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Abstract Introduction Sleep disturbances are commonly observed in individuals with depression, and are associated with severity of depression, treatment outcomes, and risk of relapse. Repetitive transcranial magnetic stimulation, including newer optimized theta-burst stimulation (TBS) protocols, is recognized as a safe and effective intervention for treatment-resistant depression (TRD). Presently, little is known about the impact of TBS treatments on sleep in individuals with depression. We examined changes in subjective sleep and depression in individuals with TRD receiving daily TBS treatments, and the relationship between changes in these symptom domains. Methods 50 participants (50% female, mean age 46.82 years) with TRD received four or six weeks of daily TBS treatments targeting the left or bilateral dorsolateral prefrontal cortex while participating in a randomized, double-blind clinical trial. Sleep disturbances and depression severity were measured at baseline, session 20 and session 30 using the Leeds Sleep Evaluation Questionnaire and 17-item Hamilton Rating Scale for Depression (HRSD-17), respectively. Linear mixed models examined whether scores changed significantly throughout treatment. Spearman’s correlations investigated whether changes in depression and sleep were associated. Results HRSD-17 scores improved significantly from baseline to weeks 4 and 6 (p 0.001). We also observed significant improvements in quality of sleep (QOS), ease of awakening from sleep (AFS), and behaviour following wakefulness (BFW) after 4 and 6 weeks of TBS (p 0.001). After 4 weeks of TBS, improvements in HRSD-17 significantly correlated with BFW scores (p= 0.008). After 6 weeks of TBS, improvements in HRSD-17 scores significantly correlated with improvements in both AFS and BFW scores (p 0.005). Conclusion Participants reported improvements in depression, sleep quality, ease of waking, and daytime alertness following TBS. Furthermore, improvements in several aspects of sleep and depression were correlated. These findings suggest that TBS may be an effective intervention for individuals experiencing comorbid depression and sleep disturbances. This also strengthens the view that sleep enhancement may contribute to better mental health outcomes. Support (if any) Support was provided by the Royal’s Institute of Mental Health Research’s Emerging Research Innovators in Mental Health award, the Fonds de Recherche en Santé – Québec Research Scholar Junior 1 grant (grant number 297133), and an anonymous donation.
Cuda et al. (Sat,) studied this question.