iTBS DST data

This pilot study investigates the effects of 20 once-daily sessions of intermittent theta-burst stimulation (iTBS)—a form of repetitive transcranial magnetic stimulation (rTMS)—applied to the left dorsolateral prefrontal cortex in 17 treatment resistant depressed inpatients (TRDs) showing cortisol non-suppression to the overnight dexamethasone suppression test (DST) at baseline. Compared to 17 matched healthy control subjects (HCs), TRDs showed higher maximum post-DST cortisol (CORmax) levels at baseline, while after 20 iTBS sessions post-DST CORmax levels decreased significantly and were comparable to those of HCs. The DST status after 20 iTBS sessions was associated with clinical outcome: 10 TRDs showed DST normalization (among them 7 were responders [70%] to iTBS), and 7 TRDs did not normalize their DST (among them 6 were non-responders [86%]) (p < 0.05 by Fisher Exact test). Our results suggest that normalization of the hypothalamic-pituitary-adrenal axis hyperactivity, significantly associated with successful iTBS treatment, is a primary result of a normalized glucocorticoid receptor signaling.