ArticlePsychotherapy and psychosomatics2026
How Standardized Is Transcranial Magnetic Stimulation Treatment for Depression? Large-Cohort Modeling Reveals Systematic Dosimetric Variability.
Article in Psychotherapy and psychosomatics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionRepetitive transcranial magnetic stimulation (rTMS) is a widely utilized, noninvasive brain stimulation technique for treating neurological and psychiatric disorders worldwide. The efficacy of rTMS is influenced by individual head morphology, which shapes the induced electric field (E-field) in the brain. The standard practice for dosing rTMS involves adjusting the intensity to a defined percentage of the motor threshold (MT), a method exemplified by the globally adopted, US FDA-approved protocol of using 120% MT for depression. Since head morphology varies systematically across ethnic groups, current dosing protocols may lead to inconsistent cortical dosing.
methodsHere, we used large-scale computational modeling (N = 1,085) to systematically evaluate TMS dosage across "White," "Han Chinese," and "Black or African Am." POPULATIONS:
resultsOur findings reveal striking ethnic disparities in the E-field ratio between the therapeutic target (left dorsolateral prefrontal cortex, DLPFC) and the calibration site (left primary motor cortex, M1). "Han Chinese" individuals exhibited a significantly higher E-field ratio (E-field
conclusionOur results suggest that applying a uniform multiplier of MT to DLPFC stimulation may introduce systematic differences in delivered cortical dose across ethnic populations, highlighting that universal dosing conventions derived predominantly from specific demographic cohorts may embed bias, such that established safety and efficacy profiles may not be uniformly applicable across diverse global populations.
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