to repetitive transcranial magnetic stimulation (rTMS) for treating therapy-resistant depression (TRD).
Background: Depression arises from disruptions in the right anterior insular and left dorsolateral prefrontal cortical (lDLPFC) regions. While psychotherapies and antidepressants are effective for major depressive disorders, a subset of individuals experiences TRD. Transcranial magnetic stimulation (TMS) and rTMS are common treatments for depression.
About the study: The BRIGhTMIND study, a five-center, double-blinded RCT, aimed to evaluate the efficacy of cgiTBS and rTMS in reducing depression symptoms in TRD patients.
The primary hypotheses focused on the effective connectivity at baseline from the right anterior insula to the lDLPFC, correlating with improvements in depressive symptoms after 26 weeks. Additionally, reduced functional connectedness between the left dorsomedial prefrontal cortex (lDMPFC) and lDLPFC was expected to improve depression symptoms.
The researchers personalized rsfMRI neuro-navigated cgiTBS based on effective connectivity, randomly assigning participants to 20 treatment sessions of either cgiTBS or rTMS over four to six weeks. The study involved individuals aged ≥18 with TRD based on DSM-V criteria for major depressive disorder.
Results: The study included 317 participants, with 255 forming the intention-to-treat population. Both treatment groups, cgiTBS and rTMS, exhibited clinically meaningful improvements in depression scores at 8, 16, and 26 weeks. No significant differences were observed between the two groups on secondary clinical outcome measures.
Conclusion: The study concluded that both cgiTBS and fMRI-neuronavigation rTMS are effective and safe treatments for TRD. Both options demonstrated significant improvements in depression and self-rated measures, highlighting the potential advantages of MRI-guided neuronavigation. Future research could explore the long-term efficacy and cost-effectiveness of MRI-neuronavigation TMS compared to non-neuronavigation TMS.
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