The heart-brain dialogue: pathways to TMS treatment optimization

Depression is a debilitating mental health condition with various possible therapies. Since no person is the same, depression treatment selection should be individualized. Stratified psychiatry uses biomarkers (biological features of a person) to identify inter-individual differences aiming to individualize the treatment selection process. In this thesis, the connection between the heart and the brain is investigated for potential differential biomarkers, focusing on optimizing the antidepressant treatment Transcranial Magnetic Stimulation (TMS). Here, the heartbeat evoked potential (HEP), Heart-Brain Connection (HBC), and the individual alpha peak frequency (iAF) are studied. Results show that the HEP might be able to determine whether an individual’s treatment with venlafaxine or TMS is more effective. Furthermore, the HBC method is validated, replicated, optimized and prospectively implemented in clinical practice, together with the iAF, to determine the optimal TMS stimulation protocol and target location for each individual patient. Future developments might result in quicker treatment response and increase treatment effects.