Personalized brain imaging may improve outcomes for treatment-resistant depression

by Brigham and Women's Hospital

edited by Gaby Clark, reviewed by Andrew Zinin

Gaby Clark

Scientific Editor

Meet our editorial team
Behind our editorial process

Andrew Zinin

Chief Editor

Meet our editorial team
Behind our editorial process Editors' notes

This article has been reviewed according to Science X's editorial process and policies. Editors have highlighted the following attributes while ensuring the content's credibility:

fact-checked

peer-reviewed publication

trusted source

proofread

The GIST Add as preferred source

A new randomized clinical trial from investigators at Mass General Brigham's Neuroscience Institute and Department of Psychiatry suggests that using personalized brain imaging to guide transcranial magnetic stimulation (TMS) may improve outcomes for people with treatment-resistant depression. Results are published in JAMA Psychiatry.

TMS is a noninvasive form of brain stimulation that uses magnetic pulses to modulate brain activity. TMS has had Food and Drug Administration (FDA) clearance for treating major depressive disorder in adults since 2008 and is often used to treat depression that has not responded to standard treatments. However, the conventional way to select the TMS treatment target relies on scalp-based measurements. These methods are practical and widely available, but they do not account for individual differences in brain circuits involved in depression.

In the new study, researchers tested whether TMS has larger antidepressant effects when treatment targets are selected using an individual's functional magnetic resonance imaging (fMRI) scan rather than conventional scalp-based targeting. The researchers leveraged accelerated TMS (aTMS), an approach that delivers multiple treatment sessions per day and can condense a course of treatment from several weeks into a single week. Their imaging-based targeting approach used resting-state functional connectivity, a type of functional MRI analysis that measures how different brain regions synchronize with one another at rest.

"Neuroimaging has taught us a tremendous amount about the brain, but it has been difficult to show that imaging can directly improve patient care," said corresponding author Dr. Joseph Taylor, the Jonathan F. Borus, MD, Endowed Chair in Psychiatry at Mass General Brigham and an assistant professor of psychiatry at Harvard Medical School.

"It is important to address this knowledge gap because imaging adds cost and complexity to TMS treatment. In this study, our goal was to measure how much impact our approach to imaging-based targeting would have above and beyond conventional scalp-based targeting."

The randomized trial included 40 adults, ages 22 to 80, with major depressive disorder and moderate to severe levels of treatment resistance. Before treatment, each participant underwent an fMRI scan. Participants were then randomized to receive aTMS using either their connectivity-based target or their scalp-based target. Participants and clinical raters were blinded to group assignment.

One month after treatment, participants who received connectivity-based targeting had significantly greater improvement in depressive symptoms than those who received scalp-based targeting. These differences were measured by the Montgomery-Åsberg Depression Rating Scale (MADRS), a widely used clinician-rated measure of depression severity. Response rates were also higher in the connectivity-based group, with 80% of participants meeting response criteria compared with 60% in the scalp-based group. Taken together, the results suggest that connectivity-based targeting may have a clinically meaningful impact on outcomes for people receiving aTMS for treatment-resistant depression.

The findings build on previous research by Taylor, including a recent trial published in Molecular Psychiatry that examined circuit-targeted modulation of anxiety symptoms in individuals with major depression.

"Retrospective analyses have hinted that functional imaging could be used to improve outcomes, but prospective evidence has been limited," Taylor said. "Our recent clinical trials provide prospective evidence that there may be clinical advantages to using functional imaging to guide aTMS treatment. These findings are important as aTMS becomes more widely available and decisions are made about how to scale this intervention for patients with depression and other psychiatric illnesses."

The researchers note that the study has several limitations, including a relatively small sample size and single-site design. They plan to conduct a larger trial to further validate the efficacy of connectivity-based aTMS in diverse patient populations and investigate the long-term effects of this treatment approach.

Publication details

Connectivity- versus scalp-based targeting of accelerated TMS for depression: A randomized trial, JAMA Psychiatry (2026). DOI: 10.1001/jamapsychiatry.2026.1100

Journal information: JAMA Psychiatry , Molecular Psychiatry

Key medical concepts

Transcranial Magnetic StimulationFunctional MRI

Clinical categories

PsychiatryPsychology & Mental health Provided by Brigham and Women's Hospital Who's behind this story?

Gaby Clark

MA in English, copy editor since 2021 with experience in higher education and health content. Dedicated to trustworthy science news. Full profile →

Andrew Zinin

Master's in physics with research experience. Long-time science news enthusiast. Plays key role in Science X's editorial success. Full profile →

Citation: Personalized brain imaging may improve outcomes for treatment-resistant depression (2026, June 24) retrieved 25 June 2026 from https://medicalxpress.com/news/2026-06-personalized-brain-imaging-outcomes-treatment.html This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.