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Updated: Aug 13, 2026
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Individualized rTMS Treatment for Depression using an fMRI-Based Targeting Method
Published on: August 2, 2021
Individualized Connectivity-Guided Versus Conventional Targeting of Accelerated Theta-Burst Stimulation in
Mingzhu Li1,2, Zijia Wu3,4,5, Xuefeng Lu4,5,6
1Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing.
The American Journal of Psychiatry
|August 12, 2026
Summary
Structural connectivity-guided intermittent theta-burst stimulation (iTBS) showed improved antidepressant outcomes compared to standard targeting. This precision neuromodulation approach offers a promising avenue for treating major depressive disorder.
Area of Science:
- Neuroscience
- Psychiatry
- Medical Imaging
Background:
- Repetitive transcranial magnetic stimulation (rTMS) targeting the dorsolateral prefrontal cortex (DLPFC) for depression has limitations due to interindividual variability.
- Individualized targeting strategies are needed to optimize rTMS efficacy.
Purpose of the Study:
- To compare the efficacy of individualized connectivity-guided intermittent theta-burst stimulation (iTBS) versus standard 5-cm targeting for major depressive disorder.
- To investigate the impact of functional connectivity (FC)-guided and structural connectivity (SC)-guided iTBS.
Main Methods:
- A single-center, randomized, double-blind, three-arm trial involving adults (18-65 years) with treatment-resistant depression.
- Participants received 20 sessions of iTBS over 2 weeks using robotic neuronavigation with 5-cm, FC-guided, or SC-guided targeting.
- Primary outcome: percentage reduction in Hamilton Depression Rating Scale (HAM-D) score at week 2.
Main Results:
- SC-guided iTBS demonstrated significantly greater HAM-D score reduction at week 2 compared to the 5-cm rule.
- Both SC-guided and FC-guided iTBS showed significant improvements at week 6 versus the 5-cm group.
- No significant between-group differences were observed by week 12. Adverse events were similar across all groups.
Conclusions:
- SC-guided iTBS shows promising preliminary evidence for enhanced antidepressant response compared to standard 5-cm targeting.
- Connectivity-guided precision neuromodulation targeting the subgenual anterior cingulate cortex (sgACC) network is supported for depression treatment.
