Transcranial magnetic stimulation (TMS) is an established treatment for depression, yet response rates remain at 50% 1 month after treatment. Despite two decades of clinical use, substantial room for improvement remains. This overview examines biomarker-guided personalization of brain stimulation. The authors trace the translational path from invasive circuit-level insights through noninvasive biomarkers to clinical deployment. With validated biomarkers, systematic optimization becomes possible: stimulation parameter tuning, state-dependent approaches, augmentation strategies, and closed-loop systems. The path forward requires randomized trials demonstrating that biomarker-guided personalization improves outcomes beyond standard care, justifying increased complexity and costs. Success would mark an important pathway in interventional psychiatry's evolution to precision medicine.
Cline et al. (Sun,) studied this question.