New Developments in the Treatment of Depression with TMS

Abstract While the precision effort using transcranial magnetic stimulation (TMS) in major depressive disorder (MDD) has mostly focused on more precise targeting, less progress has occurred in patient stratification. This chapter focuses on dysfunctions in large scale neural networks measured using functional magnetic resonance imaging (MRI) as a means of identifying baseline predictors of TMS response and subtyping depressed individuals. Illustrating this approach, the chapter describes an innovative, large (target n = 100), pragmatic mechanistic TMS study embedded within the national Veterans Administration (VA) TMS Clinical Program involving 4 VA sites and standardized treatment parameters and neuroimaging protocols. The chapter concludes with a description of the promises and pitfalls of big data approaches for patient stratification in TMS in MDD.