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. 2022 May 10;13:867091. doi: 10.3389/fpsyt.2022.867091

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Copyright © 2022 Caulfield and Brown.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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Key rTMS Parameters Guiding the Development of Next Generation rTMS Therapies. (A) Dose-Response Curve Model. Some parameters follow an inverted U-shaped curve, with peak efficacy in the middle. (B) Pulse Pattern. Intermittent theta burst stimulation (iTBS) has been FDA-cleared as a clinically non-inferior, but more efficient, form of rTMS compared to conventional 10 Hz stimulation. (C) Train Duration. Trains of 1.5 s at 10 Hz have produced the canonical excitatory effect while 5 s trains at 10 Hz produced an opposite inhibited effect. (D) Intertrain Interval (ITI). Decreased ITI has drastically reduced intracortical inhibition without changing corticospinal excitability or clinical depression outcomes. (E) Pulse Number-10 Hz. 6,800 pulses of 10 Hz rTMS did not improve clinical outcomes compared with conventional 3,000 pulse 10 Hz rTMS. (F) Pulse Number- iTBS. Doubling pulse number (1,200) produced inhibitory effects, opposing the excitation from the FDA-cleared 600 pulse protocol. (G) Sessions Per Day. Relative to conventional rTMS (top) “Accelerated rTMS” (applying more than one session per day, bottom), may produce a more rapid and effective clinical response. (H) Pulse Width. Longer pulse widths may produce more efficient cortical activation. (I) Pulse Shape. Full-sine (biphasic) waveforms appear to produce stronger stimulation than single or summated half-sine (monophasic) pulses. (J) Frequency. Despite extensive clinical investigation, various stimulation frequencies (including 20, 18, 10, and 5 Hz to the left DLPFC and 1 Hz to the right DLPFC) have not revealed a superior frequency at the group level.