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Updated: Jun 5, 2025
Individualized rTMS Treatment for Depression using an fMRI-Based Targeting Method
Published on: August 2, 2021
Resting fMRI-guided TMS evokes subgenual anterior cingulate response in depression
Romain J Duprat1, Kristin A Linn2, Theodore D Satterthwaite3
1Center for Brain Imaging and Stimulation, University of Pennsylvania, Perelman School of Medicine, Department of Psychiatry, Philadelphia, USA; Center for the Neuromodulation of Depression and Stress, University of Pennsylvania, Perelman School of Medicine, Department of Psychiatry, Philadelphia, PA, USA; University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA.
Repetitive transcranial magnetic stimulation (rTMS) targeting brain regions with strong positive functional connectivity to the subgenual anterior cingulate cortex (sgACC) can effectively modulate sgACC activity in patients with depression.
Area of Science:
- Neuroscience
- Neuroimaging
- Psychiatry
Background:
- Repetitive transcranial magnetic stimulation (rTMS) effectiveness in depression treatment correlates with targeting specific brain regions.
- The relationship between resting-state functional connectivity (rsFC) and TMS-evoked responses in the subgenual anterior cingulate cortex (sgACC) remains underexplored in depressed individuals.
Purpose of the Study:
- To investigate the association between sgACC-cortical rsFC and TMS-induced evoked responses in the sgACC.
- To compare these relationships in healthy controls and patients with depression.
Main Methods:
- 115 participants (34 with depression) underwent baseline rsFC mapping to identify sgACC 'hotspots'.
- Single-pulse TMS with interleaved fMRI was used to measure TMS-evoked BOLD responses in the sgACC.
- Generalized estimating equations analyzed the link between sgACC BOLD responses and rsFC.
Main Results:
- Cortical sites with high rsFC to the sgACC effectively modulated sgACC activity in both healthy and depressed groups.
- In depressed patients, stronger positive sgACC rsFC at the stimulation site correlated with larger TMS-evoked sgACC responses.
Conclusions:
- rsFC-based targeting offers a viable method for causally modulating sgACC activity.
- Future depression treatment strategies using rTMS should consider targeting positively-connected sites, not just anticorrelated ones, to modulate the sgACC.
