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Effect of a brief, focal acceptance and commitment therapy (ACT) protocol to accelerate repetitive transcranial magnetic stimulation treatment with theta-burst stimulation (TBS) for elderly patients with depression: A randomized, blinded, controlled clinical trial

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Bariani, Bruna ; Pinto, Bianca S. ; Santos, Leonardo A. ; Benatti, Rafael G. ; Lessa, Maira M. P. ; Loureiro, Julia C. ; Silva, Jessica F. ; Silva, Valquiria A. ; Cardeal, Henriette B. ; Pereira, Jefferson L. ; Miranda, Cristiane S. ; Forlenza, Orestes Vicente ; Leao, Caroline S. ; Ruiz, Francisco J. ; Brunoni, Andre R. ; Valiengo, Leandro
Total Authors: 16
Document type: Journal article
Source: Journal of Affective Disorders; v. 393, p. 9-pg., 2026-01-15.
Abstract

Background: Major depressive disorder (MDD) is one of the leading causes of disability, especially among elderly. Repetitive transcranial magnetic stimulation (rTMS) is an effective non-pharmacological treatment and theta burst stimulation (TBS) technique offers shorter sessions. Acceptance and Commitment Therapy (ACT) is a proven effective intervention in the treatment of MDD. However, to date, no studies have evaluated the combination of rTMS and ACT in geriatric depression. Objective: Investigate if the addition of a four-week ACT-based intervention to TBS could possibly enhance the effectiveness of the treatment for elderly adults suffering from MDD. Design, setting, and participants: A double-blind, sham-controlled RCT was performed in the University of S & atilde;o Paulo (2021-2024) with a total of 29 subjects, >= 60 years of age, with MDD and HDRS >16. Intervention: Patients received TBS during the first 20 days, with supplementary sessions at weeks 6, 8, and 12. ACT group attended four weekly 60-min ACT sessions, while the control group had support sessions. Results: ACT group showed faster response in the MDD symptoms: lower HDRS scores at week 6 (p = 0.007). However, the difference was not sustained in weeks 8 (p = 0.111) and 12 (p = 0.307). In week 6 the percentage of remissions in the ACT group (56.3 %) was significantly higher as compared to the control group (15.4 %; p = 0.024). Conclusion: ACT together with TBS facilitated treatment of symptoms faster in the case of old-age MDD, although the long-term disparity was not maintained. Other studies have to be conducted. (AU)

FAPESP's process: 22/02539-3 - Effect of a brief and focal protocol of Acceptance and Commitment Therapy (ACT) in patients with depression undergoing repetitive transcranial magnetic stimulation by the Theta-burst method: clinical trial, randomized, evaluator blinded, controlled
Grantee:Bruna Bariani Teixeira
Support Opportunities: Scholarships in Brazil - Doctorate