Excitation-Inhibition Balance and Fronto-Limbic Connectivity Distinguish TMS Treatment Outcomes in Refractory Depression

First published October 13, 2026. Researchers found EEG-model patterns that differed between people who did and did not respond to iTBS. The patterns are research candidates, not a validated prediction test.

Momi D, Wang Z, Oveisi MP, Kadak K, Bastiaens SP, Lissemore JI, Noda Y, Downar J, Rodriguez FV, Strafella R, Daskalakis ZJ, Zrenner C, Zomorrodi R, Rolle CE, Saggar M, Williams N, Keller CJ, Blumberger DM, Voineskos D, Griffiths JD.
Biological Psychiatry · Publication date: 2026-10-13
Added to site: 2026-10-16
DOI: 10.1016/j.biopsych.2026.09.027

First indexed as published October 13, 2026; Crossref records an October 2026 issue date.

Modalities

TMS, EEG

Clinical focus

Treatment-resistant depression, Response signatures, Computational modeling

Population

Patients with treatment-resistant depression receiving iTBS

Sample

90 patients

Intervention / method

TMS-evoked EEG potentials before and after left-DLPFC iTBS were fitted with connectome-based neural-mass models; response groups were compared using cross-validated multivariate analysis.

Comparator

Clinical responders versus non-responders; no sham efficacy comparison described in the abstract

Clinician summary

Responders showed larger post-treatment reductions in 3-10 Hz power and model-derived shifts toward greater inhibitory control. A pretreatment frontolimbic brain-state pattern also distinguished response groups in nested cross-validation.

How to interpret the findings

Model-derived measures, responder-group association rather than randomized mechanism testing, and no independent external validation. The abstract does not establish prospective prediction, clinical thresholds or added value over standard assessment.

Equipment and disclosures

TMS-EEG and individualized connectome modeling were used; manufacturers were not verified in the abstract. No BrainMaster attribution.

Crossref lists support from the Canadian Institutes of Health Research, Health Canada, Arrell Family Foundation, Brain Canada, Krembil Foundation, and Toronto General and Western Hospital Foundation. Conflicts were not available in the checked abstract. No correction, retraction or concern relation appeared in Crossref; 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
• Right putaminal gray matter change tracks psychomotor recovery after accelerated iTBS in melancholic treatment-resistant depression · Mixed
• 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
• 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