Clinical and Neurophysiological Effects of Robotically-Delivered fMRI-Guided Personalized Transcranial Magnetic Stimulation Therapy for Depression.

IF 16.3 1区医学 Q1 PSYCHIATRY

Psychotherapy and Psychosomatics Pub Date : 2025-04-09 DOI:10.1159/000545692

Luke J Hearne,Lachlan Webb,Robin Cash,Conor Robinson,Philip E Mosley,Joanna Ng,Simon T Thwaites,Simon Issa,Jessica Miller,Nga Yan Tse,Andrew Zalesky,Bjorn Burgher,Luca Cocchi

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Abstract

INTRODUCTION Repetitive transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex (DLPFC) is an established treatment for refractory major depressive disorder (MDD), but treatment outcomes vary substantially from person to person. Recent evidence suggests that incorporating neuroimaging-based targeting may help improve clinical outcomes. Here, we report the initial clinical outcomes of our open-label fMRI-personalized treatment protocol from the Queensland Neurostimulation Centre (QNC). METHODS This open-label, nonrandomized study was conducted between November 2021 and September 2024. Participants were a referred sample aged between 19 and 84, meeting the criteria for treatment-resistant MDD (N=61). They received 20 or 30-weekday sessions of DLPFC rTMS. The stimulation site was personalized using each individual's fMRI brain connectivity data. RESULTS The primary outcome was change in the Montgomery-Åsberg Depression Rating Scale (MADRS). MADRS was lower post-treatment (d=1.78, p<.001), with 52% and 33% response and remission rates observed. Likewise, anxiety scores (Hamilton Anxiety Rating Scale) were lower post-treatment (d=1.27, p<.001), with 46% and 28% response and remission rates observed. The treatment was most effective in patients who qualified for randomized controlled trials (RCTs; N=19, MADRS response=74%, remission=53%) and least effective in patients with bipolar or neurological disorders (N=8, MADRS response=37%, remission=25%). Neurophysiologically, functional brain connectivity in the personalized DLPFC-SGC pathway was less anti-correlated post-treatment (d=0.63, p<.001). CONCLUSION Our findings provide new clinical and neurophysiological evidence supporting the high effectiveness of fMRI-connectivity-guided personalized rTMS for MDD, especially in individuals without complex comorbidities. The results encourage future RCTs to assess the superiority of personalized targeting over standard TMS.

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来源期刊

Psychotherapy and Psychosomatics 医学-精神病学

CiteScore

29.40

自引率

6.10%

发文量

期刊介绍： Psychotherapy and Psychosomatics is a reputable journal that has been published since 1953. Over the years, it has gained recognition for its independence, originality, and methodological rigor. The journal has been at the forefront of research in psychosomatic medicine, psychotherapy research, and psychopharmacology, and has contributed to the development of new lines of research in these areas. It is now ranked among the world's most cited journals in the field. As the official journal of the International College of Psychosomatic Medicine and the World Federation for Psychotherapy, Psychotherapy and Psychosomatics serves as a platform for discussing current and controversial issues and showcasing innovations in assessment and treatment. It offers a unique forum for cutting-edge thinking at the intersection of medical and behavioral sciences, catering to both practicing clinicians and researchers. The journal is indexed in various databases and platforms such as PubMed, MEDLINE, Web of Science, Science Citation Index, Social Sciences Citation Index, Science Citation Index Expanded, BIOSIS Previews, Google Scholar, Academic Search, and Health Research Premium Collection, among others.