Right putaminal gray matter change tracks psychomotor recovery after accelerated iTBS in melancholic treatment-resistant depression

Published October 20, 2026. In a sham-controlled imaging analysis, a short-term right-putamen volume change tracked improvement in slowed movement and thinking after active accelerated iTBS. It did not track overall depression improvement, and the paper explicitly says the finding should not be read as structural normalization.

Mao D, Wu GR, Cavendish BA, De Smet S, De Witte S, Baeken C.
Journal of Affective Disorders · Publication date: 2026-10-20
Added to site: 2026-10-21
DOI: 10.1016/j.jad.2026.122652

Published online October 20, 2026, per PubMed. Added to Neurofeedback.com October 21, 2026.

Modalities

iTBS, MRI, Accelerated stimulation

Clinical focus

Treatment-resistant depression, Psychomotor retardation, Putamen

Population

Adults with melancholic treatment-resistant depression; healthy controls contributed baseline imaging comparison

Sample

61 patients and 77 controls at baseline; complete pre-post data for 50 patients, 25 active and 25 sham

Intervention / method

Twenty left dorsolateral prefrontal intermittent theta-burst sessions over four days with structural MRI before and after treatment

Comparator

Active accelerated iTBS versus sham; patients also compared with healthy controls at baseline

Clinician summary

Patients had greater right putamen gray-matter volume than controls at baseline. Among 50 completers, greater post-treatment volume increase correlated with psychomotor improvement after active but not sham iTBS. The association was absent for overall depression severity and does not establish a treatment mechanism or active-over-sham clinical benefit.

How to interpret the findings

This is a secondary regional imaging association in 50 completers. The abstract does not provide the clinical active-versus-sham treatment effect, effect sizes for the imaging association, multiplicity control, durability or adverse-event detail. MRI volume change is not synonymous with recovery or normalization.

Equipment and disclosures

The accessible abstract did not identify a stimulator manufacturer or MRI system. No BrainMaster attribution is made.

The indexed record reports no known competing financial interests or personal relationships. Funding was not identified in the checked abstract. No correction, retraction or concern relation appeared in the retained Crossref record; this is a bounded check. AI-assisted review.

Related evidence

Compare findings from the same clinical area, including mixed results.

• Latent class modeling of repetitive transcranial magnetic stimulation response trajectories in treatment-resistant depression · Positive with limitations
• Effectiveness of rTMS vs. Pharmacotherapy in Late-Life Treatment-Resistant Depression: An Observational Study of Individual Participant Data From Two Randomized Clinical Trials · Positive with limitations
• Clinical outcomes following five-day accelerated intermittent theta burst stimulation for treatment-resistant depression in routine clinical practice: A prospective naturalistic cohort study · Positive with limitations
• Excitation-Inhibition Balance and Fronto-Limbic Connectivity Distinguish TMS Treatment Outcomes in Refractory Depression · Positive with limitations
• Use of neurostimulation in patients with treatment-resistant depression: current options and future directions. · Positive with limitations
• Pilot randomized trial of intermittent theta-burst stimulation versus H-Coil transcranial magnetic stimulation for treatment-resistant depression. · Positive with limitations