Examining alterations in subjective sleep ratings in individuals with major depressive disorder receiving daily theta burst stimulation

Background: Major depressive disorder is often accompanied by sleep disturbances, which have been found to influence response to antidepressant treatments. Repetitive transcranial magnetic stimulation (rTMS), including novel optimized protocols like theta burst stimulation (TBS), is an effective int...

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Main Authors: Jennifer Cuda, David Smith, Arthur R. Chaves, Karina L. Fonseca, Jessica Drodge, Stacey Shim, Youssef Nasr, Maya El-Outa, Ram Brender, Ruxandra Antochi, Lisa McMurray, Rebecca Robillard, Sara Tremblay
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Language:English
Published: Elsevier 2025-07-01
Series:Journal of Affective Disorders Reports
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Online Access:http://www.sciencedirect.com/science/article/pii/S2666915325000630
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author Jennifer Cuda
David Smith
Arthur R. Chaves
Karina L. Fonseca
Jessica Drodge
Stacey Shim
Youssef Nasr
Maya El-Outa
Ram Brender
Ruxandra Antochi
Lisa McMurray
Rebecca Robillard
Sara Tremblay
author_facet Jennifer Cuda
David Smith
Arthur R. Chaves
Karina L. Fonseca
Jessica Drodge
Stacey Shim
Youssef Nasr
Maya El-Outa
Ram Brender
Ruxandra Antochi
Lisa McMurray
Rebecca Robillard
Sara Tremblay
author_sort Jennifer Cuda
collection DOAJ
description Background: Major depressive disorder is often accompanied by sleep disturbances, which have been found to influence response to antidepressant treatments. Repetitive transcranial magnetic stimulation (rTMS), including novel optimized protocols like theta burst stimulation (TBS), is an effective intervention for treatment-resistant depression, although little is known about the relationship between sleep and the antidepressant effects of this treatment. Methods: Sixty-six individuals with treatment-resistant depression received 4 to 6 weeks of daily TBS treatments targeting the left-unilateral or bilateral dorsolateral prefrontal cortex (DLPFC). Depression severity was measured using the Hamilton Rating Scale for Depression (HRSD-17) and subjective sleep using the Leeds Sleep Evaluation Questionnaire (LSEQ). Data was analyzed with linear mixed models and Spearman correlations. Results: TBS significantly reduced HRSD-17 scores and improved LSEQ subscales reflecting sleep quality, ease of awakening from sleep, and behavior following wakefulness. Improvements in symptoms of depression were associated with improvement in behavior following waking after 20 and 30 TBS sessions, but not with sleep quality. Limitations: Limitations include a limited sample size, lack of sham condition, subjective measures of sleep and variable number of treatments (20 or 30 TBS sessions). Conclusions: These findings suggest that TBS treatments concurrently improve subjective sleep quality and depression symptoms. Additionally, changes in depression more closely aligned with changes in sleep-related daytime functioning than with sleep quality per se. Further work is required to delineate how sleep improvements following neuromodulation may contribute to the antidepressant response.
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spelling doaj-art-bbef1fe0a905485c92c9c18c6e4f69ee2025-08-20T03:48:14ZengElsevierJournal of Affective Disorders Reports2666-91532025-07-012110093310.1016/j.jadr.2025.100933Examining alterations in subjective sleep ratings in individuals with major depressive disorder receiving daily theta burst stimulationJennifer Cuda0David Smith1Arthur R. Chaves2Karina L. Fonseca3Jessica Drodge4Stacey Shim5Youssef Nasr6Maya El-Outa7Ram Brender8Ruxandra Antochi9Lisa McMurray10Rebecca Robillard11Sara Tremblay12University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON K1Z 7K4, Canada; Department of Neuroscience, Carleton University, 1125 Colonel By Drive, Ottawa, ON K1S 5B6, CanadaUniversity of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON K1Z 7K4, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, CanadaUniversity of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON K1Z 7K4, Canada; Faculty of Health Sciences, University of Ottawa, 125 University, Ottawa, ON K1N6N5, CanadaUniversity of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON K1Z 7K4, CanadaUniversity of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON K1Z 7K4, CanadaUniversity of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON K1Z 7K4, CanadaUniversity of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON K1Z 7K4, CanadaUniversity of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON K1Z 7K4, CanadaDepartment of Psychiatry, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada; Royal Ottawa Mental Health Centre, 1145 Carling Ave, Ottawa, ON K1Z 7K4, CanadaDepartment of Psychiatry, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada; Royal Ottawa Mental Health Centre, 1145 Carling Ave, Ottawa, ON K1Z 7K4, CanadaDepartment of Psychiatry, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada; Royal Ottawa Mental Health Centre, 1145 Carling Ave, Ottawa, ON K1Z 7K4, CanadaUniversity of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON K1Z 7K4, Canada; School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON K1N 6N5, CanadaUniversity of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON K1Z 7K4, Canada; Department of Neuroscience, Carleton University, 1125 Colonel By Drive, Ottawa, ON K1S 5B6, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada; School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON K1N 6N5, Canada; Département de Psychoéducation Et Psychologie, Université du Québec en Outaouais, 283 Alexandre-Taché Boul, Gatineau, QC J8×3×7, Canada; Corresponding author at: University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Ave, Ottawa, ON K1Z 7K4, Canada.Background: Major depressive disorder is often accompanied by sleep disturbances, which have been found to influence response to antidepressant treatments. Repetitive transcranial magnetic stimulation (rTMS), including novel optimized protocols like theta burst stimulation (TBS), is an effective intervention for treatment-resistant depression, although little is known about the relationship between sleep and the antidepressant effects of this treatment. Methods: Sixty-six individuals with treatment-resistant depression received 4 to 6 weeks of daily TBS treatments targeting the left-unilateral or bilateral dorsolateral prefrontal cortex (DLPFC). Depression severity was measured using the Hamilton Rating Scale for Depression (HRSD-17) and subjective sleep using the Leeds Sleep Evaluation Questionnaire (LSEQ). Data was analyzed with linear mixed models and Spearman correlations. Results: TBS significantly reduced HRSD-17 scores and improved LSEQ subscales reflecting sleep quality, ease of awakening from sleep, and behavior following wakefulness. Improvements in symptoms of depression were associated with improvement in behavior following waking after 20 and 30 TBS sessions, but not with sleep quality. Limitations: Limitations include a limited sample size, lack of sham condition, subjective measures of sleep and variable number of treatments (20 or 30 TBS sessions). Conclusions: These findings suggest that TBS treatments concurrently improve subjective sleep quality and depression symptoms. Additionally, changes in depression more closely aligned with changes in sleep-related daytime functioning than with sleep quality per se. Further work is required to delineate how sleep improvements following neuromodulation may contribute to the antidepressant response.http://www.sciencedirect.com/science/article/pii/S2666915325000630Repetitive transcranial magnetic stimulationTheta burst stimulationSleep qualityDepression
spellingShingle Jennifer Cuda
David Smith
Arthur R. Chaves
Karina L. Fonseca
Jessica Drodge
Stacey Shim
Youssef Nasr
Maya El-Outa
Ram Brender
Ruxandra Antochi
Lisa McMurray
Rebecca Robillard
Sara Tremblay
Examining alterations in subjective sleep ratings in individuals with major depressive disorder receiving daily theta burst stimulation
Journal of Affective Disorders Reports
Repetitive transcranial magnetic stimulation
Theta burst stimulation
Sleep quality
Depression
title Examining alterations in subjective sleep ratings in individuals with major depressive disorder receiving daily theta burst stimulation
title_full Examining alterations in subjective sleep ratings in individuals with major depressive disorder receiving daily theta burst stimulation
title_fullStr Examining alterations in subjective sleep ratings in individuals with major depressive disorder receiving daily theta burst stimulation
title_full_unstemmed Examining alterations in subjective sleep ratings in individuals with major depressive disorder receiving daily theta burst stimulation
title_short Examining alterations in subjective sleep ratings in individuals with major depressive disorder receiving daily theta burst stimulation
title_sort examining alterations in subjective sleep ratings in individuals with major depressive disorder receiving daily theta burst stimulation
topic Repetitive transcranial magnetic stimulation
Theta burst stimulation
Sleep quality
Depression
url http://www.sciencedirect.com/science/article/pii/S2666915325000630
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