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Transcranial magnetic stimulation modulates transcriptomic and connectomic changes in treatment-resistant depressionMagnetic brain stimulation may change how cells respond to depression

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Key Takeaway
Note that TMS may modulate transcriptomic and connectomic changes in treatment-resistant depression.

This narrative review synthesizes the biological mechanisms underlying transcranial magnetic stimulation (TMS) for patients with treatment-resistant depression (TRD). The review focuses on how TMS influences various molecular and structural layers, including transcriptomic, epigenomic, proteomic, and metabolomic profiles, alongside connectomic changes.

Key findings indicate that TMS modulates cell type- and region-specific transcriptional programs related to neuronal development and synaptic plasticity. Additionally, the review highlights potential roles for DNA methylation and lactylation-related regulation in epigenetic changes. Proteomic and metabolomic analyses suggest changes in neurotransmitter systems, synaptic proteins, and lipid metabolism. Furthermore, TMS can alter functional and structural connectivity in prefrontal and large-scale brain networks associated with treatment response.

A primary limitation noted by the authors is that direct causal links between these molecular changes and circuit remodeling are not yet proven. Despite this, the findings suggest that identifying these biomarkers could clarify mechanisms to improve individualized TMS treatment. Clinical application of these findings is currently limited by the need for more evidence linking specific molecular changes to clinical outcomes.

How this fits prior evidence

This review addresses a gap in understanding the underlying mechanisms of TMS for treatment-resistant depression. It builds upon prior evidence regarding the neurofunctional mechanisms of MDD, such as the distinct ReHo patterns in MDD, BD, and Schizophrenia, and the shared genetic architecture between MDD and nightmare disorders. While previous evidence identified structural and functional deficits in MDD, this review explores the molecular and transcriptomic changes that may underlie those findings.

Living with treatment-resistant depression can feel like a constant uphill battle. For many, standard medications and therapies do not provide the relief they need. Researchers are looking closely at transcranial magnetic stimulation (TMS), a method that uses magnetic pulses to stimulate specific areas of the brain to improve mood.

This review looked at how these magnetic pulses affect the brain at a very deep level. The findings suggest that TMS can change how cells behave and grow, specifically in areas related to how the brain forms connections. It also appears to influence proteins, metabolism, and the way different parts of the brain communicate with each other. These changes happen in the prefrontal cortex and other large networks involved in how we process emotions.

While these findings are promising for creating more personalized treatments, there is a catch. Scientists have not yet proven a direct link between these tiny molecular changes and the actual rewiring of brain circuits. Because the evidence is still developing, these results are a step toward understanding how the brain heals, rather than a confirmed roadmap for every patient.

What this means for you:
Magnetic stimulation may change brain cell behavior and connections in people with treatment-resistant depression.

Common questions

What is transcranial magnetic stimulation (TMS)?

TMS is a treatment that uses magnetic pulses to stimulate specific parts of the brain. This review suggests that these pulses can change how cells behave, how proteins function, and how different brain networks connect. These changes are specifically studied in people with treatment-resistant depression to see if they help improve mood and brain function.

How does TMS affect the brain's structure?

The study indicates that TMS can alter both functional and structural connectivity. This means it may change how the prefrontal cortex and other large-scale brain networks communicate. These changes involve synaptic proteins and neurotransmitter systems, which are key to how the brain processes information and manages symptoms of depression.

Is it proven that these brain changes cure depression?

Not yet. While the research shows that TMS can change cell behavior and brain connections, scientists have not proven a direct causal link between these tiny molecular changes and the actual remodeling of brain circuits. The findings are currently used to help researchers understand the mechanisms of the treatment.

Study Details

Study typeSystematic review
EvidenceLevel 1
PublishedOct 2026
View Original Abstract ↓
Treatment-resistant depression (TRD) is a refractory form of major depressive disorder (MDD) for which conventional antidepressant strategies are often insufficient. Transcranial magnetic stimulation (TMS) has demonstrated clinical efficacy in TRD, but its biological mechanisms remain incompletely understood. This narrative review synthesizes current evidence across transcriptomic, epigenomic, proteomic, metabolomic, and connectomic levels and is complemented by exploratory secondary analyses of publicly available omics datasets. Transcriptomic and spatial transcriptomic studies suggest that TMS modulates cell type- and region-specific transcriptional programs related to synaptic plasticity and neuronal development. Epigenetic evidence suggests potential roles for DNA methylation and lactylation-related regulation, whereas proteomic and metabolomic studies indicate changes in synaptic proteins, neurotransmitter systems, lipid metabolism, and peripheral metabolites. Connectomic studies further show that TMS can alter functional and structural connectivity involving prefrontal and large-scale brain networks associated with treatment response. Together, current evidence indicates biological changes across multiple levels, although direct causal links between molecular changes and circuit remodeling remain largely unproven. Future longitudinal multi-omics studies in patients with TRD may help identify biomarkers, clarify mechanisms, and improve individualized TMS treatment.
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