{"doi":"10.1016/j.brs.2023.10.005","title":"1Hz right orbitofrontal TMS benefits depressed patients unresponsive to dorsolateral prefrontal cortex TMS","abstract":"Major depressive disorder (MDD) remains a significant global health challenge. Patients failing to achieve remission despite multiple conventional therapeutic interventions (i.e., difficult-to-treat or treatment-resistant depression, TRD) constitute nearly 30 % of MDD cases [[1]Rush A.J. Trivedi M.H. Wisniewski S.R. Nierenberg A.A. Stewart J.W. Warden D. et al.Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report.Am J Psychiatr. 2006; 163: 1905-1917https://doi.org/10.1176/ajp.2006.163.11.1905Crossref PubMed Scopus (3807) Google Scholar]. Repetitive transcranial magnetic stimulation (TMS) has gained traction as a promising non-invasive approach in TRD, conventionally targeting the dorsolateral prefrontal cortex (DLPFC) [[2]Janicak P.G. Dokucu M.E. Transcranial magnetic stimulation for the treatment of major depression.Neuropsychiatric Dis Treat. 2015; 11: 1549-1560https://doi.org/10.2147/ndt.s67477Crossref PubMed Scopus (0) Google Scholar]. While high-frequency TMS applied to the left DLPFC has demonstrated remission rates ranging from 19 % to 37 % [[3]Berlim M.T. Eynde F van den Tovar-Perdomo S. Daskalakis Z.J. Response, remission and drop-out rates following high-frequency repetitive transcranial magnetic stimulation (rTMS) for treating major depression: a systematic review and meta-analysis of randomized, double-blind and sham-controlled trials.Psychol Med. 2014; 44: 225-239https://doi.org/10.1017/s0033291713000512Crossref PubMed Scopus (0) Google Scholar,[4]Carpenter L.L. Janicak P.G. Aaronson S.T. Boyadjis T. Brock D.G. Cook I.A. et al.Transcranial magnetic stimulation (TMS) for depression: a multisite, naturalistic, observational study of acute treatment outcomes in clinical practice.Depress Anxiety. 2012; 29: 587-596https://doi.org/10.1002/da.21969Crossref PubMed Scopus (236) Google Scholar] but augmented 1Hz-R-DLPFC results in no extra beneficial effect [[5]Sackeim H.A. Aaronson S.T. Carpenter L.L. Hutton T.M. Mina M. Pages K. Verdoliva S. West W.S. Clinical outcomes in a large registry of patients with major depressive disorder treated with Transcranial Magnetic Stimulation.J Affect Disord. 2020; 277: 65-74https://doi.org/10.1016/j.jad.2020.08.005Crossref PubMed Scopus (50) Google Scholar], many patients remain non-responders, and alternative stimulation sites and protocols may be required. An emerging candidate target is the orbital-frontal cortex (OFC), a region pivotal in processing reward/’non-reward’ and implicated in MDD pathophysiology [[6]Rolls E.T. Cheng W. Feng J. The orbitofrontal cortex: reward, emotion and depression.Brain Commun. 2020; 2: fcaa196https://doi.org/10.1093/braincomms/fcaa196Crossref PubMed Scopus (124) Google Scholar]. Neuroimaging and deep brain stimulation studies have suggested that the right-lateral-OFC (R–OFC) may be a fruitful target for neuromodulation [[7]Cheng W. Rolls E.T. Qiu J. Liu W. Tang Y. Huang C.-C. et al.Medial reward and lateral non-reward orbitofrontal cortex circuits change in opposite directions in depression.Brain. 2016; 139: 3296-3309https://doi.org/10.1093/brain/aww255Crossref PubMed Scopus (191) Google Scholar,[8]Rao V. Sellers K. Wallace D.L. L Morgan B. Maryam B. Sani O.G. et al.Direct electrical stimulation of lateral orbitofrontal cortex acutely improves mood in individuals with symptoms of depression.Curr Biol. 2018; 28: 3893-3902https://doi.org/10.1016/j.cub.2018.10.026Abstract Full Text Full Text PDF PubMed Scopus (85) Google Scholar]. Encouragingly, a case study reported improved mood and anhedonia in an MDD patient through 1Hz-TMS over the R–OFC, following non-response to DLPFC and dorsomedial PFC (DMPFC)-TMS (DMPFC) [[9]Fettes P. Peters S. Giacobbe P. Blumberger D.M. Downar J. Neural correlates of successful orbitofrontal 1 Hz rTMS following unsuccessful dorsolateral and dorsomedial prefrontal rTMS in major depression: a case report.Brain Stimul. 2017; 10: 165-167https://doi.org/10.1016/j.brs.2016.","journal":"Brain stimulation","year":2023,"id":341747,"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":15,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9581,"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":1077766,"name":"Ylka Kolken","orcid":"0000-0002-3407-5428","position":1,"is_corresponding":false},{"id":1078283,"name":"Christina Clark Tuttle","orcid":null,"position":2,"is_corresponding":false},{"id":1078284,"name":"Joris van Neijenhof","orcid":null,"position":3,"is_corresponding":false},{"id":1078285,"name":"Richard Pitch","orcid":null,"position":4,"is_corresponding":false},{"id":1036713,"name":"Iris van Oostrom","orcid":null,"position":5,"is_corresponding":false},{"id":1078286,"name":"Vera Kruiver","orcid":null,"position":6,"is_corresponding":false},{"id":230804,"name":"Jonathan Downar","orcid":"0000-0002-5140-174X","position":7,"is_corresponding":false},{"id":602063,"name":"Alexander T. Sack","orcid":"0000-0002-1471-0885","position":8,"is_corresponding":false},{"id":241402,"name":"Martijn Arns","orcid":"0000-0002-0610-7613","position":9,"is_corresponding":false},{"id":1036302,"name":"Nikita van der Vinne","orcid":"0009-0000-9459-2729","position":10,"is_corresponding":false},{"id":1036301,"name":"Amourie Prentice","orcid":"0000-0002-7050-7216","position":0,"is_corresponding":true}],"reference_count":12,"raw_metadata":null,"created_at":"2026-07-19T01:11:08.077724Z","pmid":"37839775","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":[]}