Evidence map›Paper›PMID 38844713›Full record

ReviewCurrent topics in behavioral neurosciences2024

Mechanisms of Action of TMS in the Treatment of Depression.

Jonathan Downar, Shan H Siddiqi, Anish Mitra, Nolan Williams, Conor Liston

Abstract readReview
PubMed Publisher
In one paragraph

Review in Current topics in behavioral neurosciences, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
21citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

21 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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  11. Understanding the emergence of suicidal thoughts and behaviors in adolescence from a brain and behavioral developmental perspective.Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology · 2026
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  19. Paradigm shift in psychiatric treatments: Brain stimulation.Dusunen adam : Bakirkoy Ruh ve Sinir Hastaliklari Hastanesi yayin organi · 2024
    Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Jonathan DownarDepartment of Psychiatry, Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada. jonathan.downar@utoronto.ca.
Shan H SiddiqiCenter for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, MA, USA.
Anish MitraDepartment of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.
Nolan WilliamsDepartment of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.
Conor ListonDepartment of Psychiatry, Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Transcranial magnetic stimulation (TMS) is entering increasingly widespread use in treating depression. The most common stimulation target, in the dorsolateral prefrontal cortex (DLPFC), emerged from early neuroimaging studies in depression. Recently, more rigorous casual methods have revealed whole-brain target networks and anti-networks based on the effects of focal brain lesions and focal brain stimulation on depression symptoms. Symptom improvement during therapeutic DLPFC-TMS appears to involve directional changes in signaling between the DLPFC, subgenual and dorsal anterior cingulate cortex, and salience-network regions. However, different networks may be involved in the therapeutic mechanisms for other TMS targets in depression, such as dorsomedial prefrontal cortex or orbitofrontal cortex. The durability of therapeutic effects for TMS involves synaptic neuroplasticity, and specifically may depend upon dopamine acting at the D1 receptor family, as well as NMDA-receptor-dependent synaptic plasticity mechanisms. Although TMS protocols are classically considered 'excitatory' or 'inhibitory', the actual effects in individuals appear quite variable, and might be better understood at the level of populations of synapses rather than individual synapses. Synaptic meta-plasticity may provide a built-in protective mechanism to avoid runaway facilitation or inhibition during treatment, and may account for the relatively small number of patients who worsen rather than improve with TMS. From an ethological perspective, the antidepressant effects of TMS may involve promoting a whole-brain attractor state associated with foraging/hunting behaviors, centered on the rostrolateral periaqueductal gray and salience network, and suppressing an attractor state associated with passive threat defense, centered on the ventrolateral periaqueductal gray and default-mode network.

Indexed as

Neuronal PlasticityTranscranial Magnetic StimulationBrainDepressionDorsolateral Prefrontal CortexHumansPrefrontal CortexACCAnterior cingulateAttractorCausal network mappingDefault modeDepressionDLPFCDMPFCDopaminefMRIForagingFunctional connectivityGlutamateLTDLTPMeta-plasticityNMDANon-rewardOrbitofrontalPAGPassive threat defensePeriaqueductal grayPro-kurtosisrTMSSalienceSubgenualSynapseTMSTranscranial magnetic stimulation

Identifiers

PMID38844713

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.