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Canadian rTMS Treatment and Biomarker Network in Depression (CARTBIND) Trial

Principal Investigator:
  • Zafiris Daskalakis, Centre for Addiction and Mental Health
Team Members:
  • Fidel Vila-Rodriguez, University of British Columbia
  • Aristotle Voineskos, Centre for Addiction and Mental Health
  • Sidney H. Kennedy, University Health Network
  • Raymond Lam, University of British Columbia
  • Jonathan Downar, Toronto Western Research Institute, University of Toronto
  • Daniel Blumberger, Centre for Addiction and Mental Health
  • Tarek Rajji, Centre for Addiction and Mental Health
  • Gustavo Turecki, Douglas Hospital Research Centre
  • Christopher Honey, University of Toronto
  • University of British Columbia
  • Toronto General & Western Hospital Foundation
  • CAMH

Project Overview

Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for patients with depression who have not responded to antidepressant medications. rTMS involves stimulating the brain with a series of magnetic pulses delivered through a hand-held magnetic coil. Treatment duration is about 40 min and about 8-10 treatments per day can be administered. Recent studies have shown that a new type of rTMS – called intermittent theta-burst stimulation (iTBS) – can also be effective in treating depression. iTBS takes only 3 minutes to administer. For this proposal, Zafiris Daskalakis and his team are conducting a clinical trial comparing standard rTMS to iTBS in 294 patients with medication resistant depression over a course of 20 treatment sessions. Half will receive conventional rTMS treatment and the other half will receive iTBS. To better understand how rTMS works they are also evaluating changes in brain biology that occur with rTMS treatment. Understanding brain biology changes will help to better predict which patients will or will not respond to rTMS treatment. The teams preliminary work thus far demonstrates that iTBS works as well as standard rTMS in depression. Their preliminary work of imaging brain biology also suggests that they can effectively identify which patients respond best to rTMS treatment. If successful, this project will demonstrate a method for increasing rTMS clinic treatment capacities 8-10 fold. This 8-10-fold increase will be a crucial step forward in improving access to rTMS for all Canadians. Overall, this proposal will have ‘real-world’ impact by improving the efficiency of rTMS – one of the few established treatments in medication resistant depression – and by producing more personalized treatment approaches.