Related Experiment Video
Updated: May 10, 2026
Conventional Repetitive Transcranial Magnetic Stimulation for Depression: A Step-by-Step Protocol
Published on: November 21, 2025
[Interactive rTMS protocols in psychiatry]
J-A Micoulaud-Franchi1, R Richieri, C Lancon
1Solaris, pôle de psychiatrie universitaire, CHU Sainte-Marguerite, 270, boulevard Sainte-Marguerite, 13009 Marseille, France; INCM-CNRS UMR 6193, institut de neurosciences cognitives de la Méditerranée, 31, chemin Joseph-Aiguier, 13402 Marseille cedex 20, France; Université d'Aix-Marseille, 58, boulevard Charles-Livon, 13284 Marseille cedex 07, France; Unité de neurophysiologie, psychophysiologie et neurophénoménologie, pôle de psychiatrie universitaire, CHU Sainte-Marguerite, 270, boulevard Sainte-Marguerite, 13009 Marseille, France.
Interactive repetitive transcranial magnetic stimulation (rTMS) enhances psychiatric treatments by engaging cognitive and brain activities during stimulation. This approach optimizes neural circuit responses for conditions like major depressive episode and schizophrenia.
Area of Science:
- Neuroscience
- Psychiatry
- Neuromodulation
Background:
- Repetitive transcranial magnetic stimulation (rTMS) shows efficacy for major depressive episode (MDE) and schizophrenia but requires protocol optimization.
- The concept of "state dependency TMS" highlights that neural circuit activation states influence stimulation effects.
- Interactive rTMS protocols aim to increase treatment efficiency by engaging patients' neurocognitive activities during stimulation.
Purpose of the Study:
- To review and classify interactive rTMS protocols for treating MDE and schizophrenia.
- To discuss how these protocols interact with cognitive and brain electrical activities.
Main Methods:
- Review of interactive rTMS protocols manipulating cognitive activities (e.g., emotional tasks, CBT rTMS, affective rTMS) for MDE.
- Classification of interactive rTMS protocols manipulating brain electrical activities for MDE and schizophrenia.
- Identification of personalized rTMS (online contingent rTMS, offline alpha rTMS) and brain activity modulation techniques (tDCS rTMS, EEG-biofeedback rTMS).
Main Results:
- Interactive protocols for MDE involve emotional tasks to enhance left dorsolateral prefrontal cortex (DLPFC) sensitivity to rTMS.
- Personalized rTMS protocols tailor stimulation parameters (e.g., frequency) based on individual brain activity (EEG).
- Brain activity modulation techniques like tDCS rTMS and EEG-biofeedback rTMS aim to optimize DLPFC stimulation conditions.
Conclusions:
- Interactive rTMS protocols represent a novel approach in psychiatric treatment, integrating cognitive and cerebral activities.
- Current studies are often exploratory with small sample sizes, and the neurocognitive framework requires further clarification.
- This innovative therapeutic avenue holds promise for advancing psychiatric interventions by considering neural activity as integral to treatment.
