{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T22:05:53Z","timestamp":1790201153512,"version":"4.1.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,8,16]],"date-time":"2023-08-16T00:00:00Z","timestamp":1692144000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>The effects of repetitive transcranial magnetic stimulation (rTMS) on the left dorsolateral prefrontal cortex (DLPFC) in patients with major depressive disorder (MDD) have been proved to have antidepressant effects. However, the absence of biomarkers to assess treatment response remains a challenge. This research aims to explore the relationship between frontal lobe activity, measured using near infrared spectroscopy (NIRS), and changes in symptoms among MDD patients following rTMS treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 26 MDD patients underwent 20 sessions of 10\u2009 Hz rTMS targeting the left DLPFC. NIRS was used to measure frontal lobe activity during a verbal fluency test at baseline, after 10 rTMS sessions, and after 20 rTMS sessions. Responders were defined as individuals with more than a 50% reduction in symptoms based on the 21-item Hamilton Depression Rating Scale after 20 rTMS sessions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among the 14 responders, an increase in frontal lobe activity was significantly correlated with improvements in depressive symptoms following 10 (<jats:italic>p<\/jats:italic>\u2009= 0.0001) and 20 rTMS sessions (<jats:italic>p<\/jats:italic>\u2009=\u20090.007). Additionally, frontal lobe activity after 10 rTMS sessions was significantly associated with symptom improvement after 20 sessions (<jats:italic>p<\/jats:italic>\u2009=\u20090.001). These associations were not observed among non-responders.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The findings from this study indicate distinct patterns of frontal lobe activity between responders and non-responders to rTMS treatment, suggesting that NIRS has the potential to serve as a biomarker for monitoring treatment response in MDD patients undergoing rTMS.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpsyt.2023.1235713","type":"journal-article","created":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T10:34:06Z","timestamp":1692268446000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":15,"title":["Associations between frontal lobe activity and depressive symptoms in patients with major depressive disorder receiving rTMS treatment: a near-infrared spectroscopy study"],"prefix":"10.3389","volume":"14","author":[{"given":"Po-Han","family":"Chou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Chun","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shao-Cheng","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-Hao","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Lun","family":"Chung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Hung","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuan-Pin","family":"Su","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,8,16]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"190","DOI":"10.9758\/cpn.2021.19.2.190","article-title":"Personalization of repetitive transcranial magnetic stimulation for the treatment of major depressive disorder according to the existing psychiatric comorbidity","volume":"19","author":"Chou","year":"2021","journal-title":"Clin Psychopharmacol Neurosci"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1065","DOI":"10.1001\/jamapsychiatry.2022.2862","article-title":"Effectiveness of standard sequential bilateral repetitive transcranial magnetic stimulation vs bilateral theta burst stimulation in older adults with depression: the FOUR-D randomized noninferiority clinical trial","volume":"79","author":"Blumberger","year":"2022","journal-title":"JAMA Psychiat"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1176\/appi.ajp.2018.18091096","article-title":"Trajectories of response to dorsolateral prefrontal rTMS in major depression: a THREE-D study","volume":"176","author":"Kaster","year":"2019","journal-title":"Am J Psychiatry"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"488","DOI":"10.1097\/jcp.0b013e318151521c","article-title":"A functional magnetic resonance imaging study of the effects of low frequency right prefrontal transcranial magnetic stimulation in depression","volume":"27","author":"Fitzgerald","year":"2007","journal-title":"J Clin Psychopharmacol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1017\/S1092852900020411","article-title":"HF-rTMS treatment in medication-resistant melancholic depression: results from 18FDG-PET brain imaging","volume":"14","author":"Baeken","year":"2009","journal-title":"CNS Spectr"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ajp.2016.02.003","article-title":"Brain SPECT guided repetitive transcranial magnetic stimulation (rTMS) in treatment resistant major depressive disorder","volume":"21","author":"Jha","year":"2016","journal-title":"Asian J Psychiatr"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1189","DOI":"10.1016\/j.pnpbp.2010.06.009","article-title":"High-frequency rTMS treatment increases left prefrontal myo-inositol in young patients with treatment-resistant depression","volume":"34","author":"Zheng","year":"2010","journal-title":"Prog Neuro-Psychopharmacol Biol Psychiatry"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1016\/S0006-3223(02)01550-0","article-title":"Non-invasive neuroimaging using near-infrared light","volume":"52","author":"Strangman","year":"2002","journal-title":"Biol Psychiatry"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"201","DOI":"10.2174\/1381612825666191014164511","article-title":"The potential role of functional near-infrared spectroscopy as clinical biomarkers in schizophrenia","volume":"26","author":"Chou","year":"2020","journal-title":"Curr Pharm Des"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"180003","DOI":"10.1038\/sdata.2018.3","article-title":"Simultaneous acquisition of EEG and NIRS during cognitive tasks for an open access dataset","volume":"5","author":"Shin","year":"2018","journal-title":"Sci Data"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1320","DOI":"10.1016\/j.neunet.2009.05.009","article-title":"Hemodynamic brain-computer interfaces for communication and rehabilitation","volume":"22","author":"Sitaram","year":"2009","journal-title":"Neural Netw"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1377","DOI":"10.1109\/TBME.2009.2038667","article-title":"Motion artifact removal for functional near infrared spectroscopy: a comparison of methods","volume":"57","author":"Robertson","year":"2010","journal-title":"IEEE Trans Biomed Eng"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1016\/j.neuroimage.2013.06.043","article-title":"A NIRS-fMRI investigation of prefrontal cortex activity during a working memory task","volume":"83","author":"Sato","year":"2013","journal-title":"Neuroimage"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"378","DOI":"10.3389\/fpsyt.2020.00378","article-title":"Diagnostic and predictive applications of functional near-infrared spectroscopy for major depressive disorder: a systematic review","volume":"11","author":"Ho","year":"2020","journal-title":"Front Psych"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1136\/jnnp.23.1.56","article-title":"A rating scale for depression","volume":"23","author":"Hamilton","year":"1960","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1016\/j.brs.2017.10.010","article-title":"Early symptom improvement at 10 sessions as a predictor of rTMS treatment outcome in major depression","volume":"11","author":"Feffer","year":"2018","journal-title":"Brain Stimul"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1683","DOI":"10.1016\/S0140-6736(18)30295-2","article-title":"Effectiveness of theta burst versus high-frequency repetitive transcranial magnetic stimulation in patients with depression (THREE-D): a randomised non-inferiority trial","volume":"391","author":"Blumberger","year":"2018","journal-title":"Lancet"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1111\/pcn.13524","article-title":"Bilateral theta-burst stimulation on emotional processing in major depressive disorder: a functional neuroimaging study from a randomized, double-blind, sham-controlled trial","volume":"77","author":"Chou","year":"2023","journal-title":"Psychiatry Clin Neurosci"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1016\/j.brs.2008.09.006","article-title":"An efficient and accurate new method for locating the F3 position for prefrontal TMS applications","volume":"2","author":"Beam","year":"2009","journal-title":"Brain Stimul"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"952","DOI":"10.4088\/JCP.08m04728","article-title":"The Maudsley staging method for treatment-resistant depression: prediction of longer-term outcome and persistence of symptoms","volume":"70","author":"Fekadu","year":"2009","journal-title":"J Clin Psychiatry"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/j.jad.2015.04.010","article-title":"Suicidal ideation is associated with reduced prefrontal activation during a verbal fluency task in patients with major depressive disorder","volume":"181","author":"Pu","year":"2015","journal-title":"J Affect Disord"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"39089","DOI":"10.1038\/srep39089","article-title":"Perceived occupational stress is associated with decreased cortical activity of the prefrontal cortex: a multichannel near-infrared spectroscopy study","volume":"6","author":"Chou","year":"2016","journal-title":"Sci Rep"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"2661","DOI":"10.1017\/S0033291720004742","article-title":"Shared functional impairment in the prefrontal cortex affects symptom severity across psychiatric disorders","volume":"52","author":"Koike","year":"2022","journal-title":"Psychol Med"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"e0193994","DOI":"10.1371\/journal.pone.0193994","article-title":"Repetition of verbal fluency task attenuates the hemodynamic activation in the left prefrontal cortex: enhancing the clinical usefulness of near-infrared spectroscopy","volume":"13","author":"Kawakubo","year":"2018","journal-title":"PLoS One"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1264","DOI":"10.1126\/science.929199","article-title":"Noninvasive, infrared monitoring of cerebral and myocardial oxygen sufficiency and circulatory parameters","volume":"198","author":"Jobsis","year":"1977","journal-title":"Science"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"498","DOI":"10.1016\/j.neuroimage.2013.05.126","article-title":"Neuroimaging-aided differential diagnosis of the depressive state","volume":"85","author":"Takizawa","year":"2014","journal-title":"Neuroimage"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1506","DOI":"10.1016\/j.neuroimage.2006.10.043","article-title":"Virtual spatial registration of stand-alone fNIRS data to MNI space","volume":"34","author":"Tsuzuki","year":"2007","journal-title":"Neuroimage"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1064","DOI":"10.1016\/j.neuroimage.2007.09.031","article-title":"Construction of a 3D probabilistic atlas of human cortical structures","volume":"39","author":"Shattuck","year":"2008","journal-title":"Neuroimage"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"655292","DOI":"10.3389\/fpsyt.2021.655292","article-title":"Deep neural network to differentiate brain activity between patients with first-episode schizophrenia and healthy individuals: a Multi-Channel near infrared spectroscopy study","volume":"12","author":"Chou","year":"2021","journal-title":"Front Psych"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1226","DOI":"10.1016\/j.neuroimage.2006.04.200","article-title":"Detection of cerebral blood flow changes during repetitive transcranial magnetic stimulation by recording hemoglobin in the brain cortex, just beneath the stimulation coil, with near-infrared spectroscopy","volume":"32","author":"Hada","year":"2006","journal-title":"Neuroimage"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"814611","DOI":"10.3389\/fpsyt.2022.814611","article-title":"rTMS therapy reduces Hypofrontality in patients with depression as measured by fNIRS","volume":"13","author":"Kawabata","year":"2022","journal-title":"Front Psych"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"876136","DOI":"10.3389\/fpsyt.2022.947987","article-title":"Increased prefrontal activation during verbal fluency task after repetitive transcranial magnetic stimulation treatment in depression: a functional near-infrared spectroscopy study","volume":"13","author":"Huang","year":"2022","journal-title":"Front Psych"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"922","DOI":"10.1016\/j.brs.2013.04.006","article-title":"A near infra-red study of blood oxygenation changes resulting from high and low frequency repetitive transcranial magnetic stimulation","volume":"6","author":"Cao","year":"2013","journal-title":"Brain Stimul"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2023.1235713\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T10:34:08Z","timestamp":1692268448000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2023.1235713\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,16]]},"references-count":33,"alternative-id":["10.3389\/fpsyt.2023.1235713"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2023.1235713","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,16]]},"article-number":"1235713"}}