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Conventional Repetitive Transcranial Magnetic Stimulation for Depression: A Step-by-Step Protocol
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How Standardized Is Transcranial Magnetic Stimulation Treatment for Depression? Large-Cohort Modeling Reveals

Bella Bingbing Zhang1, Tim Tianze Lin1, Penny Ping Qin1

  • 1Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.

Psychotherapy and Psychosomatics
|June 8, 2026
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Summary
This summary is machine-generated.

Repetitive transcranial magnetic stimulation (rTMS) dosing may be biased across ethnic groups due to head morphology. Computational modeling revealed significant differences in electric field delivery, necessitating adjusted dosing protocols for diverse populations.

Keywords:
DepressionDosing strategiesElectric field modelingPopulation variabilityTranscranial magnetic stimulation

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Area of Science:

  • Neuroscience
  • Medical Physics
  • Computational Biology

Background:

  • Repetitive transcranial magnetic stimulation (rTMS) is a key non-invasive brain stimulation therapy for neurological and psychiatric conditions.
  • The effectiveness of rTMS is significantly influenced by individual head anatomy, which affects the induced electric field (E-field) distribution in the brain.
  • Current rTMS dosing relies on a percentage of the motor threshold (MT), a standardized approach that may not account for anatomical variations.

Purpose of the Study:

  • To investigate ethnic variations in rTMS dosing by evaluating the induced E-field across different populations.
  • To determine if current standardized rTMS dosing protocols result in consistent cortical stimulation across diverse ethnic groups.
  • To develop improved, individualized dosing strategies for rTMS based on anatomical differences.

Main Methods:

  • Utilized large-scale computational modeling with a sample size of 1085 individuals.
  • Systematically evaluated TMS dosage across 'White', 'Han Chinese', and 'Black or African Am.' populations.
  • Analyzed the ratio of the E-field at the therapeutic target (left dorsolateral prefrontal cortex, DLPFC) to the calibration site (left primary motor cortex, M1), considering scalp-to-cortex distance (SCD).

Main Results:

  • Identified significant ethnic disparities in the E-field ratio between the DLPFC and M1.
  • 'Han Chinese' individuals showed a higher E-field ratio (1.226) compared to 'White' individuals (1.090).
  • Variations in scalp-to-cortex distance were identified as the primary driver of these observed differences in E-field distribution.

Conclusions:

  • Standard rTMS dosing protocols may lead to inconsistent cortical stimulation across different ethnic populations due to anatomical variations.
  • Developed population-level adjustment formulas and individualized SCD-based dosing equations to address these disparities.
  • Highlights the potential for bias in universal dosing conventions and the need for tailored approaches to ensure uniform safety and efficacy in diverse global populations.