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We hypothesize that active TBS will show a greater reduction in depressive symptoms than sham and no TBS (control). Approximately 120 patients with major depression who are undergoing 8- to 10-week ST will be randomly assigned to additionally receive 4-weeks of bilateral active TBS, bilateral sham TBS, or no TBS. TBS will be administered as intermittent TBS (iTBS) to the left side of the dorsolateral prefrontal cortex to increase and continuous TBS (cTBS) to the right to decrease excitability. Depressive symptoms will be assessed with the Montgomery-\u00c5sberg Depression Rating Scale (MADRS) and the Beck Depression Inventory-II (BDI-II). Functional levels will be assessed with the Global Assessment of Functioning (GAF) scale, and therapy-specific changes with the Young Schema Questionnaire (YSQ-S3R). Differences in efficacy between groups will be analyzed by linear mixed model repeated measures. This forthcoming study is expected to provide important insights into potential benefits of combining ST with bilateral TBS in patients with major depression and may lead to more effective therapeutic strategies.\u00a0Trial registration:\u00a0DRKS00039152 registered 10\/02\/2026.<\/jats:p>","DOI":"10.1007\/s00406-026-02341-8","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T07:47:48Z","timestamp":1790322468000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Bilateral theta burst stimulation as an add-on to schema therapy in major depression: methods and design of a randomized, sham-controlled study"],"prefix":"10.1007","author":[{"given":"Milenko","family":"Kujovic","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Bahr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathias","family":"Riesbeck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Dei\u00df","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivana","family":"Koncarevic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Lipka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Plewnia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Meisenzahl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"2341_CR1","unstructured":"World Health Organization (2019) International statistical classification of diseases and related health problems (11th ed.). https:\/\/icd.who.int\/ accessed 23.02.2026"},{"key":"2341_CR2","doi-asserted-by":"publisher","DOI":"10.17886\/rki-gbe-2017-058","author":"J Bretschneider","year":"2017","unstructured":"Bretschneider J, Kuhnert R, Hapke U (2017) Depressive Symptomatik bei Erwachsenen in Deutschland. 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