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Observational Study
. 2025 Jan 2;20(1):e0316339.
doi: 10.1371/journal.pone.0316339. eCollection 2025.

The Scania Accelerated Intermittent Theta-burst Implementation Study (SATIS)-Lessons from an accelerated treatment protocol

Marcus Persson  1 , Viktor Fabri  1   2 , Alexander Reijbrandt  1   3 , Annika Lexén  4 , Hans Eriksson  1   5 , Pouya Movahed Rad  6
Affiliations
Observational Study

The Scania Accelerated Intermittent Theta-burst Implementation Study (SATIS)-Lessons from an accelerated treatment protocol

Marcus Persson et al. PLoS One. .

Abstract

Background and objective: The Scania Accelerated Intermittent Theta-burst Implementation Study (SATIS) aimed to investigate the tolerability, preliminary effectiveness, and practical feasibility of an accelerated intermittent theta burst stimulation (aTBS) protocol in treating depression.

Methods: We used an open-label observational design, recruiting 20 patients (aged 19-84 years) from two public brain stimulation centers in Sweden. During the five-day treatment period and at a follow-up visit after 30 days we closely monitored adverse events and collected self-rated side effect data. Objective (MADRS, CGI) and subjective (MADRS-S) measures of symptoms and functioning (EQ-5D) were also assessed. Feasibility was evaluated using direct patient ratings combined with a qualitative approach evaluating staff experience.

Results: All patients reported adverse events at some point, the most common being headache (18/20 patients), but they were generally transient. MADRS scores decreased from 28.4 (min = 17, max = 38. SD = 6.9) at baseline to 20.0 (min = 1, max = 42. SD = 11.6) after the last day of treatment. 25% (n = 5) met the response criteria, with a mean time to response of 2.2 days (min = 1, max = 3. SD = 1.1). The practical arrangements surrounding this new treatment proved challenging for the organization, but patients reported few practical problems.

Conclusion: SATIS provided further insights into the potential benefits and challenges associated with aTBS protocols. Effectiveness and drop-out rates were comparable to national data of conventional iTBS, but with a markedly faster time to response. More resources were required than anticipated, increasing the clinical workload.

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Conflict of interest statement

The authors, Marcus Persson, Viktor Fabri, Alexander Reijbrandt, Annika Lexén, and Pouya Movahed Rad, have no competing interests to declare. Hans Eriksson is currently a full-time employee at HMNC Brain Health, a pharmaceutical company developing treatments for depression. This does not alter our adherence to PLOS ONE policies on data and material sharing.

Figures

Fig 1
Fig 1. The Scania aTBS implementation study (SATIS) trial profile.
rTMS repetitive Transcranial Magnetic Stimulation, ECT Electroconvulsive Therapy, MRI Magnetic Resonance Imaging. a Wanted therapy instead, wanted ECT instead, unable to come to the clinic because of agoraphobia, did not want to participate, unable to travel to Helsingborg for treatment, got diagnosed with autism the day before and needed time to adjust, unable to attend treatment until early 2022, did not want to stop medication with benzodiazepines and antiepileptics. b Sibling with epilepsy, suspected epileptic seizure requiring electroencephalogram before treatment which was not possible to obtain prior to end of inclusion period. c Dorsal column stimulator from 2002.
Fig 2
Fig 2. Top: Individual Montgomery-Åsberg Depression Rating Scale (MADRS) scores in the PP-group.
Red line represents mean MADRS scores at all measured time-points (screening, 0 = baseline, 1 = after the first day of treatment, 3 = after the third day of treatment, 5 = after all treatments, 35 = at the 30-day follow-up). The three patients with the highest score (38,39 and 42) after day 5, all received ECT during the 30-day follow-up period. Two of those achieved lasting remission and one only met response criteria at follow-up. This patient had MADRS 12 after completing 5 ECT sessions but worsened some until follow-up. Bottom: Individual Montgomery-Åsberg Depression Rating Scale Self-assessment (MADRS-S) scores in the PP-group. Red line represents mean MADRS-S scores at all measured time-points (screening, 0 = baseline, 1 = after the first day of treatment, 2 = after the second day of treatment, 3 = after the third day of treatment, 4 = after the fourth day of treatment, 5 = after all treatments, 35 = at the 30-day follow-up).
Fig 3
Fig 3
CGI-I after the last day of treatment (left) and at the 30 day follow-up (right) in the PP-group (n = 18). CGI-I Clinical Global Impression—Improvement. No patients were rated “much worse” or “very much worse”. Three patients received ECT between the last day of treatment and the 30-day follow-up.
See this image and copyright information in PMC

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