Neurostimulation protocol
MDD, depressive symptoms
Eligible participants were enrolled consecutively and a stratified random number sequence was generated by an independent statistician for each site, according to treatment with mood stabilisers, atypical antipsychotics, or their combination. Randomisation occurred with allocation concealment Each site utilised a MagPro X100 stimulator (MagVenture, Denmark), with the UBC site utilising a dual active/sham Cool-B65 A/P coil and the UofC site a COOL-B70 or MCF-P-B70 placebo coil. Both sites utilised anatomical MRIs and neuronavigation (Visor2, ANT Neuro, the Netherlands). Resting motor threshold (rMT) was determined by visual inspection at the UBC site and by using EMG electrodes at the UofC site placed over the first dorsal interosseous muscle, with threshold determined as the stimulus intensity required to elicit 5/10 EMG responses >50µV.Patients were randomised to sham- or active-iTBS, consisting of a total of 600 pulses per session delivered as triplets at 50 Hz repeated at 5 Hz (2s on 8s off) at 120% rMT, which had been shown to improve depressive symptoms in MDD (Blumberger et al. 