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This randomized, placebo-controlled trial evaluated whether personalizing accelerated intermittent theta-burst stimulation (aiTBS) using resting-state fMRI connectivity and EEG-derived stimulation frequency could improve outcomes in treatment-resistant depression. Fifty-one patients were randomized to fMRI-connectivity-guided aiTBS, combined fMRI/EEG-guided aiTBS, or sham; 43 completed the protocol. Participants received 10 sessions daily for 5 consecutive days. Neither active treatment significantly outperformed sham for the primary MADRS outcome at 1 week or secondary DARS anhedonia scores. Response and remission rates also did not differ significantly between groups. The findings suggest that individualized targeting and frequency selection did not provide additional antidepressant benefit over sham in this trial, highlighting the need for further adequately powered studies.

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This randomized, placebo-controlled trial evaluated whether personalizing accelerated intermittent theta-burst stimulation (aiTBS) using resting-state fMRI connectivity and EEG-derived stimulation frequency could improve outcomes in treatment-resistant depression. Fifty-one patients were randomized to fMRI-connectivity-guided aiTBS, combined fMRI/EEG-guided aiTBS, or sham; 43 completed the protocol. Participants received 10 sessions daily for 5 consecutive days. Neither active treatment significantly outperformed sham for the primary MADRS outcome at 1 week or secondary DARS anhedonia scores. Response and remission rates also did not differ significantly between groups. The findings suggest that individualized targeting and frequency selection did not provide additional antidepressant benefit over sham in this trial, highlighting the need for further adequately powered studies.
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