{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T16:17:28Z","timestamp":1783527448246,"version":"3.55.0"},"reference-count":38,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Intermittent theta-burst stimulation (iTBS) is an established treatment for major depressive disorder (MDD), but sham-controlled evidence for once-daily protocols remains limited.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine whether 10 sessions of once-daily iTBS is superior to sham iTBS for adults with MDD.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This randomized clinical trial was conducted at an outpatient psychiatric clinic in North Norway between January 1, 2022, and June 30, 2025, among 73 patients with MDD, aged 22 to 65 years, with a Montogomery-\u00c5sberg Depression Rating Scale (MADRS) score of 20 or more, regardless of treatment refractoriness level. Statistical analyses were completed in October 2025.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Participants were randomized to 10 weekday sessions of once-daily iTBS (600 pulses at 120% of the resting motor threshold) or sham stimulation delivered with a validated sham coil to the left dorsolateral prefrontal cortex. A 4-week follow-up evaluated sustained effects.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Main outcomes were between-group differences in depression scores on day 10, measured with the clinician-rated MADRS and the Beck Depression Inventory\u2013II (BDI-II). Secondary outcomes included MADRS scores on day 5, MADRS and BDI-II scores at follow-up, and response and remission rates on day 10. Repeated depression measures were analyzed using linear mixed-effects models in a modified intention-to-treat sample. Adverse events were assessed daily and compared between groups.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Seventy-three participants (mean [SD] age, 36.1 [10.6] years, 40 female [54.8%]) completed the study: 41 were randomized to active iTBS and 32 to sham. iTBS was superior to sham on day 10 for MADRS scores (mean difference, 3.57 [95% CI, 0.79-6.35]; Hedges\n g<\/jats:italic>\n \u2009=\u20090.61;\n P<\/jats:italic>\n \u2009=\u2009.01), but not for BDI-II scores (mean difference, 3.05 [95% CI, \u22122.72 to 8.82];\n P<\/jats:italic>\n \u2009=\u2009.30). iTBS was also superior to sham on day 5 for MADRS scores (mean difference, 2.89 [95% CI, 0.13-5.64]; Hedges\n g<\/jats:italic>\n \u2009=\u20090.50;\n P<\/jats:italic>\n \u2009=\u2009.04) but not significant at follow-up due to improvement in the sham group. Treatments were well tolerated, with mild and transient adverse events.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this randomized clinical trial of adults with MDD, a fixed 10-session schedule of once-daily iTBS resulted in greater reductions in clinician-rated depressive symptoms than sham during the treatment phase. The group difference was not sustained at the 4-week follow-up. These findings highlight the importance of treatment duration and extended follow-up in interpreting clinical response.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT05516095<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.21262","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T15:30:29Z","timestamp":1783524629000},"page":"e2621262","source":"Crossref","is-referenced-by-count":0,"title":["Intermittent Theta-Burst Stimulation and Depressive Symptoms in Major Depressive Disorder"],"prefix":"10.1001","volume":"9","author":[{"given":"Marte C.","family":"\u00d8rbo","sequence":"first","affiliation":[{"name":"Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Troms\u00f8, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ole K.","family":"Gr\u00f8nli","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, UiT The Arctic University of Norway, Troms\u00f8, Norway"},{"name":"Division of Mental Health and Substance Abuse, University Hospital of North Norway, Troms\u00f8, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mats S.","family":"Brochs","sequence":"additional","affiliation":[{"name":"Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Troms\u00f8, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oddgeir","family":"Friborg","sequence":"additional","affiliation":[{"name":"Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Troms\u00f8, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Torgil Riise","family":"Vangberg","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, UiT The Arctic University of Norway, Troms\u00f8, Norway"},{"name":"PET Imaging Center, University Hospital of North Norway, Troms\u00f8, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Runar","family":"Selaas","sequence":"additional","affiliation":[{"name":"Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Troms\u00f8, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camilla","family":"Larsen","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Division of Diagnostic Services, University Hospital of North Norway, Troms\u00f8, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Mittner","sequence":"additional","affiliation":[{"name":"Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Troms\u00f8, Norway"},{"name":"Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Trondheim, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zsolt","family":"Turi","sequence":"additional","affiliation":[{"name":"Department of Neuroanatomy, Institute for Anatomy and Cell Biology, University of Freiburg, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00e1bor","family":"Csifcs\u00e1k","sequence":"additional","affiliation":[{"name":"Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Troms\u00f8, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per M.","family":"Aslaksen","sequence":"additional","affiliation":[{"name":"Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Troms\u00f8, Norway"},{"name":"Department of Child and Adolescent Psychiatry, University Hospital of North Norway, Troms\u00f8, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"issue":"1","key":"zoi260590r1","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1186\/s12888-025-06932-y","article-title":"Global burden of mental disorders in 204 countries and territories, 1990-2021: results from the Global Burden of Disease Study 2021.","volume":"25","author":"Fan","year":"2025","journal-title":"BMC Psychiatry"},{"issue":"2","key":"zoi260590r2","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1001\/jamapsychiatry.2016.3644","article-title":"Repetitive transcranial magnetic stimulation for the acute treatment of major depressive episodes: a systematic review with network meta-analysis.","volume":"74","author":"Brunoni","year":"2017","journal-title":"JAMA Psychiatry"},{"issue":"2","key":"zoi260590r3","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1016\/j.clinph.2019.11.002","article-title":"Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): an update (2014-2018).","volume":"131","author":"Lefaucheur","year":"2020","journal-title":"Clin Neurophysiol"},{"key":"zoi260590r4","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1016\/j.clinph.2024.12.015","article-title":"Consensus review and considerations on TMS to treat depression: a comprehensive update endorsed by the National Network of Depression Centers, the Clinical TMS Society, and the International Federation of Clinical Neurophysiology.","volume":"170","author":"Trapp","year":"2025","journal-title":"Clin Neurophysiol"},{"issue":"10131","key":"zoi260590r5","doi-asserted-by":"publisher","first-page":"1683","DOI":"10.1016\/S0140-6736(18)30295-2","article-title":"Effectiveness of theta burst versus high-frequency repetitive transcranial magnetic stimulation in patients with depression (THREE-D): a randomised non-inferiority trial.","volume":"391","author":"Blumberger","year":"2018","journal-title":"Lancet"},{"key":"zoi260590r6","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1016\/j.jpsychires.2017.02.015","article-title":"Efficacy of theta burst stimulation (TBS) for major depression: an exploratory meta-analysis of randomized and sham-controlled trials.","volume":"90","author":"Berlim","year":"2017","journal-title":"J Psychiatr Res"},{"key":"zoi260590r7","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1016\/j.pnpbp.2015.11.009","article-title":"Different forms of prefrontal theta burst stimulation for executive function of medication-resistant depression: evidence from a randomized sham-controlled study.","volume":"66","author":"Cheng","year":"2016","journal-title":"Prog Neuropsychopharmacol Biol Psychiatry"},{"issue":"1","key":"zoi260590r8","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1038\/s41398-021-01441-4","article-title":"Theta burst stimulation for the acute treatment of major depressive disorder: a systematic review and meta-analysis.","volume":"11","author":"Voigt","year":"2021","journal-title":"Transl Psychiatry"},{"issue":"2","key":"zoi260590r9","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1176\/appi.ajp.2021.20101429","article-title":"Stanford neuromodulation therapy (SNT): a double-blind randomized controlled trial.","volume":"179","author":"Cole","year":"2022","journal-title":"Am J Psychiatry"},{"key":"zoi260590r10","doi-asserted-by":"crossref","DOI":"10.1016\/j.biopsych.2025.07.018","article-title":"Efficacy and safety of accelerated intermittent theta-burst stimulation for adolescents with major depressive disorder: a randomized, double-blind, sham-controlled study.","author":"Liu","year":"2026","journal-title":"Biol Psychiatry"},{"issue":"pt 7","key":"zoi260590r11","doi-asserted-by":"publisher","first-page":"2088","DOI":"10.1093\/brain\/awu109","article-title":"Efficacy of prefrontal theta-burst stimulation in refractory depression: a randomized sham-controlled study.","volume":"137","author":"Li","year":"2014","journal-title":"Brain"},{"issue":"3","key":"zoi260590r12","doi-asserted-by":"publisher","first-page":"e210963","DOI":"10.1001\/jamanetworkopen.2021.0963","article-title":"Efficacy of active vs sham intermittent theta burst transcranial magnetic stimulation for patients with bipolar depression: a randomized clinical trial.","volume":"4","author":"McGirr","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"5","key":"zoi260590r13","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1001\/jamapsychiatry.2025.0013","article-title":"Accelerated theta-burst stimulation for treatment-resistant depression: a randomized clinical trial.","volume":"82","author":"Ramos","year":"2025","journal-title":"JAMA Psychiatry"},{"key":"zoi260590r14","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.pnpbp.2017.10.016","article-title":"A systematic review and meta-analysis on placebo response to repetitive transcranial magnetic stimulation for depression trials.","volume":"81","author":"Razza","year":"2018","journal-title":"Prog Neuropsychopharmacol Biol Psychiatry"},{"issue":"s1","key":"zoi260590r15","doi-asserted-by":"publisher","first-page":"s34","DOI":"10.1017\/cjn.2023.24","article-title":"Placebo effects and neuromodulation: ethical considerations and recommendations.","volume":"50","author":"Mollica","year":"2023","journal-title":"Can J Neurol Sci"},{"issue":"1","key":"zoi260590r16","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1186\/s13063-023-07674-6","article-title":"The antidepressant effect of intermittent theta burst stimulation (iTBS): study protocol for a randomized double-blind sham-controlled trial.","volume":"24","author":"\u00d8rbo","year":"2023","journal-title":"Trials"},{"issue":"22","key":"zoi260590r17","doi-asserted-by":"publisher","first-page":"1998","DOI":"10.1001\/jama.2025.4347","article-title":"CONSORT 2025 statement: updated guideline for reporting randomized trials.","volume":"333","author":"Hopewell","year":"2025","journal-title":"JAMA"},{"issue":"4","key":"zoi260590r18","doi-asserted-by":"publisher","first-page":"548","DOI":"10.33314\/jnhrc.v17i4.1042","article-title":"The Declaration of Helsinki on medical research involving human subjects: a review of seventh revision.","volume":"17","author":"Shrestha","year":"2020","journal-title":"J Nepal Health Res Counc"},{"issue":"4","key":"zoi260590r19","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1192\/bjp.134.4.382","article-title":"A new depression scale designed to be sensitive to change.","volume":"134","author":"Montgomery","year":"1979","journal-title":"Br J Psychiatry"},{"issue":"1","key":"zoi260590r20","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1016\/j.clinph.2020.10.003","article-title":"Safety and recommendations for TMS use in healthy subjects and patient populations, with updates on training, ethical and regulatory issues: expert guidelines.","volume":"132","author":"Rossi","year":"2021","journal-title":"Clin Neurophysiol"},{"issue":"12","key":"zoi260590r21","doi-asserted-by":"publisher","first-page":"2008","DOI":"10.1016\/j.clinph.2009.08.016","article-title":"Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research.","volume":"120","author":"Rossi","year":"2009","journal-title":"Clin Neurophysiol"},{"key":"zoi260590r22","first-page":"22","article-title":"The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10.","volume":"59","author":"Sheehan","year":"1998","journal-title":"J Clin Psychiatry"},{"issue":"1","key":"zoi260590r23","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1186\/s12888-018-1679-x","article-title":"Standardisation framework for the Maudsley Staging Method for treatment resistance in depression.","volume":"18","author":"Fekadu","year":"2018","journal-title":"BMC Psychiatry"},{"key":"zoi260590r24","doi-asserted-by":"publisher","first-page":"101","DOI":"10.3389\/fnhum.2018.00101","article-title":"Real-time prediction of observed action requires integrity of the dorsal premotor cortex: evidence from repetitive transcranial magnetic stimulation.","volume":"12","author":"Brich","year":"2018","journal-title":"Front Hum Neurosci"},{"issue":"1","key":"zoi260590r25","doi-asserted-by":"publisher","first-page":"3651","DOI":"10.4088\/JCP.16cs10905","article-title":"Consensus recommendations for the clinical application of repetitive transcranial magnetic stimulation (rTMS) in the treatment of depression.","volume":"79","author":"McClintock","year":"2018","journal-title":"J Clin Psychiatry"},{"issue":"3","key":"zoi260590r27","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1159\/000376585","article-title":"The WHO-5 Well-Being Index: a systematic review of the literature.","volume":"84","author":"Topp","year":"2015","journal-title":"Psychother Psychosom"},{"issue":"6","key":"zoi260590r28","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1037\/0022-006X.56.6.893","article-title":"An inventory for measuring clinical anxiety: psychometric properties.","volume":"56","author":"Beck","year":"1988","journal-title":"J Consult Clin Psychol"},{"key":"zoi260590r29","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1016\/j.clinph.2022.06.008","article-title":"A questionnaire to collect unintended effects of transcranial magnetic stimulation: a consensus based approach.","volume":"141","author":"Giustiniani","year":"2022","journal-title":"Clin Neurophysiol"},{"issue":"2","key":"zoi260590r30","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1016\/j.cct.2003.10.016","article-title":"Assessment of blinding in clinical trials.","volume":"25","author":"Bang","year":"2004","journal-title":"Control Clin Trials"},{"issue":"2","key":"zoi260590r31","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1176\/appi.ajp.2016.16020225","article-title":"Patient expectancy as a mediator of placebo effects in antidepressant clinical trials.","volume":"174","author":"Rutherford","year":"2017","journal-title":"Am J Psychiatry"},{"issue":"9","key":"zoi260590r32","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.25531","article-title":"Magnitude of the placebo response across treatment modalities used for treatment-resistant depression in adults: a systematic review and meta-analysis.","volume":"4","author":"Jones","year":"2021","journal-title":"JAMA Netw Open"},{"key":"zoi260590r33","doi-asserted-by":"publisher","first-page":"210","DOI":"10.3389\/fpsyg.2015.00210","article-title":"Rethinking the role of sham TMS.","volume":"6","author":"Duecker","year":"2015","journal-title":"Front Psychol"},{"issue":"3","key":"zoi260590r34","doi-asserted-by":"publisher","DOI":"10.1016\/j.brs.2026.103067","article-title":"Dose-response relationships in transcranial brain stimulation: physics, physiology and mechanism.","volume":"19","author":"Soleimani","year":"2026","journal-title":"Brain Stimul"},{"issue":"6","key":"zoi260590r35","doi-asserted-by":"publisher","first-page":"768","DOI":"10.1016\/j.cpr.2010.06.001","article-title":"Self-reported versus clinician-rated symptoms of depression as outcome measures in psychotherapy research on depression: a meta-analysis.","volume":"30","author":"Cuijpers","year":"2010","journal-title":"Clin Psychol Rev"},{"issue":"12","key":"zoi260590r36","doi-asserted-by":"publisher","first-page":"3893","DOI":"10.1038\/s41380-024-02630-5","article-title":"Theta burst stimulation for depression: a systematic review and network and pairwise meta-analysis.","volume":"29","author":"Kishi","year":"2024","journal-title":"Mol Psychiatry"},{"key":"zoi260590r37","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l1079","author":"Mutz","year":"2019","journal-title":"BMJ"},{"key":"zoi260590r38","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/j.clinph.2024.06.004","article-title":"Should rTMS be considered a first-line treatment for major depressive episodes in adults?","volume":"165","author":"O\u2019Sullivan","year":"2024","journal-title":"Clin Neurophysiol"},{"key":"zoi260590r26","unstructured":"Beck? AT, Steer? RA, Brown? GK. Beck Depression Inventory\u2013II (BDI-II). American Psychological Association PsycNet. 1996. Accessed May 21, 2026. https:\/\/psycnet.apa.org\/doiLanding?doi=10.1037%2Ft00742-000"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2851350\/rbo_2026_oi_260590_1782846615.95725.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T15:30:31Z","timestamp":1783524631000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2851350"}},"subtitle":["A Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2026,7,8]]},"references-count":38,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.21262","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,8]]}}}