Project title

Continuous Theta-Burst Stimulation as an add-on Treatment for Bipolar Depression

Project description

In the current research project, we aim to investigate the clinical efficacy of continuous theta burst stimulation (cTBS) on the right DLPFC as an add-on treatment in bipolar depression. The safety of the cTBS protocol and efficacy of the treatment on depressive, cognitive and psychomotor symptoms will be investigated.

Project duration

01/06/2018 - 1/06/2021


Bernard Sabbe

PhD Researcher

Kaat Hebbrecht


Eline Schellens, Ingrid Vanderplas, Alysia Van Saet, Tina Lauwers, Manuel Morrens, Bernard Sabbe


For more information please contact Kaat Hebbrecht:

Tel. n°: 015 30 40 30

E-mail: kaat.hebbrecht@uantwerpen.be

ClinicalTrials.gov Identifier



The impact of high-frequency repetitive transcranial magnetic stimulation on fine motor functions in medication-resistant major depression.

Schrijvers DL, Baeken C, De Raedt R, Sabbe BG.Neuropsychobiology. 2012;66(4):252-8. 


Repetitive Transcranial Magnetic Stimulation (rTMS) is considered as an accepted, evidence-based treatment option for patients with Major Depressive Disorder (MDD) by the American Psychiatric Association (APA), the Canadian Network for Mood and Anxiety Treatments (CANMAT), and the World Federation of Societies of Biological Psychiatry (WFSBP) (Milev et al., 2016; Trevino et al., 2014). The precise working mechanisms of TMS are still unclear. Brain imaging studies have proposed an underlying neurobiological mechanisms based on the theoretical framework of deregulated cortico-thalamic- limbic pathways in unipolar major depression (hypometabolic state in the DLPFC and dorsal ACC; enhanced activity in the amygdala and activation of the core stress system). These brain imaging studies have shown that left-sided HF TMS treatment resulted in higher metabolic activity in the anterior cingulate cortex (ACC) and right-sided LF-rTMS resulted in metabolic ACC decreases.

The antidepressant effect of rTMS in bipolar depression is poorly investigated. There are only four randomized controlled trials (RCT) in the literature investigating the effects of rTMS in patients with bipolar depression (BD). However, given the debilitating nature of bipolar depression and its frequent non-response to pharmacological treatments, it would be interesting to investigate the efficacy and safety of rTMS as a novel treatment strategy (Bauere et al., 2012; Judd et al., 2002).  This study aims to investigate the clinical efficacy of a new TMS protocol (continuous theta burst stimulation (cTBS)) on the right DLPFC as an add-on treatment in bipolar depression (type I/II). The secondary objective is to investigate the effect on cognitive and psychomotor symptoms. And the tertiary objective is to investigate the possible predictive value of inflammatory markers and/or cognitive and psychomotor symptoms for response to cTBS.