Functional brain imaging may help guide accelerated transcranial magnetic stimulation (TMS) for individuals with treatment-resistant depression, according to a June 24 study from Mass General Brigham's Neuroscience Institute and Department of Psychiatry. The findings were published in JAMA Psychiatry.
The randomized clinical trial tested whether using personalized functional magnetic resonance imaging (fMRI) scans to select TMS targets would result in better outcomes than conventional scalp-based targeting methods. TMS is a non-invasive procedure that uses magnetic pulses to modulate brain activity and has been cleared by the Food and Drug Administration since 2008 for adults with major depressive disorder who have not responded to standard treatments.
Researchers used an accelerated TMS (aTMS) protocol, delivering multiple sessions per day over one week, rather than several weeks. Forty adults aged 22 to 80 years old with moderate-to-severe treatment-resistant depression participated in the study. Each underwent an fMRI scan before being randomized into two groups: one receiving connectivity-based targeting guided by their own resting-state functional connectivity data, and the other receiving traditional scalp-based targeting. Both participants and clinical raters were blinded to group assignments.
Results showed that one month after treatment, those who received connectivity-based targeting had significantly greater improvement in depressive symptoms as measured by the Montgomery-Åsberg Depression Rating Scale compared to those treated with scalp-based targeting. The response rate was also higher among participants who received connectivity-guided aTMS—80 percent met response criteria versus 60 percent in the scalp-targeted group.
The study builds on previous research by Taylor examining circuit-targeted modulation of anxiety symptoms in major depression. "Retrospective analyses have hinted that functional imaging could be used to improve outcomes, but prospective evidence has been limited," said Taylor. "Our recent clinical trials provide prospective evidence that there may be clinical advantages to using functional imaging to guide aTMS treatment. These findings are important as aTMS becomes more widely available and decisions are made about how to scale this intervention for patients with depression and other psychiatric illnesses."
Researchers acknowledged limitations such as small sample size and single-site design, noting plans for larger trials aimed at validating efficacy across diverse populations and assessing long-term effects.
