Low-Frequency Right Repetitive Transcranial Magnetic Stimulation for the Treatment of Depression After Traumatic Brain Injury: A Randomized Sham-Controlled Pilot Study
Open accessAbstract
OBJECTIVE: Major depression is the most common psychiatric sequela of traumatic brain injury (TBI), but effective treatment continues to be a challenge, with few studies providing guidance. METHODS: In a pilot study, the authors evaluated the effect size of low-frequency right-sided (LFR) repetitive transcranial magnetic stimulation (rTMS), compared with sham treatment, over the right dorsolateral prefrontal cortex (DLPFC) in patients (N=30) with TBI depression and co-occurring neuropsychiatric symptoms, including suicidal thoughts, anxiety, posttraumatic stress disorder, sleep disturbance, behavioral problems, and cognitive dysfunction. Exploratory analyses of diffusion tensor imaging pre- and postintervention were performed to determine the effect size of LFR rTMS on white matter integrity. RESULTS: Small (Hedge's g=0.19) and highly variable effects of LRF rTMS over right DLPFC in TBI depression were observed. Similarly, the effect of LFR rTMS for treatment of comorbid neuropsychiatric symptoms varied from small to moderate. CONCLUSIONS: These findings suggest that the observed effects of LFR rTMS over the right DLPFC in TBI depression and co-occurring neuropsychiatric symptoms are small, at best, and, preliminarily, that low-frequency right DLPFC stimulation has limited potential in this patient population. However, studies employing different rTMS parameters (e.g., type, location, frequency, duration) or other participant characteristics (e.g., TBI severity, chronicity, comorbidity, concurrent treatment) may potentially yield different responses.
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Studies on TMS for suicidality are often limited by small sample sizes, inconsistencies in how suicidality is measured across studies, and contradictory findings.
“Studies are often limited by small sample sizes, inconsistencies in how suicidality is measured across studies, and contradictory findings [75,76].”
From Frontal Pole Neuromodulation for Impulsivity and Suicidality in Veterans With Mild Traumatic Brain Injury and Common Co-Occurring Mental Health Conditions: Protocol for a Pilot Randomized Controlled Trial (2024) · cites this paper as [75]
The Discussion (page not provided) identifies the small sample size as this study’s main limitation, and the Secondary Outcomes section reports a suicide-symptom result measured with the BSSI. The paper does not establish that TMS studies of suicidality often use inconsistent measures or have contradictory findings across studies; its small-sample limitation concerns this particular trial. (LLM, conf=0.85)
Experimental — accuracy not yet measuredDrawing overall conclusions from the existing literature on TMS for suicidality remains challenging because of the heterogeneity of the data.
“However, drawing overall conclusions from the existing literature on TMS for suicidality remains challenging because of the heterogeneity of the data.”
From Frontal Pole Neuromodulation for Impulsivity and Suicidality in Veterans With Mild Traumatic Brain Injury and Common Co-Occurring Mental Health Conditions: Protocol for a Pilot Randomized Controlled Trial (2024) · cites this paper as [75]
The Abstract discusses limited studies of rTMS for depression after traumatic brain injury, and Secondary Outcomes reports variable effects across symptoms in this pilot trial. Neither passage assesses whether heterogeneity in the literature on TMS for suicidality makes overall conclusions difficult; searches for that topic found no such passage in our copy. (LLM, conf=0.75)
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- Authors
- Rao, V., Bechtold, K., McCann, U., Roy, D., Peters, M., Vaishnavi, S., Yousem, D., Mori, S., Yan, H., Leoutsakos, J., Tibbs, M., & Reti, I.
- Affiliations
- Johns Hopkins University (US)
- ORCID
- Venue
- The Journal of Neuropsychiatry and Clinical Neurosciences
- Published
- 2019-10
- Volume
- 31
- Issue
- 4
- Pages
- 306-318
- ISSN
- 0895-0172 (ISSN-L)
- 1545-7222
- OpenAlex
- W2940610098
- Cited by
- 60
- References
- 51
- Citations by year
- 2026: 8 · 2025: 5 · 2024: 11 · 2023: 8 · 2022: 9 · 2021: 9 · 2020: 9 · 2019: 1
- FWCI
- 3.09
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Neuropsychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Keywords
- repetitive transcranial magnetic stimulation, low-frequency rTMS, traumatic brain injury, post-traumatic depression, dorsolateral prefrontal cortex, neuropsychiatric symptoms, suicidal ideation, post-traumatic stress disorder, sleep disorders, white matter integrity, diffusion tensor imaging, treatment effect size
- MeSH terms
- Brain Injuries, Traumatic, Adult, Depression, Female, Humans, Male, Brief Psychiatric Rating Scale, Pilot Projects, Comorbidity, Prefrontal Cortex, Transcranial Magnetic Stimulation
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