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Patients received 15 daily sessions of active or sham neuronavigated rTMS (Figure-of-8 coil, five 1\u00a0Hz 60\u00a0s 110% RMT trains). Outcome measures included depressive response (\u2265\u200950% MADRS reduction, CGI\u2009\u2264\u20092) and remission (MADRS\u2009&lt;\u20097, CGI\u2009=\u20091) rates, treatment emergent hypo\/mania (YMRS), depressive and anxiety symptoms (HAM-A).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>48 patients (25 sham, 23 active) completed treatment, with 3 drop-outs each in active and sham groups. Active rTMS did not produce superior response or remission rates at endpoint or 6 or 12\u00a0weeks (ps\u2009&gt;\u20090.05). There was no significant group\u2009*\u2009time interaction (ps\u2009&gt;\u20090.05) in a multivariate ANOVA with MADRS, HAMA and YMRS as dependent variables. Exploratory analysis found MADRS improvement to be moderated by baseline anxiety (p\u2009=\u20090.02) and melancholia (p\u2009=\u20090.03) at week 3, and depressive onset at weeks 6 (p\u2009=\u20090.03) and 12 (p\u2009=\u20090.04). In subjects with below-mean anxiety (HAMA\u2009&lt;\u200920.7, n\u2009=\u200924), MADRS improvement from active rTMS was superior to sham at week 3 (ITT, t\u2009=\u20092.49, p\u2009=\u20090.04, Cohen\u2019s d\u2009=\u20091.05). No seizures were observed. Groups did not differ in treatment-emergent hypomania (p\u2009=\u20090.1).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Limitations<\/jats:title>\n                <jats:p>Larger sample size might be needed to power subgroup analyses. Moderation analyses were exploratory. Single-blind design. Unblinding before follow-up assessments due to ethical reasons.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>1-Hz 110% RMT (5\u2009\u00d7\u200960\u00a0s trains) <jats:bold>R<\/jats:bold>-DLPFC-LF rTMS was not effective for antidepressant non-responding BD but may be further investigated at increased dosage and\/or in BD patients with low anxiety.<\/jats:p>\n                <jats:p><jats:italic>Trial registration<\/jats:italic> CCRB Clinical Trials Registry, CUHK, CUHK_CCT00440. Registered 04 December 2014, <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www2.ccrb.cuhk.edu.hk\/registry\/public\/279\">https:\/\/www2.ccrb.cuhk.edu.hk\/registry\/public\/279<\/jats:ext-link><\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s40345-021-00245-1","type":"journal-article","created":{"date-parts":[[2021,12,8]],"date-time":"2021-12-08T02:02:40Z","timestamp":1638928960000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Antidepressant efficacy of low-frequency repetitive transcranial magnetic stimulation in antidepressant-nonresponding bipolar depression: a single-blind randomized sham-controlled trial"],"prefix":"10.1186","volume":"9","author":[{"given":"Arthur D. P.","family":"Mak","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastiaan F. 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