Accelerated Theta Burst Stimulation Transcranial Magnetic Stimulation (iTBS-TMS) Pururauka program for severe depressive episode and suicide ideation

Q: How were depressive symptoms and suicidal ideation assessed?

Depressive symptoms were evaluated using HAM-D and MADRS at baseline, daily during treatment, and at 1-, 3-, and 6-month follow-ups. Suicidal ideation was assessed using HAM-D item 3 across the same time points.

Q: What were the main outcomes and safety findings?

Mean HAM-D scores decreased markedly from baseline to day 5 and remained low at six months. Suicidal ideation resolved in most participants by day 3 and stayed minimal thereafter; no serious adverse events were reported and satisfaction remained high throughout the protocol.

Sep 28, 2026

Uploaded by Levi

The Pururauka protocol is an accelerated intermittent theta burst stimulation (iTBS) intervention designed to rapidly reduce depressive symptoms and suicidal ideation in people with severe major depressive episodes and insufficient response to at least two prior pharmacological treatments. In a five-day regimen targeting the left dorsolateral prefrontal cortex, 36 adults with non-psychotic depression and elevated HAM-D and HAM-D item 3 scores were followed at baseline, during treatment, and up to six months. Results show substantial, sustained symptom reductions with minimal suicidal ideation and no serious adverse events.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages12

Reading Time30 min

AccessFree to download

Introduction

Pururauka program background and rationale

Methods

Participants and inclusion criteria

Intervention and outcome assessments

Results

Changes in depressive and suicidal ideation measures

Safety and satisfaction

Conclusion

Brain, Behavior, & Immunity-Health 51 (2026) 101154 Contents lists available at ScienceDirect Brain, Behavior, & Immunity - Health journal [homepage:](homepage: www.editorialmanager.com/bbih/default.aspx)[ www.editorialmanager.com/bbih/default.aspx](homepage: www.editorialmanager.com/bbih/default.aspx) | Accelerated Theta Burst Stimulation Transcranial Magnetic Stimulation (iTBS-TMS) Pururauka program for severe depressive episode and suicide ideation
Hesed Virto-Farfan a,* , Carlos Virtob, Gustavo E. Tafet c
a Scientific Institute, Andean University of Cusco, Cusco, Peru b School of Medicine, Andean University of Cusco, Cusco, Peru
c Texas A&M University, Department of Psychiatry and Behavioral Sciences, Texas, USA | | | | --- | --- | --- | | A R T I C L E I N F O | | A B S T R A C T | | Keywords:
Neuromodulation
Transcranial magnetic stimulation Theta burst stimulation
Severe depressive episode
Suicidal ideation
Prefrontal cortex Psychoneuroimmunology of depression | | Introduction: The Pururauka protocol is an accelerated intermittent theta burst stimulation (iTBS) paradigm designed to rapidly reduce depressive symptoms and suicidal ideation in individuals with severe major depressive episodes. This study evaluated its clinical effects in patients presenting with insufficient response to at least two prior pharmacological treatments, current suicidal ideation, and more than two previous suicide attempts.
Methods: Thirty-six adults with non-psychotic major depressive disorder (ICD-11) and HAM-D-17 scores >20 received a five-day accelerated iTBS intervention (180,000 pulses total) targeting the left dorsolateral prefrontal cortex. Depressive symptoms were assessed using the HAM-D and MADRS at baseline, daily during treatment, and at 1-, 3-, and 6-month follow-ups. Suicidal ideation was evaluated with HAM-D item 3 across the same time points. Satisfaction was measured with a visual analogue scale (VAS). Safety assessments included EEG screening and neuropsychiatric evaluations. Ethical approval was obtained from the Andean University of Cusco Ethics Committee (INFORME 023-2024-CIEI-UAC).
Results: Mean HAM-D scores decreased from 38.89 at baseline to 13.61 at day 5 and 12.36 at six months (p < 0.001). Suicidal ideation resolved in most participants by day 3 and remained minimal or absent during followup. MADRS scores showed similar patterns, with 68 % of participants presenting no depressive symptoms immediately after treatment. No serious adverse events occurred, and satisfaction scores remained high throughout the protocol.
Conclusion: The Pururauka accelerated iTBS protocol was associated with rapid and sustained reductions in depressive symptoms and suicidal ideation in individuals with severe depressive episodes and insufficient response to previous medications. These preliminary findings warrant confirmation in future randomized controlled trials. | About the name of the program Pururauka belongs to the Inca Cusco mythology, originated in the battle of Yawarpampa, in which the Chancas attempt to attack the capital of the Inca Empire. Due to a shortage of Inca warriors and the urgency of the situation, Inca prince Tupac Yupanqui ordered the construction of stone mound, dressing them as soldiers to deceive the Chancas about the size of the Inca army. According to legend, these statues transformed into warriors when the Willaq Umu, the Inca priest, prayed to the god Inti for help. Their intervention helped the Inca army secure victory, allowing Tupac Yupanqui to become Pachacuteq, the ruler who led the Inca empire This article is part of a special issue entitled: Psychoneuroimmunoendocrinology in Ibero-America published in Brain, Behavior, & Immunity - Health. * Corresponding author. Urb. Ingeniería Larapa Grande A-7, USA. E-mail [address:](address: hesedvirto@gmail.com)[ hesedvirto@gmail.com](address: hesedvirto@gmail.com) (H. Virto-Farfan). [https://doi.org/10.1016

FAQs

What is the Pururauka protocol in this study?

The Pururauka protocol is an accelerated intermittent theta burst stimulation (iTBS) paradigm delivered as transcranial magnetic stimulation to reduce depressive symptoms and suicidal ideation. It targets the left dorsolateral prefrontal cortex over five days.

How were depressive symptoms and suicidal ideation assessed?

Depressive symptoms were evaluated using HAM-D and MADRS at baseline, daily during treatment, and at 1-, 3-, and 6-month follow-ups. Suicidal ideation was assessed using HAM-D item 3 across the same time points.

What were the main outcomes and safety findings?

Mean HAM-D scores decreased markedly from baseline to day 5 and remained low at six months. Suicidal ideation resolved in most participants by day 3 and stayed minimal thereafter; no serious adverse events were reported and satisfaction remained high throughout the protocol.

Sep 28, 2026

Uploaded by Levi