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MRI-guided dmPFC-rTMS as a Treatment for Treatment-resistant Major Depressive Disorder
Published on: August 11, 2015
Domain-Specific Efficacy of Accelerated Repetitive Transcranial Magnetic Stimulation in Neuropsychiatric Disorders: A
Hangbin Zhang1, Jacob Green1, Shraddha Dwivedi1
1Brain Imaging and TMS Laboratory, Department of Psychology, University of Arizona, Tucson, Arizona.
Background:
Accelerated repetitive transcranial magnetic stimulation (arTMS) (≥2 sessions/day) delivers high neuromodulatory doses over compressed timelines. It is increasingly used to target circuit-level dysfunction and treat diverse psychiatric conditions. However, its domain-specific efficacy and dose-dependent neuroplastic mechanisms remain incompletely understood.
Methods:
We conducted a preregistered systematic review and random-effects meta-analysis (PROSPERO: CRD42024536096) of randomized controlled trials comparing arTMS with sham stimulation. Searches of PubMed, Embase, Web of Science, and Cochrane Library (through July 23, 2024) identified 44 trials (N = 1671; 46.3% female) across 20 symptom domains. Standardized mean differences (Hedges' g) quantified treatment effects. Meta-regressions examined the moderating effects of stimulation parameters and participant demographics.
Results:
Compared with sham, arTMS yielded moderate antidepressant effects (g = 0.61; 95% CI, 0.38 to 0.85) and significant improvements in anxiety (g = 0.43; 95% CI, 0.05 to 0.81), obsessive-compulsive symptoms (g = 0.45; 95% CI, 0.02 to 0.88), working memory (g = 0.45; 95% CI, 0.11 to 0.79), and declarative memory (g = 0.30; 95% CI, 0.02 to 0.58). Session frequency, intersession interval, cumulative pulse dose, age, and sex significantly moderated outcomes in specific domains, implicating dose- and sex-linked plasticity mechanisms. Risk of bias was predominantly low. Adverse events were mild and transient.
Conclusions:
arTMS yields rapid, domain-specific, transdiagnostic benefits with a favorable safety profile. Moderator analyses support a mechanistic model wherein stimulation-induced plasticity interacts with individual neurobiology to shape clinical response. These findings highlight arTMS as a scalable, circuit-targeted intervention and provide quantitative parameters to guide precision-medicine trials.
