Impact of prior treatment on remission with intermittent theta burst versus high-frequency repetitive transcranial magnetic stimulation in treatment resistant depression

Background: Multiple prior treatment failures are associated with reduced rates of remission to subsequent antidepressant treatment, including rTMS. The degree of treatment resistance that is especially predictive of inferior outcome is uncertain. Intermittent theta burst stimulation (iTBS) is a newer form of rTMS where less is known regarding clinical predictors of remission. The THREE-D study demonstrated that iTBS is non-inferior to 10 Hz rTMS for the treatment of depression. Objective: Determine if the number and type of prior pharmacotherapy trials affect the rate of remission with two types of rTMS. Method: Compare remission rates based on prior pharmacotherapy using data from the THREE-D trial (NCT01887782). Results: No differences in remission rates were noted between the three levels of treatment resistance, however, participants with 3 compared to <3 treatment failures had lower rates of remission: 17.3% versus 29.4% (chi(2) 4.87; df = 1; p = 0.03). Conclusions: Three or more treatment failures may be associated with lower remission rates with rTMS. (C) 2019 The Author(s). Published by Elsevier Inc.