Changes in core symptoms of Posttraumatic Stress Disorder associated with a novel sequential bilateral protocol: a case series

While repetitive transcranial magnetic stimulation (rTMS) has demonstrated therapeutic potential for Posttraumatic Stress Disorder (PTSD), optimal treatment parameters have not been established.We present a naturalistic observational case series on a sequential bilateral (SBL) protocol consisting of 10Hz to the left DLPFC, followed by iTBS to the right DLPFC in 11 patients with PTSD and comorbid major depressive disorder (MDD).Primary outcomes included change in overall scores and core symptom cluster scores on the PTSD Clinician Checklist-5 (PCL-5).Changes in depressive and anxious symptoms were assessed as secondary outcomes.Total PCL-5 scores decreased significantly by an average 47% from baseline to final TMS session, with a large effect size.There were statistically significant reductions for each cluster sub-score, depressive and anxious symptoms from baseline to final TMS session, sustained at 6-month follow-up.With limitations, results suggest that this SBL protocol may be therapeutic for patients with PTSD and comorbid MDD.