Abstract
Personalized treatments are gaining momentum across all fields of medicine. Precision
medicine can be applied to neuromodulatory techniques, in which focused brain stimulation
treatments such as repetitive transcranial magnetic stimulation (rTMS) modulate brain
circuits and alleviate clinical symptoms. rTMS is well tolerated and clinically effective
for treatment-resistant depression and other neuropsychiatric disorders. Despite its
wide stimulation parameter space (location, angle, pattern, frequency, and intensity
can be adjusted), rTMS is currently applied in a one-size-fits-all manner, potentially
contributing to its suboptimal clinical response (∼50%). In this review, we examine
components of rTMS that can be optimized to account for interindividual variability
in neural function and anatomy. We discuss current treatment options for treatment-resistant
depression, the neural mechanisms thought to underlie treatment, targeting strategies,
stimulation parameter selection, and adaptive closed-loop treatment. We conclude that
a better understanding of the wide and modifiable parameter space of rTMS will greatly
improve the clinical outcome.
Keywords
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Article info
Publication history
Published online: October 28, 2022
Accepted:
October 23,
2022
Received in revised form:
October 20,
2022
Received:
July 5,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
Published by Elsevier Inc on behalf of Society of Biological Psychiatry.
