Trajectories of improvement with repetitive transcranial magnetic stimulation for treatment-resistant major depression in the BRIGhTMIND trial

Briley, P.M.; Webster, L.; Lankappa, S.; Pszczolkowski, S.; H. McAllister-Williams, R.; Liddle, P.F.; Auer, D.P.; Morriss, R.

Abstract

Repetitive transcranial magnetic stimulation (rTMS) is an established non-invasive brain stimulation treatment for major depressive disorder, but there is marked inter-individual variability in response. Using latent class growth analysis with session-by-session patient global impression ratings from the recently completed BRIGhTMIND trial, we identified five distinct classes of improvement trajectory during a 20-session treatment course. This included a substantial class of patients noticing delayed onset of improvement. Contrary to prior expectations, members of a class characterised by early and continued improvement showed greatest inter-session variability in stimulated location. By relating target locations and inter-session variability to a well-studied atlas, we estimated an average of 3.0 brain networks were stimulated across the treatment course in this group, compared to 1.1 in a group that reported symptom worsening (p < 0.001, d = 0.893). If confirmed, this would suggest that deliberate targeting of multiple brain networks could be beneficial to rTMS outcomes.

Citation

Briley, P., Webster, L., Lankappa, S., Pszczolkowski, S., H. McAllister-Williams, R., Liddle, P., Auer, D., & Morriss, R. (2024). Trajectories of improvement with repetitive transcranial magnetic stimulation for treatment-resistant major depression in the BRIGhTMIND trial. npj Mental Health Research, 3, Article 32. https://doi.org/10.1038/s44184-024-00077-8

• Journal Article Type: Article
• Acceptance Date: Jun 5, 2024
• Online Publication Date: Jun 27, 2024
• Publication Date: Jun 27, 2024
• Deposit Date: May 30, 2025
• Publicly Available Date: Jun 6, 2025
• Journal: npj Mental Health Research
• Electronic ISSN: 2731-4251
• Publisher: Springer Nature
• Peer Reviewed: Peer Reviewed
• Volume: 3
• Article Number: 32
• DOI: https://doi.org/10.1038/s44184-024-00077-8
• Public URL: https://nottingham-repository.worktribe.com/output/36877709
• Publisher URL: https://www.nature.com/articles/s44184-024-00077-8