Imaging TMS: antidepressant mechanisms and treatment optimization

Abstract

With the antidepressant efficacy of Transcranial Magnetic Stimulation well-established by several meta-analyses, there is growing interest in its mechanism of action. TMS has been shown to engage, and in some cases, normalize functional connectivity and neurotransmitter levels within networks dysfunctional in the depressed state. In this review, I will suggest candidate biomarkers, based on neuroimaging, that may be predictive of response to TMS. I will then review the effects of TMS on networks and neurotransmitter systems involved in depression. Throughout, I will also discuss how our current understanding of response predication and network engagement may be used to personalize treatment and optimize its efficacy.

Keywords:

• Depression
• TMS
• neuroimaging
• functional connectivity
• neuronavigation
• biomarker

Disclosure statement

Dr. Marc J. Dubin reports materials transfer to complete studies of TMS for depression from Neuronetics, Inc., grant funding for a clinical trial of Low Field Magnetic Stimulation for Major Depression from TAL Medical, Inc.

Additional information

Funding

This work was supported by grants from the Brain and Behavior Research Foundation (National Alliance for Research on Schizophrenia and Depression Young Investigator Award) to MJD and by the Pritzker Neuropsychiatric Disorders Research Consortium.