This randomized, blinded clinical trial (n=40 adults, ages 22–80) compared connectivity-based vs. scalp-based (Beam F3) targeting of accelerated TMS (aTMS) for treatment-resistant major depressive disorder, with the primary outcome of MADRS score at 1 month post-treatment and follow-up for 1 year.
Connectivity-based targeting produced a median MADRS score reduction of 24 points vs. 18 points with scalp-based targeting (P=.02), with an effect size (Cohen d analog) of 0.8 (95% CI, 0.26–1.54) and a number needed to scan of 5.
Very small sample (n=40), limiting generalizability and power for subgroup analyses; single academic center; results described as hypothesis-generating, with authors calling for a confirmatory efficacy trial.
When aTMS is planned for treatment-resistant depression, a single resting-state fMRI scan to individualize the DLPFC target to the convergent depression circuit may meaningfully boost antidepressant response — roughly 1 extra scan per 5 patients could improve outcomes. These results support conducting a larger confirmatory trial before adopting this as standard practice.
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