Theta burst stimulation with 80 and 120% resting motor threshold do not differ in their antidepressant efficacy: a retrospective analysis.

Depression scores improved in both intensity groups. The lower-intensity group met the study's non-inferiority criterion on the clinician-rated depression scale and reported fewer side effects, but the retrospective design cannot show that intensity alone caused the difference.

Abdelnaim MA, Reissmann A, Kerkel K, Aamer M, Huebner J, Poeppl TB, Schoisswohl S, Langguth B.
European archives of psychiatry and clinical neuroscience · Publication date: 2026-09-26
Added to site: 2026-09-28
DOI: 10.1007/s00406-026-02384-x

Electronic publication date verified in Europe PMC. This source date is separate from the site's addition date.

Modalities

iTBS, rTMS

Clinical focus

Depression, Stimulation intensity, Tolerability

Population

Patients with unipolar or bipolar depression receiving intermittent theta-burst stimulation

Sample

215 patients: 107 treated at 80% resting motor threshold and 108 at 120%

Intervention / method

Clinical iTBS delivered at either 80% or 120% of resting motor threshold; other treatment parameters were not available in the checked abstract

Comparator

80% versus 120% resting motor threshold

Clinician summary

The adjusted HAMD-21 difference was -0.90 points (95% CI -2.61 to 0.82) against a 2.25-point non-inferiority margin. Response rates ranged from 30.84% to 38.32% and remission from 23.36% to 31.48%, without significant between-group differences. Side effects occurred in 20.56% versus 27.77%.

How to interpret the findings

Treatment intensity was not randomized, leaving selection and confounding risks. The cohort combined unipolar and bipolar depression, lacked a sham or untreated group, and the abstract does not report treatment-course details, follow-up duration or adjusted safety comparisons. Non-inferiority on one scale does not establish that lower intensity is optimal for every patient.

Equipment and disclosures

The checked abstract identifies iTBS intensity by resting motor threshold but does not report the device, coil, target or session schedule.

The PubMed record states that the authors declared no competing interests. Funding details were not available in the checked index record.

Related evidence

Compare findings from the same clinical area, including mixed results.

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• Stanford Neuromodulation Therapy (SNT): A Double-Blind Randomized Controlled Trial. · Positive with limitations
• Clinical Efficacy of High-Frequency Deep Repetitive Transcranial Magnetic Stimulation in the Treatment of Depression and the Predictive Role of Baseline Triglyceride Levels: A Randomized Sham-Controlled Trial. · Positive with limitations
• TMS-EEG Correlate of Suicidal Ideation in Individuals with Depression: A Multi-Site Synthesis. · Positive with limitations
• Motor Cortex rTMS Alleviates Pain and Comorbid Depression After Spinal Cord Injury with a Correlate in M1 Intracortical Inhibition. · Positive with limitations
• A PRISMA-compliant Systematic Review and Meta-Analysis of the Late Positive Potential in Depression. · Positive with limitations
• Feasibility, tolerability, and preliminary effectiveness of an accelerated bilateral intermittent theta-burst stimulation protocol in adults with posttraumatic stress disorder and comorbid depressive disorder following mild traumatic brain injury. · Positive with limitations
• Accelerated TMS is associated with changes of subgenual cingulate-default mode network coupling in depression: an observational 7 Tesla fMRI study. · Mixed
• Identifying poor responders to repetitive transcranial magnetic stimulation using structural brain networks. · Positive with limitations
• TMS-Evoked Cortical Reactivity Signatures as a Multidimensional Biomarker of Depression: A TMS-EEG Meta-Analysis from Diagnosis to Prognosis. · Positive with limitations
• The effects of cognitive-behavioural therapy (CBT) on heart rate variability (HRV) in people with depression and/or anxiety disorders: A systematic review and meta-analysis · Positive with limitations