Review examines combined rTMS and antidepressants for depression

The review considers how repetitive transcranial magnetic stimulation (rTMS) may interact with antidepressant pharmacotherapy in depression, including treatment-resistant depression. Drawing on previously published studies, it discusses proposed effects on cortical excitability, monoaminergic signaling, synaptic plasticity and distributed brain networks; it reports no new datasets or original analyses.

The authors describe clinical evidence suggesting that combined treatment may bring earlier improvement, increase response and remission, and reduce relapse risk. They also note that effects vary across patients and symptom domains. Neuroimaging studies have reported functional and structural changes, including changes in hippocampal volume, but the causal relationship between these findings and symptom improvement is unresolved.

The review frames the interaction as dependent on factors including medication class, stimulation protocol and timing, cortical excitability, and individual neurobiology—not as uniformly additive or synergistic. It identifies biomarker- and symptom-informed targeting and optimized sequencing as areas for further work. As a synthesis of prior studies, it does not establish that combination treatment is superior for all patients or provide a validated approach for selecting treatment.