Surveying efforts to boost the antidepressant effects of repetitive transcranial magnetic stimulation with non-pharmacological adjunct interventions: a systematic scoping review

Abstract Current efforts to optimize the antidepressant efficacy of repetitive transcranial magnetic stimulation (rTMS) focus on personalizing protocols, e.g., neuroimaging-based target selection, but little attention is given what should occur during these three-to-thirty-minute sessions. This a potential blind-spot in psychiatric research, particularly for treating patients with internalizing disorders. We cannot assume are relaxed brain state due nature syndromes, despite instructions relax. Of particular concern evidence suggesting that can modulate response stimulation. Thus, we conducted systematic scoping review, per PRISMA extension Scoping Reviews (PRISMA-ScR), search PubMed database clinical studies applied non-pharmacological adjunct interventions rTMS. Specific inclusion criteria: neuropsychiatric underwent rTMS; assessed effects depression severity scales irrespective diagnosis; and were or overlapped rTMS 3087 query results, 16 included. Nine published within last three years seven preceding 15 years, growing interest such albeit low number publications. The quality as only six included control group, which two reported non-significant differences, one did not provide sufficient data calculate size, indicated large small effect size boosted efficacy, diminished efficacy. Adjunct varied widely, including psychotherapy, bright light therapy, sleep deprivation, manipulated neural activity, physical cognitive training. In addition informing intervention, our findings allow inferences mechanisms action terms current theories, whether its akin selective serotonin reuptake inhibitors. Research Category Technology Methods Clinical Research: 10. Transcranial Magnetic Stimulation (TMS) Keywords: rTMS, Depression, Brain