"Transcranial magnetic stimulation (TMS) protocols comprise numerous parameters, including stimulation frequency, pulse pattern, cortical target, targeting method, intensity, session dose, pulse dose, and treatment density. The optimal treatment parameters and the interactions among these parameters remain unknown. Protocols in routine clinical use were not derived from a systematic optimization process. Instead, standard once-daily FDA-cleared protocols reflect the constraints of early devices and the design of pivotal regulatory trials. Which TMS parameters predict superior efficacy therefore remains an empirical question of considerable clinical importance.

The NeuroStar TrakStar database is the largest real-world TMS outcomes database, comprising over 170,000 patients treated across more than 1,500 clinical sites. This large sample size enables detection of parameter effects across diverse patient characteristics and clinical contexts encountered in practice. Drawing on this dataset, Dr Cole will examine the independent contributions of stimulation location, frequency, dose, and treatment density to antidepressant outcomes in major depressive disorder (MDD), alongside patient-level predictors including symptom profile, sex, and age.

The talk will conclude by identifying areas for future investigation, including the role of brain state at the time of stimulation, maintenance strategies, approaches to treatment personalization that yield clinically meaningful improvement, and the impact of concurrent pharmacological and behavioral interventions. These findings aim to provide an empirical foundation for data-driven optimization of TMS protocols.