治療抵抗性うつ病集団における自然な状態での個別化されたコネクティビティ誘導加速脳刺激の有効性

Personalized connectivity-guided accelerated intermittent theta burst stimulation (iTBS), like the Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT), shows high efficacy for treatment-resistant depression (TRD) in Western cohorts. However, generalizability to other demographics with substantial comorbidity remains unclear. Here, we evaluate connectivity-guided iTBS in a naturalistic Asian TRD population with high comorbidity burden.

Twenty TRD participants received 50 sessions of TAO-TMS (Tree-based Algorithm for Optimized Transcranial Magnetic Stimulation) over 5 days. Participants averaged 1.6 psychiatric comorbidities, including personality disorders, autism and obsessive-compulsive disorder. TAO-TMS personalizes targets within attentional networks and maximize anti-correlation with the subgenual anterior cingulate cortex. Its near-scalp targets reduce stimulation intensity under the SAINT protocol, improving patient comfort. Clinical response was defined as ≥50% reduction in the Montgomery-Åsberg Depression Rating Scale within four weeks of treatment.

TAO-TMS yielded 70% response rate. Among patients who met typical randomized-trial eligibility criteria (N = 11), response rate was 83%. For context, non-accelerated BeamF3 TMS at the same hospital historically achieved response rate of 21%, indicating a patient population profile less responsive to TMS than those recruited in typical clinical trials. Post-hoc electric-field modeling showed that TAO-TMS improved network focality by 21% over BeamF3 targets. Functional connectivity changes were significant within every participant, but highly heterogeneous across participants. TAO-TMS was more cost-effective than electroconvulsive therapy (ECT), saving US$37,838 with higher quality-adjusted life years (QALYs 0.69 vs 0.65).

These findings provide early evidence for the generalizability of connectivity-guided personalized TMS in a naturalistic Asian TRD population with substantial psychiatric comorbidities. TAO-TMS offers a cost-effective alternative to ECT, positioning it as a viable precision psychiatry intervention.