| abstract | It has been argued that clinical depression is accompanied by reductions in cortical excitability of the left prefrontal cortex (PFC). In support
of this, repetitive transcranial magnetic stimulation (rTMS), which is a method of enhancing cortical excitability, has shown antidepressant
efficacy when applied over the left PFC, although the overall therapeutic effects remain inconclusive. The cerebral pathophysiology of
depression is, however, not limited to dysfunctions in the PFC, thus, targeting alternative brain regions with rTMS may provide new therapeutic
windows in the treatment of depression. Evidence from electroencephalography and lesion studies suggests that not only is the left
PFC involved in depression but also the parietal cortex and cerebellum. Furthermore, rTMS over the parietal cortex and the cerebellum
has been found to improve mood and emotional functioning, at least in healthy volunteers. We have integrated these findings in an rTMSoriented
theoretical framework for the neurobiology of low mood and depression. To establish the possible therapeutic efficacy of this
model, whereby, for example, the application of slow rTMS over the right parietal cortex and fast rTMS over the cerebellum may be beneficial
in different subtypes of depression, clinical rTMS studies that target the parietal cortex and cerebellum are warranted. |
