Rapid magnetic brain stimulation eases depression within days, but benefits fade within weeks

Despite decades of advances in mental health care, depression remains one of the world’s most disabling conditions. Many people with major depressive disorder (MDD) fail to find lasting relief from antidepressants or psychological therapies. Studies indicate that the global burden is expected to rise, with more than 466 million people projected to be living with depressive disorders by 2040.

In search of something beyond conventional treatment pathways, researchers in a new study turned to intermittent theta-burst stimulation (iTBS) to see how well it works for adults with major depressive disorder. Cleared by the FDA for clinical use in 2018, iTBS is a noninvasive brain stimulation technique that delivers rapid bursts of magnetic pulses to stimulate neural activity in the brain.

After 10 once-daily sessions, iTBS improved depression symptoms more than sham (placebo) treatment. Patients receiving the active treatment showed significantly greater improvement than those in the placebo group, with the treatment effect already evident after the first five sessions. However, these benefits were not sustained and had disappeared by the four-week follow-up, as improvements in the sham treatment group caught up with those in the iTBS group.

The findings were published in JAMA Network Open.

Pulse vs. placebo

Depression is most commonly treated with psychotherapy, in which people work through their thoughts and emotions with a mental health professional, or with antidepressant medications such as selective serotonin reuptake inhibitors (SSRIs). For some, either approach works well on its own, but many people benefit most from a combination of both. However, in many severe cases, neither method shows significant benefit.

One approach that has shown promise in treating depression is repetitive transcranial magnetic stimulation (rTMS), which uses magnetic pulses to stimulate brain activity. Researchers later developed a faster version called intermittent theta-burst stimulation (iTBS), which delivers the same type of stimulation in a shorter treatment time. Expert guidelines now recognize both approaches because there is strong evidence supporting rTMS’s effectiveness.

While iTBS is already a widely used treatment for depression, several gaps remain in the scientific evidence regarding its effectiveness in specific settings. Does it work better than placebo? Is the widely used once-daily dose effective? Do the benefits stay or fade away over time?

To answer these questions, the researchers enrolled 73 adults ages 22 to 65 with major depressive disorder from an outpatient clinic in North Norway. Participants were randomly assigned to receive either iTBS (41 people) or sham treatment (32 people). The placebo procedure used a specially designed coil that looked, sounded and felt like the real device, including the tingling sensation on the scalp, but delivered no actual brain stimulation. Every participant received one session a day for 10 weekdays.

The researchers tracked participants’ depression using surveys and brain scans at four key moments—before treatment began, halfway through on day 5, right after the final session on day 10 and again a month later—to see not just whether the treatment worked but also whether the benefits lasted.

By both the 5th and 10th days of treatment, doctors noticed that patients receiving the real stimulation had significantly fewer depression symptoms than those receiving the sham treatment. Symptoms dropped by about 42% in the iTBS group, compared with 22% in the sham group. However, when participants rated their own symptoms, both groups improved by similar amounts. By four weeks after treatment, the gap between the two groups had closed as the sham group continued to improve.

The researchers suggest that while a 10-session course of iTBS can produce quick improvements in depression symptoms, it may not be long enough to make those benefits last or maintain an advantage over the placebo effect. Further research is required to identify an optimal dose and treatment regimen to sustain the benefits over the long term.

Who’s behind this story?

Sanjukta Mondal

Master’s in Chemistry. Freelance science journalist and communicator. Published in Chemistry World, BioSpace, and The Hindu.

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Sadie Harley

BSc Life Sciences & Ecology. Microbiology lab background with pharmaceutical news experience in oil, gas, and renewable industries.

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Andrew Zinin

Master’s in physics with research experience. Long-time science news enthusiast. Plays key role in Science X’s editorial success.

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