Brain with glowing neural networks being stimulated by magnetic waves.

Can rTMS Help with Treatment-Resistant Depression After Traumatic Brain Injury?

Rhea Morgan in Health & Wellness November 2025 • 4 min read.

"A new study explores using repetitive transcranial magnetic stimulation (rTMS) to target depression in TBI patients, offering hope for those who haven't found relief through traditional treatments."

Depression following a traumatic brain injury (TBI) can be particularly stubborn, often resisting standard treatments like medication and therapy. This leaves many individuals feeling lost and without options. However, new research is exploring alternative approaches, offering a glimmer of hope for those with treatment-resistant depression after TBI.

Repetitive transcranial magnetic stimulation (rTMS) is emerging as a promising tool in neuropsychiatry. It's a non-invasive technique that uses magnetic pulses to stimulate specific areas of the brain, aiming to improve neural activity and alleviate depressive symptoms. While rTMS has shown success in treating major depressive disorder, its effectiveness in TBI-related depression is still under investigation.

A recent pilot study published in the Journal of Neurotrauma delves into the potential of rTMS for individuals with treatment-resistant depression following a TBI. The study explores a unique approach: using individualized brain mapping to precisely target rTMS stimulation. Let's break down the study's findings and what they could mean for the future of TBI and depression treatment.

The Study: Targeting Brain Networks with rTMS

Brain with glowing neural networks being stimulated by magnetic waves.

The pilot study, though small, employed a randomized, controlled, double-blinded design – the gold standard for research. Fifteen participants with treatment-resistant depression and a history of TBI were enrolled. These individuals had previously tried multiple antidepressant medications without success.

Participants were divided into two groups: one receiving active rTMS treatment and the other receiving a sham (placebo) treatment. The rTMS treatment involved stimulating the left side of the brain with excitatory pulses and the right side with inhibitory pulses. What made this study unique was the method of targeting the stimulation.

Individualized Brain Mapping: Researchers used functional MRI (fMRI) to map each participant's brain activity. This identified the dorsal attention network (DAN) and the default mode network (DMN).
Targeting the Difference: The rTMS target was the dorsolateral prefrontal cortex (DLPFC), specifically the area showing the biggest difference in activity between the DAN and DMN. This individualized approach aimed to fine-tune the treatment for each participant's unique brain activity.

After 20 sessions, the researchers assessed the participants' depression symptoms using the Montgomery-Åsberg Depression Rating Scale (MADRS). They also analyzed changes in brain connectivity using fMRI data.

A Promising Start, But More Research Needed

This pilot study offers encouraging initial evidence that rTMS, when targeted with individualized brain mapping, may be a feasible and effective treatment for treatment-resistant depression after TBI. The study's findings highlight the importance of personalized approaches in mental health treatment.

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This article is based on research published under:

DOI-LINK: 10.1089/neu.2018.5889, Alternate LINK

Title: Repetitive Transcranial Magnetic Stimulation With Resting-State Network Targeting For Treatment-Resistant Depression In Traumatic Brain Injury: A Randomized, Controlled, Double-Blinded Pilot Study

Subject: Neurology (clinical)

Journal: Journal of Neurotrauma

Publisher: Mary Ann Liebert Inc

Authors: Shan H. Siddiqi, Nicholas T. Trapp, Carl D. Hacker, Timothy O. Laumann, Sridhar Kandala, Xin Hong, Ludwig Trillo, Pashtun Shahim, Eric C. Leuthardt, Alexandre R. Carter, David L. Brody

Published: 2019-04-15

Everything You Need To Know

What is rTMS, and how does it work for treatment-resistant depression following a Traumatic Brain Injury (TBI)?

Repetitive transcranial magnetic stimulation, or rTMS, is a non-invasive technique that utilizes magnetic pulses to stimulate specific brain regions. In the context of treatment-resistant depression following Traumatic Brain Injury (TBI), rTMS aims to improve neural activity and alleviate depressive symptoms by targeting areas identified through individualized brain mapping. While rTMS has demonstrated success in treating major depressive disorder, its application to TBI-related depression is still under investigation to determine its effectiveness and optimal protocols.

How was the pilot study structured to investigate the effects of rTMS on individuals with treatment-resistant depression and a history of Traumatic Brain Injury (TBI)?

The pilot study published in the Journal of Neurotrauma involved fifteen participants with treatment-resistant depression and a history of TBI. These participants had previously tried multiple antidepressant medications without success. They were divided into two groups: one receiving active rTMS treatment and the other receiving a sham (placebo) treatment. The active group received rTMS stimulation targeting the dorsolateral prefrontal cortex (DLPFC), specifically the area showing the biggest difference in activity between the dorsal attention network (DAN) and default mode network (DMN), as identified through functional MRI (fMRI).

What are the dorsal attention network (DAN) and default mode network (DMN), and how were they used in the rTMS study targeting depression after Traumatic Brain Injury (TBI)?

The dorsal attention network (DAN) and the default mode network (DMN) are two distinct brain networks. The DAN is involved in externally directed attention and cognitive control, while the DMN is active during internally directed thought and mind-wandering. Functional MRI (fMRI) was used to map each participant's brain activity to identify these networks. By targeting the dorsolateral prefrontal cortex (DLPFC) area showing the biggest difference in activity between the DAN and DMN, the researchers aimed to fine-tune the rTMS treatment for each participant's unique brain activity, potentially optimizing its effectiveness in alleviating treatment-resistant depression after TBI.

What is the Montgomery-Åsberg Depression Rating Scale (MADRS), and how was it used to evaluate the effectiveness of rTMS treatment in the study?

The Montgomery-Åsberg Depression Rating Scale, or MADRS, is a tool used to assess the severity of depression symptoms. In the pilot study, researchers used the MADRS to evaluate participants' depression symptoms after 20 sessions of rTMS treatment. Additionally, changes in brain connectivity were analyzed using functional MRI (fMRI) data to determine if the rTMS intervention had an impact on neural activity and network function, alongside the subjective improvement measured by MADRS.

What are the implications of the pilot study's findings regarding rTMS and treatment-resistant depression after Traumatic Brain Injury (TBI), and what future research is needed?

While the pilot study offers encouraging initial evidence that rTMS, when targeted with individualized brain mapping, may be a feasible and effective treatment for treatment-resistant depression after TBI, it is essential to interpret the findings cautiously due to the small sample size (15 participants). Larger, more comprehensive studies are needed to confirm these results, optimize rTMS protocols, and identify which TBI patients are most likely to benefit from this approach. Future research should also investigate the long-term effects of rTMS and compare its effectiveness to other emerging treatments for TBI-related depression.