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Updated: Jul 12, 2026
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MRI-guided dmPFC-rTMS as a Treatment for Treatment-resistant Major Depressive Disorder
Published on: August 11, 2015
Substance Use and Antidepressant Response to Transcranial Magnetic Stimulation in Major Depressive Disorder
Daniel Alejandro Gonzalez1, Tagalsir Osama1, Simon Vandekar2
1Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt University School of Medicine, Nashville, TN, USA.
Journal of Affective Disorders
|July 10, 2026
Summary
Repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder (MDD) shows varied responses. This study found low-to-moderate baseline substance use did not significantly impact rTMS antidepressant effectiveness.
Area of Science:
- Neuroscience
- Psychiatry
- Clinical Research
Background:
- Repetitive transcranial magnetic stimulation (rTMS) is an established treatment for major depressive disorder (MDD).
- Clinical response to rTMS is highly variable, necessitating identification of factors influencing individual outcomes.
- Co-occurring substance use disorders are common in MDD and linked to poorer psychiatric prognoses, but their impact on rTMS response is unclear.
Purpose of the Study:
- To investigate the association between baseline alcohol, nicotine, and cannabis use and treatment response in patients with MDD undergoing rTMS.
- To determine if substance use patterns predict the degree of symptom improvement following rTMS therapy.
Main Methods:
- A naturalistic cohort of 356 individuals with MDD receiving rTMS was analyzed.
- Baseline substance use (alcohol, nicotine, cannabis) was assessed via self-report.
- Multivariable linear regression models examined the relationship between substance use and percent change in Patient Health Questionnaire-9 (PHQ-9) scores.
Main Results:
- Alcohol use frequency showed a potential association with PHQ-9 change in categorical analysis, but lacked a clear dose-response relationship.
- No significant associations were found between other assessed alcohol, nicotine, or cannabis use variables and rTMS treatment response.
- Overall, low-to-moderate substance use patterns in this sample did not robustly predict antidepressant response to rTMS.
Conclusions:
- Baseline substance use, as measured in this study, does not appear to be a strong predictor of rTMS antidepressant response in MDD.
- Further research with detailed, temporally specific substance use assessments is required to fully elucidate the relationship between substance use patterns and rTMS outcomes.
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