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Updated: Oct 22, 2026
Individualized rTMS Treatment for Depression using an fMRI-Based Targeting Method
Published on: August 2, 2021
Right putaminal gray matter change tracks psychomotor recovery after accelerated iTBS in melancholic
Deng Mao1, Guo-Rong Wu2, Beatriz Araújo Cavendish3
1Ghent Experimental Psychiatry (GHEP) Laboratory, Department of Head and Skin, Ghent University, Department of Psychiatry, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
Background:
Psychomotor retardation is a prominent and disabling feature of melancholic depression. Accelerated intermittent theta-burst stimulation (aiTBS) may hasten antidepressant effects, but neural substrates of early symptom improvement remain unclear. Given the central role of frontostriatal circuitry in motivation and behavioral activation, structural alterations in the striatum may represent a possible neural substrate of early therapeutic change.
Methods:
Structural MRI was acquired from 61 patients with melancholic TRD and 77 healthy controls, and voxel-based morphometry was used to assess baseline striatal gray matter volume differences. Patients then underwent a randomized, double-blind, sham-controlled trial of left dorsolateral prefrontal aiTBS, comprising 20 sessions over four days. In 50 patients with complete pre- and post-treatment data, we tested whether GMV change in the baseline-identified striatal region was associated with clinical change in the active and sham groups (n = 25 each).
Results:
Patients showed greater right putamen GMV than controls at baseline. After active aiTBS, greater right putamen GMV increase was associated with greater psychomotor retardation improvement. This association was absent after sham stimulation and was not observed for overall depression severity.
Conclusion:
The right putamen appears structurally altered in melancholic TRD. After active aiTBS, short-term putamen GMV increase was associated with psychomotor rather than broader depressive improvement. This pattern should not be interpreted as structural normalization but may reflect a relationship between putaminal change and early psychomotor recovery.
