Comparison of effectiveness of common targeting heuristics in repetitive transcranial magnetic stimulation treatment of depression

Katrin Sakreida; Nicholas T Trapp; Sarah Kreuzer; Ulrike Rubin; Dieter Schnabel; Jana Hovančáková; Alexander T Sack; Irene Neuner; Thomas Frodl; Timm B Poeppl

doi:10.1136/bmjment-2025-301598

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Comparison of effectiveness of common targeting heuristics in repetitive transcranial magnetic stimulation treatment of depression

Journal article

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Peer reviewed

Comparison of effectiveness of common targeting heuristics in repetitive transcranial magnetic stimulation treatment of depression

Katrin Sakreida, Nicholas T Trapp, Sarah Kreuzer, Ulrike Rubin, Dieter Schnabel, Jana Hovančáková, Alexander T Sack, Irene Neuner, Thomas Frodl and Timm B Poeppl

BMJ mental health, Vol.28(1), e301598

05/19/2025

DOI: 10.1136/bmjment-2025-301598

PMCID: PMC13059834

PMID: 40389305

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Abstract

Background Repetitive transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex (DLPFC) is an effective non-pharmacological, non-invasive intervention for depression. However, the optimal strategy for localising the DLPFC treatment site on the patient’s scalp is heavily disputed. Routine strategies were previously incrementally refined and compared in terms of anatomical accuracy, but little is known about their impact on clinical outcomes.ObjectiveTo assess the impact of three common scalp-based heuristics for magnetic coil positioning on the treatment outcome of rTMS.MethodsThis retrospective analysis of real-world clinical data involved patients suffering from a major depressive episode (n=94) who received a 4-week course of excitatory rTMS to the left DLPFC. The treatment target (ie, coil position) was either determined at an absolute distance anterior to the motor hotspot (‘6 cm rule’) or defined in reference to the EEG electrode position F3 using a traditional (‘Beam F3’) or optimised (‘Beam F3 Adjusted’) approach.FindingsThere was no statistically significant difference between the ‘6 cm rule’ and the ‘Beam F3’ method nor between the ‘Beam F3’ and the ‘Beam F3 Adjusted’ method in head-to-head comparisons of averaged per cent change of scores on depression rating scales (all p>0.605) and response rate (all p>0.475).ConclusionsEnhancing targeting precision via scalp-based heuristics does not affect treatment outcomes.Clinical implicationsThere is no need for clinicians to switch from their familiar to an ‘advanced’ approach among these common targeting heuristics.

Psychiatry

Cross-Sectional Studies

Data Interpretation, Statistical

Depression

Short report

Details

Title: Subtitle: Comparison of effectiveness of common targeting heuristics in repetitive transcranial magnetic stimulation treatment of depression
Creators: Katrin Sakreida - RWTH Aachen University
Nicholas T Trapp - University of Iowa
Sarah Kreuzer - University of Regensburg
Ulrike Rubin - Krankenhaus Düren
Dieter Schnabel - Krankenhaus Düren
Jana Hovančáková - RWTH Aachen University
Alexander T Sack - Maastricht University
Irene Neuner - RWTH Aachen University
Thomas Frodl - RWTH Aachen University
Timm B Poeppl - RWTH Aachen University
Resource Type: Journal article
Publication Details: BMJ mental health, Vol.28(1), e301598
DOI: 10.1136/bmjment-2025-301598
PMID: 40389305
PMCID: PMC13059834
NLM abbreviation: BMJ Ment Health
ISSN: 2755-9734
eISSN: 2755-9734
Publisher: BMJ Publishing Group Ltd, Royal College of Psychiatrists and British Psychological Society
Grant note: PO 2826/3-1 / Deutsche Forschungsgemeinschaft (http://dx.doi.org/10.13039/501100001659)
Language: English
Date published: 05/19/2025
Academic Unit: Psychiatry; Iowa Neuroscience Institute
Record Identifier: 9984824299002771

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