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Войти в исследования Psychiatry research · 2026
Reward circuitry predicts the effects of fMRI-guided accelerated prolonged iTBS in treatment-resistant depression.
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Puri Neil, Ly Taylor, Rufino Katrina A, Newlin Elizabeth, Ridgeway-Diaz Julia, Truong Kelly, Oh Hyuntaek
Аннотация
BACKGROUND: Transcranial magnetic stimulation (TMS) offers a noninvasive alternative to pharmacotherapy for treatment-resistant depression (TRD). A new fMRI-guided accelerated TMS protocol demonstrates rapid clinical efficacy, although predictive biomarkers of response have not yet been established. This study examines the efficacy of the new TMS protocol in a unique clinical setting and explores a biomarker for predicting antidepressant response to accelerated intermittent theta burst stimulation (iTBS).
METHODS: We conducted a retrospective chart review of 29 patients (ages 18-74) who received accelerated iTBS targeting the left dorsolateral prefrontal cortex (DLPFC). Patients received 10 iTBS sessions per day for 5 consecutive days, totaling 50 sessions. Depressive symptoms were assessed using the Montgomery-Asberg Depression Rating Scale (MADRS) throughout the treatment. Resting-state fMRI data was used to conduct correlational analysis between the mesolimbic pathway and clinical improvement.
RESULTS: Patients exhibited a rapid and significant reduction in MADRS scores, with response and remission rates of 72.41% and 65.52%, respectively, by Day 5. Suicidality significantly improved from baseline to Day 5, with 86% of patients having a resolution of suicidality by Day 5. Resting state functional connectivity (RSFC) between the right NAcc and left VTA was significantly associated with greater percent reduction in depressive symptoms.
DISCUSSION: Our findings suggest that accelerated iTBS yields rapid antidepressant effects and robust reductions in suicidality in treating TRD. Moreover, RSFC within the mesolimbic pathway may serve as a potential biomarker for predicting treatment response. Future work should conduct double-blind, sham-controlled trials with larger samples.
METHODS: We conducted a retrospective chart review of 29 patients (ages 18-74) who received accelerated iTBS targeting the left dorsolateral prefrontal cortex (DLPFC). Patients received 10 iTBS sessions per day for 5 consecutive days, totaling 50 sessions. Depressive symptoms were assessed using the Montgomery-Asberg Depression Rating Scale (MADRS) throughout the treatment. Resting-state fMRI data was used to conduct correlational analysis between the mesolimbic pathway and clinical improvement.
RESULTS: Patients exhibited a rapid and significant reduction in MADRS scores, with response and remission rates of 72.41% and 65.52%, respectively, by Day 5. Suicidality significantly improved from baseline to Day 5, with 86% of patients having a resolution of suicidality by Day 5. Resting state functional connectivity (RSFC) between the right NAcc and left VTA was significantly associated with greater percent reduction in depressive symptoms.
DISCUSSION: Our findings suggest that accelerated iTBS yields rapid antidepressant effects and robust reductions in suicidality in treating TRD. Moreover, RSFC within the mesolimbic pathway may serve as a potential biomarker for predicting treatment response. Future work should conduct double-blind, sham-controlled trials with larger samples.