Repetitive transcranial magnetic stimulation (rTMS) combined with antidepressant pharmacotherapy for depression: state-dependent mechanisms, clinical evidence, and translational challenges

Published October 18, 2026. The review describes encouraging evidence that combining rTMS with antidepressant medication may improve the timing or durability of response for some people. It also emphasizes that the interaction is not uniformly additive and may depend on medication, stimulation protocol, brain state and individual context.

Deng J, Shao Y, Jiang L, Wu B, Roberts N, Wang Q, Jia Z.
Molecular Psychiatry · Publication date: 2026-10-18
Added to site: 2026-10-20
DOI: 10.1038/s41380-026-03930-8

Published October 18, 2026. Added to Neurofeedback.com October 20, 2026.

Modalities

rTMS, TMS, Antidepressant pharmacotherapy

Clinical focus

Depression, Combination treatment, State-dependent mechanisms

Population

People with depression represented across the clinical studies discussed by the review

Sample

Previously published mechanistic, neuroimaging and clinical studies; no new participants or pooled denominator were reported in the checked abstract

Intervention / method

The review examines how antidepressant class, rTMS protocol and timing, cortical excitability, metaplasticity and individual context may shape combined-treatment effects.

Comparator

Comparators varied across the underlying literature; this narrative review did not report a single pooled active or sham comparison in the checked abstract

Clinician summary

The authors integrate state-dependent neurophysiology with heterogeneous clinical evidence. They describe possible gains in early improvement, response, remission and relapse prevention, while emphasizing expectancy and sham-blinding problems, protocol and medication heterogeneity, and the need for biomarker-informed targeting. The checked abstract provides no pooled effect estimate or formal certainty rating.

How to interpret the findings

This is a narrative review rather than a new randomized trial or a reported meta-analysis. The checked abstract does not describe a systematic search, pooled denominator, quantitative effect estimate or formal certainty assessment. Underlying evidence is heterogeneous, expectancy and sham blinding remain important limitations, and the proposed mechanisms are not proven clinical mediators.

Equipment and disclosures

No single stimulation system or manufacturer represents the evidence summarized by this review. No BrainMaster attribution.

Supported by National Natural Science Foundation of China grants 82471953, 82271947 and 82502501, the West China Hospital 1·3·5 project, the CAMS Innovation Fund for Medical Sciences and the Chengdu Science and Technology Program. The authors declared no competing interests. No indexed 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.

• Transcranial low voltage pulsed electromagnetic fields in patients with treatment-resistant depression. · Positive with limitations
• The effects of swLORETA Z-score neurofeedback for patients comorbid with major depressive disorder and anxiety symptoms. · Positive with limitations
• Effects of swLORETA Z-score neurofeedback in Z-coherence of the fronto-limbic circuit in patients with major depressive disorder. · Positive with limitations
• Stanford Neuromodulation Therapy (SNT): A Double-Blind Randomized Controlled Trial. · Positive with limitations
• Clinical Efficacy of High-Frequency Deep Repetitive Transcranial Magnetic Stimulation in the Treatment of Depression and the Predictive Role of Baseline Triglyceride Levels: A Randomized Sham-Controlled Trial. · Positive with limitations
• TMS-EEG Correlate of Suicidal Ideation in Individuals with Depression: A Multi-Site Synthesis. · Positive with limitations
• Motor Cortex rTMS Alleviates Pain and Comorbid Depression After Spinal Cord Injury with a Correlate in M1 Intracortical Inhibition. · Positive with limitations
• A PRISMA-compliant Systematic Review and Meta-Analysis of the Late Positive Potential in Depression. · Positive with limitations
• Feasibility, tolerability, and preliminary effectiveness of an accelerated bilateral intermittent theta-burst stimulation protocol in adults with posttraumatic stress disorder and comorbid depressive disorder following mild traumatic brain injury. · Positive with limitations
• Accelerated TMS is associated with changes of subgenual cingulate-default mode network coupling in depression: an observational 7 Tesla fMRI study. · Mixed
• Identifying poor responders to repetitive transcranial magnetic stimulation using structural brain networks. · Positive with limitations
• Theta burst stimulation with 80 and 120% resting motor threshold do not differ in their antidepressant efficacy: a retrospective analysis. · Positive with limitations
• TMS-Evoked Cortical Reactivity Signatures as a Multidimensional Biomarker of Depression: A TMS-EEG Meta-Analysis from Diagnosis to Prognosis. · Positive with limitations
• The effects of cognitive-behavioural therapy (CBT) on heart rate variability (HRV) in people with depression and/or anxiety disorders: A systematic review and meta-analysis · Positive with limitations