Neuromodulation and neural networks in psychiatric disorders: current status and emerging prospects.

Abstract

Psychiatric disorders lead to disability, premature mortality and economic burden, highlighting the urgent need for more effective treatments. The understanding of psychiatric disorders as conditions of large-scale brain networks has created new opportunities for developing targeted, personalised, and mechanism-based therapeutic interventions. Non-invasive brain stimulation (NIBS) techniques, such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), can directly modulate dysfunctional neural networks, enabling treatments tailored to the individual's unique functional network patterns.As NIBS techniques depend on our understanding of the neural networks involved in psychiatric disorders, this review offers a neural network-informed perspective on their applications. We focus on key disorders, including depression, schizophrenia, and obsessive-compulsive disorder, and examine the role of NIBS on cognitive impairment, a transdiagnostic feature that does not respond to conventional treatments. We discuss the advancements in identifying NIBS response biomarkers with the use of electrophysiology and neuroimaging, which can inform the development of optimised, mechanism-based, personalised NIBS treatment protocols.We address key challenges, including the need for more precise, individualised targeting of dysfunctional networks through integration of neurophysiological, neuroimaging and genetic data and the use of emerging techniques, such as low- intensity focused ultrasound, which has the potential to improve spatial precision and target access. We finally explore future directions to improve treatment protocols and promote widespread clinical use of NIBS as a safe, effective and patient-centred treatment for psychiatric disorders.