Mood, Brain Structure, and Neuromodulation: Insights from Recent Studies

Accelerated sequential rTMS targeting the left dorsolateral prefrontal cortex (dlPFC) and dorsomedial prefrontal cortex (dmPFC) produced significant improvements in depressive symptoms and fatigue in adults with major depressive disorder (MDD).

This finding shifts assessment and scheduling priorities compared with once‑daily, single‑site dlPFC rTMS. The accelerated dual‑site approach delivers multiple sessions per day and targets mood and fatigue sooner, prompting reconsideration of baseline fatigue and simple emotion‑processing measures when evaluating candidates and arranging treatment schedules.

In an open‑label study of 51 adults with MDD, participants received four sessions per day for four consecutive days with assessments at baseline, end of treatment, and week 4. The protocol produced a significant MADRS improvement (p < 0.001, d = −0.343) and a significant fatigue reduction (p = 0.010, d = −0.572) by treatment end; responder and remission rates increased and gains were maintained at the week‑4 follow‑up.

Symptom reductions observed at treatment end were sustained at week 4, supporting the potential for a short, intensive course to deliver durable early benefit. That preservation argues for routine week‑4 follow‑up as a pragmatic outcome checkpoint.

Changes in emotional arousal on the Affect Rating Task (ART) correlated with subsequent MADRS improvement: increases in arousal to positive and neutral images at treatment end were associated with larger MADRS gains at week 4 (p = 0.047 and p = 0.019; adjusted R2 ≈ 0.10–0.16). ART changes may therefore serve as an early, behaviorally grounded metric of treatment response in this neuromodulation context.