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

Po-Han Chou ¹, Yen-Feng Lin ², Ming-Kuei Lu ³, Hsin-An Chang ⁴, Che-Sheng Chu ⁵, Wei Hung Chang ⁶, Taishiro Kishimoto ⁷, Alexander T. Sack ⁸, Kuan-Pin Su ^{2, 9*}

¹Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan., ²Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan, ³Department of Neurology, China Medical University Hospital, Taichung, Taiwan., ⁴Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ⁵Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ⁶Department of Psychiatry, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan, ⁷Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan, ⁸Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands., ⁹An-Nan Hospital, China Medical University, Tainan, Taiwan.

Received: December 13, 2020; Accepted: December 24, 2020; Published online: December 24, 2020.

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.; Keywords: depression, brain stimulation, repetitive transcranial magnetic stimulation, rTMS, theta-burst stimulation, TBS

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