OptiTMS: Personalising brain stimulation for depression
Depression affects millions of people worldwide, yet many patients still do not respond to available treatments.
Repetitive transcranial magnetic stimulation (rTMS) is an important non-medication treatment option, but its effectiveness varies widely from person to person. This may be due to where exactly the brain is being targeted during treatment.
Researchers at the Department of Psychiatry are working to change that.
Optimised Transcranial Magnetic Stimulation (OptiTMS) trial for the treatment of depression is led by A/Prof Robin Cash. This is a multi-site double-blinded two-arm parallel-group superiority randomised controlled trial involving researchers who are internationally recognised for their expertise in this area. The trial investigates whether personalised brain targeting can improve outcomes for people with major depressive disorder. Funded by the National Health and Medical Research Council, the trial is sponsored by the University of Melbourne, with sites at the Royal Melbourne Hospital, St Vincent’s Hospital Melbourne, Black Dog Institute and Queensland Neurostimulation Centre.
Why personalise rTMS?
Traditional rTMS stimulates a standard location in the brain’s dorsolateral prefrontal cortex (DLPFC). While many patients benefit, others experience little improvement.
The OptiTMS study is based on a simple but powerful idea that no two brains are wired exactly the same. The research team uses a brain MRI scan to map each individual’s brain, enabling precise targeting of circuitry related to depression. This more advanced method has only become possible in recent years following advances in computational methodology in which the Melbourne team are world leaders. It improves on conventional methods which more crudely target the DLPFC based on external scalp-based measurements and a one-size-fits-all approach. The goal is to stimulate the circuit most linked to mood regulation in each individual, thus increasing the likelihood of clinical response.
Initial studies provide promising preliminary support for the clinical efficacy of this approach, which will now be compared with conventional targeting in a multisite clinical trial.
How the study works:
Participants undergo:
- Brain imaging to map functional connectivity
- Personalised TMS targeting based on their brain networks
- 4 week course of once-per-day TMS (Monday-Friday)
- Clinical follow-up at 6 months
The trial compares personalised targeting to standard approaches to determine whether tailoring stimulation improves symptom relief.
Looking ahead:
By bringing personalised neuroscience into clinical psychiatry, the team hopes to move depression treatment toward a future where therapies are targeted, efficient, and tailored to each individual.
For more information on the trial and how to get involved, please visit the OptiTMS webpage or contact the team via tms-clinical-trial@unimelb.edu.au. Thank you.