Introduction
’s polysymptomatic, anxiety, depressive disorder, MDD, depression, Depression
SECONDARY, CORTEX
Depression is among the leading causes of disability, negatively influences quality of life, and is the main determinant of suicide (Transcranial magnetic stimulation (TMS) is a safe and well-tolerated intervention that has been extensively studied as a treatment for major depressive disorder (MDD), with over 150 randomized controlled trials (RCTs) and confirmed efficacy in many meta-analyses (The LPFC is only 1 target identified in a common brain circuit of effective neurostimulation for depression (Recently, the medial prefrontal cortex (MPFC) along with the anterior cingulate cortex (ACC) were posited as promising alternative targets for Deep TMS treatment of MDD, due to their involvement in reward, emotions, mood, and habits (The purpose of the current multicenter RCT was to explore whether the efficacy of the H7 coil is noninferior to that of the FDA-cleared H1 coil in patients with MDD, with the eventual goal of providing clinicians multiple options for patient treatment. A successful show of noninferiority would mean clinicians could prescribe to any given patient either treatment with the same expected efficacy. In an attempt to guide clinicians to make informed choices regarding choice of treatment based on the literature and secondary analysis of this study’s results, a secondary purpose of this study was a preliminary exploration of whether an a priori clinical or electrophysiological differential predictor for TMS H-coils (C-DEPTH or E-DEPTH) for patient selection can be identified.It is currently unknown which patients with MDD are expected to benefit from any specific TMS protocol, and in particular, which will benefit from lateral and which from MPFC stimulation (Optimally, C-DEPTH would be based on symptom clusters at baseline and would provide clinicians a straightforward method for differentiating between patients who are likely to respond to one stimulation target over the other. Here, exploration for such a clinical marker was informed by recent evidence of the H1 coil’s polysymptomatic effect on depression and anxiety symptoms (