Review
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Oct 19, 2020; 10(10): 223-233
Published online Oct 19, 2020. doi: 10.5498/wjp.v10.i10.223
Mechanisms of repetitive transcranial magnetic stimulation for anti-depression: Evidence from preclinical studies
Di Luan, Ming-Ge Zhao, Ya-Chen Shi, Ling Li, Yu-Jia Cao, Hai-Xia Feng, Zhi-Jun Zhang
Di Luan, Ya-Chen Shi, Ling Li, Yu-Jia Cao, Zhi-Jun Zhang, Department of Neurology, Affiliated Zhongda Hospital, Research Institution of Neuropsychiatry, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
Ming-Ge Zhao, Hai-Xia Feng, Department of Nursing, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
Zhi-Jun Zhang, Department of Psychology, Xinxiang Medical University, Xinxiang 453003, Henan Province, China
Zhi-Jun Zhang, Mental Health Center, Zhejiang University School of Medicine, Hangzhou 310013, Zhejiang province, China
Author contributions: Luan D and Zhang ZJ developed the framework of the paper; Luan D wrote the first draft; all authors worked in subsequent drafts, confirmed the last version before submission, and approved the final manuscript.
Supported by the National Key R and D Program of China, No. 2016YFC1306700; The Key Projects of National Natural Science Foundation of China, No. 81830040; Science and Technology Program of Guangdong, China, No. 2018B030334001; and Program of Excellent Talents in Medical Science of Jiangsu Province, China, No. JCRCA2016006.
Conflict-of-interest statement: The authors deny any conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Zhi-Jun Zhang, MD, PhD, Doctor, Full Professor, Department of Neurology, Affiliated Zhongda Hospital, Research Institution of Neuropsychiatry, School of Medicine, Southeast University, No. 87 Dingjiaqiao, Nanjing 210009, Jiangsu Province, China. janemengzhang@vip.163.com
Received: June 16, 2020
Peer-review started: June 16, 2020
First decision: July 30, 2020
Revised: August 11, 2020
Accepted: September 2, 2020
Article in press: September 2, 2020
Published online: October 19, 2020
Abstract

This review summarizes the anti-depressant mechanisms of repetitive transcranial magnetic stimulation in preclinical studies, including anti-inflammatory effects mediated by activation of nuclear factor-E2-related factor 2 signaling pathway, anti-oxidative stress effects, enhancement of synaptic plasticity and neurogenesis via activation of the endocannabinoid system and brain derived neurotrophic factor signaling pathway, increasing the content of monoamine neurotransmitters via inhibition of Sirtuin 1/monoamine oxidase A signaling pathway, and reducing the activity of the hypothalamic-pituitary-adrenocortical axis. We also discuss the shortcomings of transcranial magnetic stimulation in preclinical studies such as inaccurate positioning, shallow depth of stimulation, and difficulty in elucidating the neural circuit mechanism up- and down-stream of the stimulation target brain region.

Keywords: Repetitive transcranial magnetic stimulation, Anti-depressant mechanisms, Nuclear factor-e2-related factor 2, Endocannabinoid system, Monoamine oxidase, Hypothalamic-pituitary-adrenocortical axis, Brain derived neurotrophic factor

Core Tip: Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for major depressive disorder. This paper reviews the anti-depressant mechanisms of rTMS that have been found in preclinical studies in recent years and discusses the shortcomings of TMS in preclinical studies.