Transcranial magnetic stimulation (TMS) is a noninvasive treatment approach for major depressive disorder (MDD). A recently proposed method1 is to stimulate a sub-region in the left dorsolateral prefrontal cortex (DLPFC) that is most anti-correlated with the subgenual cingulate (SGC) as obtained from resting-state functional MRI (rsfMRI). To test the reliability of this approach, we examined 100 data sets from the Human Connectome Project (HCP)5 with each subject scanned 4 times on two different days. We found large variability in the inter-scan rsfMRI-guided target for each subject, which can significantly reduce the efficacy of TMS therapy in MDD.
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