Accelerated intermittent theta burst stimulation in late-life depression: A possible option for older depressed adults in need of ECT during the COVID-19 pandemic

Konstantinou, Gerasimos N.; Downar, Jonathan; Daskalakis, Zafiris J.; Blumberger, Daniel M.

OBJECTIVES: Electroconvulsive therapy (ECT) is an essential psychiatric service that has an important role in treating older adult patients with severe or treatment-resistant depression (TRD). During the COVID-19 pandemic, ECT services may be limited due to infection control measures. We report a case of a 66-year-old female patient with a severe major depressive episode who had previously responded to right unilateral ECT and was treated with two modified accelerated intermittent theta-burst stimulation (aiTBS) protocols. METHODS: The two aiTBS treatment courses consisted of 8 daily sessions over five consecutive days, followed by gradual tapering, using 1800 pulses per session pre-COVID-19 (first course), and 600 pulses per session during the pandemic (second course). RESULTS: Moderate to severe baseline depressive symptoms reached remission levels after both courses. CONCLUSIONS: The 600-pulses aiTBS treatment protocol reported here warrants further study and evaluation but may be a potential option in cases where older adults with severe depressive symptoms cannot access ECT during the COVID-19 pandemic.