Response and Remission Across Transcranial Magnetic Stimulation Protocols for Treatment-Resistant Depression: A Narrative Review

Ayushi Saxena

doi:10.36948/ijfmr.2026.v08i05.90184

Response and Remission Across Transcranial Magnetic Stimulation Protocols for Treatment-Resistant Depression: A Narrative Review

Author(s)	Dr. Ayushi Saxena
Country	India
Abstract	Daily high-frequency repetitive transcranial magnetic stimulation (rTMS) to the left dorsolateral prefrontal cortex (DLPFC) is an established treatment for depression that has not responded to medication, but a standard course takes four to six weeks of sessions that can last close to 40 minutes each. Intermittent theta burst stimulation (iTBS), accelerated schedules and alternative coil designs have all been developed to shorten treatment or improve its effect. This narrative review examines how often patients respond and remit under these approaches, drawing on 13 studies: four randomized trials comparing theta burst stimulation with conventional rTMS, one sham-controlled trial of deep TMS in late-life depression, seven studies of accelerated iTBS and one network meta-analysis of theta burst stimulation against sham. Theta burst stimulation was non-inferior to conventional rTMS in two large trials, and response and remission were similar between the two approaches in two further trials, one of which used connectivity-guided targeting. Deep TMS with the H1 coil produced remission in 40.0% of older adults against 14.8% with sham. Two parallel sham-controlled trials found accelerated iTBS superior to sham, with remission of 57.1% against 0% immediately after a five-day, connectivity-guided protocol, and 34% against 16% at week 5 with a pragmatic protocol delivered over three weeks. Open-label and retrospective studies were more variable, and the only direct comparison with standard iTBS found numerically lower response with a one-week accelerated course. Across 23 randomized trials, left-sided iTBS roughly doubled the likelihood of response compared with sham, although confidence in that evidence was rated low or very low. Theta burst stimulation at standard daily dosing now rests on a solid evidence base. Accelerated iTBS works better than sham, but whether it matches or improves on a standard course has not yet been tested in an adequately powered randomized trial.
Keywords	Transcranial Magnetic Stimulation, Theta Burst Stimulation, Treatment-Resistant Depression, Accelerated TMS, Response, Remission
Field	Medical / Pharmacy
Published In	Volume 8, Issue 5, September-October 2026
Published On	2026-10-21
DOI	https://doi.org/10.36948/ijfmr.2026.v08i05.90184

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Response and Remission Across Transcranial Magnetic Stimulation Protocols for Treatment-Resistant Depression: A Narrative Review

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