Two versus one high-frequency repetitive transcranial magnetic stimulation session per day for treatment-resistant depression

Christos Theleritis, Pavlos Sakkas, Thomas Paparrigopoulos, Silia Vitoratou, Chara Tzavara, Stefania Bonaccorso, Antonios Politis, Constantin R. Soldatos, Costantin Psarros

Research output: Contribution to journalArticlepeer-review


Objectives: High-frequency repetitive transcranial magnetic stimulation (HF-rTMS) has proven antidepressant effects, but the optimal frequency of sessions remains unclear. Methods:We conducted a 3-week, sham-controlled trial to assess the antidepressant efficacy of 1 active HF-rTMS session per day (A1 group) compared with 2 per day (A2 group) and equivalent sham sessions (once a day, S1 group; twice a day, S2 group) in patients with treatmentresistant major depression with a subsequent 2-week follow-up period. One hundred seventy-seven patients were screened, of whom 105 met eligibility criteria and 98 consented and were randomized. The HF-rTMS (20 Hz) was targeted to the left prefrontal cortex in sessions of approximately 40 trains (2 seconds each) at 100% resting motor threshold with an intertrain interval of 1 minute. Treatment response was defined as a 50%or greater decrease in the Hamilton Depression Rating Scale (HDRS) score and/or Clinician Global Impressions-Severity of Illness (CGI-S) score of 3 or less. Remission was defined as HDRS score less than 8 and/or CGI-S score of 2 or less. Results: Practically none of the subjects in either sham groups achieved remission. Increased odds of remission were present for CGI-S by stimulating twice rather than once per day (odds ratio [OR] = 1.5, P = 0.018), whereas there was a marginal result for HDRS (OR = 3.9, P = 0.066). Patients who had lower baseline HDRS (OR = 0.75, P = 0.014) and CGI-S scores (OR = 0.18, P = 0.001) were more likely to achieve remission. Conclusions: Twice per day active HF-rTMS might be more effective than once per day active HF-rTMS or sham stimulation.

Original languageEnglish (US)
Pages (from-to)190-197
Number of pages8
JournalJournal of ECT
Issue number3
StatePublished - 2017


  • Depression
  • Randomized controlled trial
  • Transcranial magnetic stimulation

ASJC Scopus subject areas

  • Neuroscience (miscellaneous)
  • Psychiatry and Mental health


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