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Peer-reviewedCC BY 4.0Alpha Psychiatry

Advancing Repetitive Transcranial Magnetic Stimulation for Depression: Novel Protocols, Precision Targeting, and Future Directions

  • Wenzhong Liu1,2
  • Yang Fan1,2
  • Pingping Ma2,3
  • Ting Song2,3
  • Bo Liu2,3,4
  • Kezhi Liu1,2,3,4
  • Youguo Tan1,2,3,4
4 affiliations
  1. 1Department of Psychiatry, The Affiliated Hospital, Southwest Medical University, 646000 Luzhou, Sichuan, China
  2. 2School of Mental Health, Southwest Medical University, 643020 Zigong, Sichuan, China
  3. 3Department of Psychiatry, Zigong Mental Health Center, 643020 Zigong, Sichuan, China
  4. 4Center for Psychiatry Research, Zigong Institute of Brain Science, 643020 Zigong, Sichuan, China
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Abstract

Major depressive disorder (MDD) remains a significant global health challenge, with substantial limitations inherent in current pharmacotherapeutic and psychotherapeutic approaches. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a safe, effective, and non-invasive neuromodulation therapy, particularly for treatment-resistant depression (TRD). However, conventional rTMS is limited by long treatment duration and variable interindividual efficacy. This expert opinion examines recent advances in rTMS optimization strategies aimed at overcoming these limitations. Key areas of progress include the development of novel stimulation protocols such as theta-burst stimulation (TBS); accelerated regimens and priming TMS; the use of magnetic resonance imaging (MRI)-guided TMS; and the integration of closed-loop systems using real-time electroencephalography (EEG) or functional near-infrared spectroscopy (fNIRS) feedback. Additionally, technological innovations, including robot-assisted TMS and wearable devices, promise to enhance targeting accuracy and treatment accessibility. Despite these developments, significant challenges impede clinical translation, including the high cost of personalized protocols, insufficient standardization and validation of novel approaches, and technical barriers to closed-loop implementation. Future efforts should focus on cost reduction, large-scale randomized controlled trials, biomarker development, and device portability. Ultimately, optimized rTMS shows significant potential to become a more efficient, precise, and accessible cornerstone of depression therapy.

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Cite

BibTeXRIS
BibTeX
@article{liu2026advancing,
  title = {{Advancing Repetitive Transcranial Magnetic Stimulation for Depression: Novel Protocols, Precision Targeting, and Future Directions}},
  author = {Wenzhong Liu and Yang Fan and Pingping Ma and Ting Song and Bo Liu and Kezhi Liu and Youguo Tan},
  journal = {Alpha Psychiatry},
  year = {2026},
  month = sep,
  doi = {10.31083/ap48750},
  url = {https://doi.org/10.31083/ap48750},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Advancing Repetitive Transcranial Magnetic Stimulation for Depression: Novel Protocols, Precision Targeting, and Future Directions
AU  - Wenzhong Liu
AU  - Yang Fan
AU  - Pingping Ma
AU  - Ting Song
AU  - Bo Liu
AU  - Kezhi Liu
AU  - Youguo Tan
PY  - 2026
DA  - 2026/09/03
JO  - Alpha Psychiatry
DO  - 10.31083/ap48750
UR  - https://doi.org/10.31083/ap48750
AB  - Major depressive disorder (MDD) remains a significant global health challenge, with substantial limitations inherent in current pharmacotherapeutic and psychotherapeutic approaches. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a safe, effective, and non-invasive neuromodulation therapy, particularly for treatment-resistant depression (TRD). However, conventional rTMS is limited by long treatment duration and variable interindividual efficacy. This expert opinion examines recent advances in rTMS optimization strategies aimed at overcoming these limitations. Key areas of progress include the development of novel stimulation protocols such as theta-burst stimulation (TBS); accelerated regimens and priming TMS; the use of magnetic resonance imaging (MRI)-guided TMS; and the integration of closed-loop systems using real-time electroencephalography (EEG) or functional near-infrared spectroscopy (fNIRS) feedback. Additionally, technological innovations, including robot-assisted TMS and wearable devices, promise to enhance targeting accuracy and treatment accessibility. Despite these developments, significant challenges impede clinical translation, including the high cost of personalized protocols, insufficient standardization and validation of novel approaches, and technical barriers to closed-loop implementation. Future efforts should focus on cost reduction, large-scale randomized controlled trials, biomarker development, and device portability. Ultimately, optimized rTMS shows significant potential to become a more efficient, precise, and accessible cornerstone of depression therapy.
SN  - 2757-8038
ER  -