TMS-Evoked Cortical Reactivity Signatures as a Multidimensional Biomarker of Depression: A TMS-EEG Meta-Analysis from Diagnosis to Prognosis.

The review identifies promising EEG responses for further research into tracking depression and treatment response.

Xie JY, Zhao T, Guo L, Li D, Zhao Y, Wang Z, Wang P, Meng L, Wang G, Yang Z.
Biological psychiatry · Publication date: 2026-10-03
Added to site: 2026-10-04
DOI: 10.1016/j.biopsych.2026.09.022

Published online October 3, 2026, verified in PubMed. Site addition: October 4, 2026.

Modalities

TMS/rTMS, EEG, ERP

Clinical focus

Depression, Candidate biomarkers

Population

Major depressive disorder and healthy controls

Sample

21 studies; 1,025 patients and 517 controls

Intervention / method

Single-pulse TMS-EEG measures across characterization, treatment monitoring and baseline prediction

Comparator

Healthy controls and study-specific treatment/outcome contrasts

Clinician summary

N100 was elevated in depression (g=0.35). Treatment-related N100 reduction was associated with remission (g=0.85); baseline prediction was preliminary.

How to interpret the findings

Group associations do not validate an individual diagnostic or treatment-selection test. The abstract omits domain-specific denominators, confidence intervals, bias assessments, preprocessing details and external predictive validation. Cohort independence cannot be confirmed.

Equipment and disclosures

Equipment varied or was unspecified in the abstract.

Funding and competing interests unavailable in checked records.

Related evidence

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

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