{"doi":"10.1016/j.brs.2023.09.011","title":"Right lateral orbitofrontal cortex inhibitory transcranial magnetic stimulation for treatment of refractory mood and depression","abstract":"High-frequency repetitive Transcranial Magnetic Stimulation (rTMS) of the left dorsolateral prefrontal cortex (DLPFC) is an effective treatment for Major Depressive Disorder (MDD), but up to half of patients can have significant residual depressive symptoms using this treatment approach [[1]Somani A. Kar S.K. Efficacy of repetitive transcranial magnetic stimulation in treatment-resistant depression: the evidence thus far.Gen Psychiatr. 2019; 32e100074PubMed Google Scholar]. Developing new approaches to enhance rTMS treatment efficacy is critically important considering that the majority of patients pursue rTMS only after failing to respond to available pharmacological and psychotherapeutic treatment options. Right lateral orbitofrontal cortex (rlOFC) has been shown to play a prominent role in the circuit mechanisms of depression [[2]Rolls E.T. Cheng W. Feng J. The orbitofrontal cortex: reward, emotion and depression.Brain Commun. 2020; 2: fcaa196Crossref PubMed Scopus (140) Google Scholar], but has not been extensively studied as a treatment target. In this open-label case series study, we examined the safety, feasibility, and efficacy of sequential bilateral rlOFC inhibitory augmentation stimulation for patients showing limited response to 20 sessions of conventional high-frequency left DLPFC stimulation. 33 patients (average age = 42.9 ± 16.8, 20 female) with moderately-severe MDD (average Inventory of Depressive Symptomatology-Self-Report [IDS-SR] [[3]Rush A.J. Giles D.E. Schlesser M.A. Fulton C.L. Weissenburger J. Burns C. The inventory for depressive Symptomatology (IDS): preliminary findings.Psychiatr Res. 1986; 18: 65-87Crossref PubMed Scopus (760) Google Scholar] = 44 ± 10.8, Patient Health Questionnaire [PHQ-9] = 19 ± 4.1) with a high degree of negative ruminative thinking (Ruminative Response Scale [[4]Nolen-Hoeksema S. Morrow J. A prospective study of depression and posttraumatic stress symptoms after a natural disaster: the 1989 Loma Prieta Earthquake.J Pers Soc Psychol. 1991; 61: 115-121Crossref PubMed Scopus (2326) Google Scholar] [RRS] = 64 ± 14.4) were enrolled in this study and underwent a course of treatment at the UCLA TMS Clinical and Research Service. They were highly treatment-resistant as evidenced by having tried on average 7.7 ± 4 different antidepressant medications (antidepressants and antipsychotics) and 1.5 ± 2 courses of psychotherapy with suboptimal improvement. The UCLA Institutional Review Board approved this retrospective analysis of de-identified data. Clinical measures were collected prior to, after every five sessions, and at the end of treatment. Because of its high negative predictive value, the IDS-SR was used to assess symptom improvement during treatment. The PHQ-9 was used to assess the overall treatment outcome. Patients initially received treatment with 10 Hz rTMS (3000 pulses) administered to left DLPFC with the stimulating coil placed using the Beam F3 method and stimulation intensity titrated as tolerated to 120% of motor threshold (MT), which was determined at the first treatment session. We utilized a measurement-based care paradigm previously described [5Lee J.C. Wilson A.C. Corlier J. Tadayonnejad R. Marder K.G. Pleman C.M. et al.Strategies for augmentation of high-frequency left-sided repetitive transcranial magnetic stimulation treatment of major depressive disorder.J Affect Disord. 2020; 277: 964-969Crossref PubMed Scopus (13) Google Scholar, 6Tadayonnejad R. Wilson A.C. Chu S.A. Corlier J. Citrenbaum C. Ngo T.D.P. et al.Use of right orbitofrontal repetitive transcranial magnetic stimulation (rTMS) augmentation for treatment-refractory obsessive-compulsive disorder with comorbid major depressive disorder.Psychiatr Res. 2022; 317114856Crossref PubMed Scopus (5) Google Scholar, 7Tadayonnejad R. Wilson A.C. Corlier J. Lee J.C. Ginder N.D. Levitt J.G. et al.Sequential multi-locus transcranial magnetic stimulation for treatment of obsessive-compulsive disorder with comorbid maj","journal":"Brain stimulation","year":2023,"id":329510,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":19,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9607,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":970458,"name":"Cole Citrenbaum","orcid":"0000-0001-6069-2430","position":1,"is_corresponding":false},{"id":700213,"name":"Doan Ngo","orcid":"0000-0002-9411-2083","position":2,"is_corresponding":false},{"id":304892,"name":"Juliana Corlier","orcid":"0000-0002-1342-5505","position":3,"is_corresponding":false},{"id":700214,"name":"Scott A. Wilke","orcid":"0000-0002-7421-4015","position":4,"is_corresponding":false},{"id":1049910,"name":"Aaron Slan","orcid":"0009-0000-8657-1530","position":5,"is_corresponding":false},{"id":890060,"name":"Margaret G. Distler","orcid":null,"position":6,"is_corresponding":false},{"id":321679,"name":"Gil D. Hoftman","orcid":"0000-0003-4546-8048","position":7,"is_corresponding":false},{"id":1050409,"name":"Adesewa E Adelekun","orcid":null,"position":8,"is_corresponding":false},{"id":1049909,"name":"Michael K. Leuchter","orcid":"0000-0002-9060-6721","position":9,"is_corresponding":false},{"id":1028653,"name":"Ralph J. Koek","orcid":null,"position":10,"is_corresponding":false},{"id":700216,"name":"Nathaniel D. Ginder","orcid":"0000-0003-1854-2337","position":11,"is_corresponding":false},{"id":516250,"name":"David E. Krantz","orcid":"0000-0002-4208-1633","position":12,"is_corresponding":false},{"id":1049911,"name":"Hewa Artin","orcid":"0000-0003-1564-4151","position":13,"is_corresponding":false},{"id":739955,"name":"Thomas B. Strouse","orcid":"0000-0003-3085-8035","position":14,"is_corresponding":false},{"id":525688,"name":"Ausaf Bari","orcid":"0000-0002-5279-5023","position":15,"is_corresponding":false},{"id":304896,"name":"Andrew F. Leuchter","orcid":"0000-0003-2402-7083","position":16,"is_corresponding":false},{"id":653933,"name":"Reza Tadayonnejad","orcid":"0000-0002-4665-6721","position":0,"is_corresponding":true}],"reference_count":11,"raw_metadata":null,"created_at":"2026-07-19T01:09:01.509601Z","pmid":"37716637","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}