Recently an article accepted in in European Psychiatry by Lee et al (2025- 10.1192/j.eurpsy.2025.10049 ) showed some fantastic results in improving suicidal ideation in late life depression. They presented data from 84 individuals with late life depression and showed that the overall effect of achieving remission of suicidal ideation is similar for standard rTMS and theta burst stimulation. However, the remission rates for male and female participants were very different for the standard rTMS and theta burst stimulation. Male and female did not seem to differ significantly in standard rTMS. Whereas, in theta burst stimulation a significant difference can observed in the remission rate ( Figure 1, produced based on the data given in the article)
A paper published in 2024 by Slan et al in the Journal of Affective Disorders (https://lnkd.in/e2DtWj8M ) provided a different picture for rTMS and theta burst outcome. In their study they reported male particiants had significantly greater improvement with theta burst stimulation. Whereas, in the standard rTMS, difference between male and female participants was not significant. See the figure 2.
In view of these contrasting findings, it becomes difficult to consider theta burst stimulation as a reliable intervention in some situations. Variability of response for the theta burst stimulation on the MEP has been well documented, to the extent that the average effect of theta burst was not considered different than the baseline. See the figure 3 taken from Hamada et al (2013: 10.1093/cercor/bhs147)
Hamada M, Murase N, Hasan A, Balaratnam M, Rothwell JC. The role of interneuron networks in driving human motor cortical plasticity. Cereb Cortex. 2013 Jul;23(7):1593-605. doi: 10.1093/cercor/bhs147.
Lee HH, Göke K, Wathra RA, Mulsant B, Trevizol AP, Downar J, McClintock SM, Nestor SM, Noda Y, Rajji TK, Daskalakis ZJ, Blumberger DM. Clinical effects and correlates of standard rTMS and theta burst stimulation on suicidal ideation in late-life depression. Eur Psychiatry. 2025 Jun 27:1-28. doi: 10.1192/j.eurpsy.2025.10049.
Slan AR, Citrenbaum C, Corlier J, Ngo D, Vince-Cruz N, Jackson NJ, Valles TE, Wilke SA, Hoftman GD, Koek RJ, Leuchter MK, Krantz DE, Strouse TB, Tadayonnejad R, Ginder ND, Distler MG, Lee JH, Adelekun AE, Einstein EH, Oughli HA, Leuchter AF. The role of sex and age in the differential efficacy of 10 Hz and intermittent theta-burst (iTBS) repetitive transcranial magnetic stimulation (rTMS) treatment of major depressive disorder (MDD). J Affect Disord. 2024 Dec 1;366:106-112. doi: 10.1016/j.jad.2024.08.129.
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