Journal
PSYCHOLOGICAL MEDICINE
Volume 45, Issue 16, Pages 3411-3432Publisher
CAMBRIDGE UNIV PRESS
DOI: 10.1017/S0033291715001609
Keywords
Dorsolateral prefrontal cortex; neurobiological mechanisms; repetitive transcranial magnetic stimulation; treatment-resistant depression
Categories
Funding
- Centre for Addiction and Mental Health (CAMH) Foundation
- Brain and Behavior Research Foundation Young Investigator Grant
- Schizophrenia Junior Faculty Grant from CAMH Foundation
- Canadian Institutes of Health Research (CIHR)
- US National Institutes of Health (NIH)
- Klarman Family Foundation
- Buchan Family Foundation
- Toronto General and Western Hospital Foundation
- Lundbeck
- ANT Neuro
- Brain Canada
- Brain and Behavior Research Foundation
- Canadian Foundation for Innovation
- CIHR
- Ontario Ministry of Health and Long-Term Care
- Ontario Ministry of Research and Innovation
- NIH
- W. Garfield Weston Foundation
- National Health and Medical Research Council (NHMRC) Practitioner Fellowship [606 907]
- Cervel Neurotech
- CAMH Foundation
- Bristol-Myers Squibb (medications for a NIH-funded clinical trial)
- Pfizer (medications for a NIH-funded clinical trial)
- Ontario Mental Health Foundation (OMHF)
- SickKids Foundation
- Ontario Ministry of Long Term Care
- Brainsway Ltd
- Pfizer
- Merck
- Sepracor Inc.
- AstraZeneca
- OMHF
- Temerty Family and Grant Family
- Campbell Institute
- Temerty Family through CAMH Foundation
- Campbell Family Research Institute
- Campbell Research Institute
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Depression is one of the most prevalent mental illnesses worldwide and a leading cause of disability, especially in the setting of treatment resistance. In recent years, repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising alternative strategy for treatment-resistant depression and its clinical efficacy has been investigated intensively across the world. However, the underlying neurobiological mechanisms of the antidepressant effect of rTMS are still not fully understood. This review aims to systematically synthesize the literature on the neurobiological mechanisms of treatment response to rTMS in patients with depression. Medline (1996-2014), Embase (1980-2014) and PsycINFO (1806-2014) were searched under set terms. Three authors reviewed each article and came to consensus on the inclusion and exclusion criteria. All eligible studies were reviewed, duplicates were removed, and data were extracted individually. Of 1647 articles identified, 66 studies met both inclusion and exclusion criteria. rTMS affects various biological factors that can be measured by current biological techniques. Although a number of studies have explored the neurobiological mechanisms of rTMS, a large variety of rTMS protocols and parameters limits the ability to synthesize these findings into a coherent understanding. However, a convergence of findings suggest that rTMS exerts its therapeutic effects by altering levels of various neurochemicals, electrophysiology as well as blood flow and activity in the brain in a frequency-dependent manner. More research is needed to delineate the neurobiological mechanisms of the antidepressant effect of rTMS. The incorporation of biological assessments into future rTMS clinical trials will help in this regard.
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