Efficacy of Intermittent ThetaBurst Stimulation Compared to 10 Hz Stimulation on Dorsolateral Prefrontal Cortex in Treatment Resistant Major Depressive Disorder: a Double-blind Randomized Study

Efficacy of Intermittent ThetaBurst Stimulation Compared to 10 Hz Stimulation on Dorsolateral Prefrontal Cortex in Treatment Resistant Major Depressive Disorder: a Double-blind Randomized Study

This trial will compare innovating stimulation parameters, intermittent Theta Burst Stimulation, to the standard high frequency stimulation protocol. The Left dorsolateral prefrontal cortex, targeted by MRI navigation will be the site of stimulation in both treatment conditions. The study seeks to determine if there is a superiority in therapeutic efficacy with iTBS protocol compared to conventional one.

Inclusion Criteria:

• Age 18 years to 75 years
• Both gender eligible
• Volontary and able to give consent
• Major depressive episode (MADRS > 20) single or recurrent
• Resistance to at least 2 antidepressants ,
• Treated by antidepressant at efficient stable posology since more than 6 weeks

Exclusion Criteria:

• Initiation or modification of antidepressant drug
• Neurodegenerative diseas
• Bipolar I, II disorder
• Schizophrenia, schizoaffective disorder, schizophreniform, delusional disorder, or current psychotic symptoms
• Substance abuse in past 15 days
• Substance dependence not weaned
• Benzodiazepine and any anticonvulsant during rTMS treatment course
• ECT failure in medical history
• Contra-indication to rTMS and MRI
• Pregnancy
• Difficulty to obtain informed consent