Personalization of Repetitive Transcranial Magnetic Stimulation for the Treatment of Major Depressive Disorder According to the Existing Psychiatric Comorbidity

Abstract

Repetitive transcranial magnetic stimulation (rTMS) and intermittent theta-burst stimulation (iTBS) are evidenced-based treatments for patients with major depressive disorder (MDD) who fail to respond to standard first-line therapies. However, although various TMS protocols have been proven to be clinically effective, the response rate varies across clinical applications due to the heterogeneity of real-world psychiatric comorbidities, such as generalized anxiety disorder, posttraumatic stress disorder, panic disorder, or substance use disorder, which are often observed in patients with MDD. Therefore, individualized treatment approaches are important to increase treatment response by assigning a given patient to the most optimal TMS treatment protocol based on his or her individual profile. This literature review summarizes different rTMS or TBS protocols that have been applied in researches investigating MDD patients with certain psychiatric comorbidities and discusses biomarkers that may be used to predict rTMS treatment response. Furthermore, we highlight the need for the validation of neuroimaging and electrophysiological biomarkers associated with rTMS treatment responses. Finally, we discuss on which directions future efforts should focus for developing the personalization of the treatment of depression with rTMS or iTBS.

The Korean Medication Algorithm Project for Depressive Disorder 2021: Comparisons with Other Treatment Guidelines

“…However, KMAP-DD 2021, recommended rTMS as a first-line treatment for pregnant patients with severe MDD. This recommendation was in line with recent evidence that non-invasive neurostimulation including rTMS could be an effective and feasible alternative treatment for antenatal depression [ 67 , 68 ] and MDD patients with specific psychiatric comorbidities [ 69 ]. Moreover, CANMAT 2016, considers rTMS a first-line treatment for MDD patients who have failed at least one AD treatment [ 43 ], while KMAP-DD 2021, recommended rTMS as the second-line treatment.…”

Korean Medication Algorithm for Depressive Disorder 2021, Fourth Revision: An Executive Summary

“…ECT for non-psychotic severe MDD with self-harm or suicidal risk regardless of psychotic features and TMS for pregnant women were recommended as first-line. Most Korean experts consider ECT (92% in 2021 vs. 92.4% in 2017) and rTMS (89% in 2021 vs. 86.0% in 2017) to be good treatment strategies in line with recent evidence [ 53 , 54 ]. Compared to 44.3% in 2017, 43.8% of experts conduct ECT in 2021, while compared to 31.6% in 2017, 40.6% in 2021 have used rTMS in real practice.…”

Targeting Three Brain Regions (Bilateral SMA, Left and Right DLPFC) Sequentially in One Session Using Combined Repetitive Transcranial Magnetic Stimulation and Intermittent Theta-burst Stimulation in Treatment-refractory Obsessive-compulsive Disorder: A Case Report

“…Moreover, our case was at an early stage of her illness, and the effect of our rTMS protocol in patients with chronic refractory OCD needs to be confirmed. Our case report also highlights the importance of personalized treatment plans according to psychiatric comorbidities in patients with OCD [ 21 ].…”