ArticleFrontiers in psychiatry2026
Equivalent efficacy of left versus right hemisphere accelerated intermittent theta burst stimulation for major depressive disorder.
Article in Frontiers in psychiatry, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Intermittent theta burst stimulation (iTBS) to the dorsolateral prefrontal cortex (DLPFC) for major depression has been FDA-approved in the United States since 2018. Accelerated iTBS (aiTBS) protocols of multiple treatments per day have shown promising response and remission rates for major depression, especially when combined with connectivity-guided targeting. Brain networks associated with emotion regulation demonstrate significant changes in connectivity after effective iTBS. However, these findings have been confined to treatment of the left DLPFC, despite literature suggesting equivalent outcomes with right side stimulation. To date there has not been a direct comparison of clinical outcomes and connectivity changes between left and right DLPFC aiTBS for depression. Methods: Forty-four patients aged 50-79 with chronic major depressive disorder underwent open-label accelerated fMRI-guided aiTBS (45 sessions, 9 days) to the DLPFC (18 left, 26 right). Depression, anxiety, and anhedonia symptoms were assessed, and resting-state fMRI was obtained at baseline (Visit 1), after 15 sessions (Visit 2), and end of treatment (Visit 3). Patients who were not demonstrating at least 10% improvement in depression at Visit 2 were switched to contralateral stimulation for the remaining 30 sessions. Results: For the entire cohort (N = 44), mean depression (IDS-C Conclusion: Accelerated iTBS to the right DLPFC appears to have equivalent efficacy as aiTBS to the left DLPFC in terms of magnitude of reduction of depressive, anxious, and anhedonic symptoms in a late-life population. However, connectivity changes associated with treatment were asymmetric, and may reflect hemispheric lateralization of functional network responses to iTBS. Further work is needed to confirm the comparative efficacy and network dynamics of left versus right hemisphere aiTBS for depression.
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