The neurobiological synergy of transcranial magnetic stimulation and mindfulness-based interventions in treatment-resistant depression: a narrative review.
Sonora Yun, Martijn Figee
Frontiers in Psychiatry 2026 DOI: 10.3389/fpsyt.2026.1805825 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Topics | Default mode network Depression Meditation |
| Keywords | Mbi Central executive network Mindfulness based interventions Rtms Salience network |
| Key findings | Combining rTMS with mindfulness-based interventions may enhance therapeutic outcomes for treatment-resistant depression by leveraging shared network targets (DMN, CEN, SN) and state-dependent synergy. |
Abstract
Treatment-resistant depression (TRD) poses a significant challenge, with many patients failing to achieve remission with conventional therapies. While repetitive Transcranial Magnetic Stimulation (rTMS) is an established and effective neuromodulatory treatment for TRD, a notable proportion of patients do not fully respond. Despite the clinical utility of rTMS, response variability remains a significant barrier to treatment optimization. We propose that this variability may be driven, in part, by fluctuations in baseline network configuration and momentary brain states. This motivates the investigation of behavioral state manipulation as a means to prime neural circuits for enhanced receptivity to neuromodulation. This mini-review proposes that combining TMS with adjunctive, short-duration mental practices, specifically Mindfulness Based Interventions (MBI), may enhance therapeutic outcomes. Given that both TMS and mindfulness converge on modulating brain networks regulating emotions, attention and self-referential processes, it is plausible that their concurrent or sequential use could yield additive or even synergistic effects on network reorganization. We will explore the theoretical neurobiological mechanisms that may support a potential synergistic or additive effect and synthesize the limited but promising evidence from analogous therapeutic combinations to argue for the clinical viability of this novel approach. This review aims to: (1) Summarize the shared network targets (DMN, CEN, and SN) of rTMS and mindfulness; (2) Propose a state-dependent synergy model for their integration; and (3) Synthesize existing evidence to guide future clinical trial design.
Comparable studies
Other narrative reviews on depression, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Synaptic Dysfunction in Depression: Potential Therapeutic Targets | 2012 | Review | |
| Mindfulness-Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse | 2003 | Review | |
| Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation Adults with treatment-resistant depression | 2021 | Review | |
| Classic psychedelics: An integrative review of epidemiology, therapeutics, mystical experience, and brain network function. General population | 2019 | Integrative review | |
| Sudarshan Kriya Yogic Breathing in the Treatment of Stress, Anxiety, and Depression: Part II—Clinical Applications and Guidelines | 2005 | Review |
Citations in the library
Cites 12
- Meditation experience is associated with differences in default mode network activity and connectivity Proceedings of the National Academy of Sciences November 23, 2011
- Meditation leads to reduced default mode network activity beyond an active task Cognitive, Affective, & Behavioral Neuroscience April 22, 2015
- Increased default mode network connectivity associated with meditation Neuroscience Letters October 28, 2010
- Mindfulness meditation increases default mode, salience, and central executive network connectivity Scientific Reports August 2, 2022
- Meta-analytic evidence that mindfulness training alters resting state default mode network connectivity Scientific Reports July 18, 2022
and 7 more in the library