A novel sequential bilateral neurostimulation approach for treatment-resistant depression involving high-frequency repetitive transcranial magnetic stimulation to the left dorsolateral prefrontal cortex and intermittent theta burst to the right dorsolateral prefrontal cortex

High-frequency unilateral repetitive transcranial magnetic stimulation (rTMS) applied to the left dorsolateral prefrontal cortex (LDLPFC) is an established approach for treatment-resistant major depressive disorder (TR-MDD). However, typical response rates defined as >50 % reduction in depression scale scores have been inadequate; a recent systematic review and meta-analysis estimated response rates at approximately 29 % [1]. Suboptimal response and remission rates have led to the development of novel protocols to serve as augmentation or alternative treatment strategies.