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Updated: Jan 16, 2026
Conventional Repetitive Transcranial Magnetic Stimulation for Depression: A Step-by-Step Protocol
Published on: November 21, 2025
A sequential dual-site repetitive transcranial magnetic stimulation for major depressive disorder: A randomized
Yi-Jie Zhao1, Shitong Xiang2, Ruiqin Chen1
1Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China; Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.
Abstract:
Repetitive transcranial magnetic stimulation (rTMS) is approved for major depressive disorder (MDD), but it is limited by variable efficacy. Here, we examine antidepressant effects of our sequential dorsolateral prefrontal cortex (dlPFC)-dorsomedial prefrontal cortex (dmPFC) accelerated rTMS protocol, which includes a 4-day treatment with 4 sessions per day. At week 4, the Montgomery-Åsberg Depression Rating Scale (MADRS) reduction is significantly larger in the active group, and critical, significant differences were apparent on day 4. For active and sham-controlled groups, respectively, response rates are 57.69% and 23.08%, and remission rates are 38.46% and 15.38%. Of responders, over 85% remain in remission over 6 months. Resting-state fMRI shows dissociable symptom improvement associated with increased dlPFC-frontoparietal and decreased dmPFC-amygdalo-subcallosal cingulate functional connectivity. We highlight a cost-efficient generalizable rTMS approach targeting differential networks in MDD, which shows rapid and sustained antidepressant effects with a relatively small number of pulses and minimal treatment duration. The study is registered with ChiCTR (ChiCTR2100046042).
