ORIGINAL RESEARCH article
Front. Hum. Neurosci.
Sec. Brain Imaging and Stimulation
This article is part of the Research TopicCognitive enhancement by brain stimulation techniquesView all 7 articles
Identification of Cognitive Predictors of Remission in Depression Following Limited Effect of Repetitive Transcranial Magnetic Stimulation on Hot and Cold Cognitive Systems
Provisionally accepted
Dorsa Derakhshan1,2*
Peter Giacobbe1,2,3*
Anthony Feinstein2,3Nir Lipsman2,3,4Anthony Levitt2,3Moshe Eizenman5Jennifer Rabin1,2- 1Sunnybrook Research Institute (SRI), Toronto, Canada
- 2University of Toronto Institute of Medical Science, Toronto, Canada
- 3University of Toronto Temerty Faculty of Medicine, Toronto, Canada
- 4Sunnybrook Research Institute, Toronto, Canada
- 5University of Toronto Institute of Biomedical Engineering, Toronto, Canada
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Introduction: Cognitive dysfunction is a chronic and debilitating element of major depressive disorder (MDD), which manifests as abnormal processing in hot (emotion-laden) and cold (emotion-independent) cognitive systems. Although the antidepressant properties of repetitive transcranial magnetic stimulation (rTMS) are well-established, its impact on hot and cold cognition requires further elucidation. Methods: Prospective study of patients with MDD undergoing an acute course of high frequency rTMS to the left dorsolateral prefrontal cortex (L-DLPFC). MDD patients (N=24) received a 4-to-6-week course of rTMS during which they were evaluated for depressive symptoms and completed cognitive assessments. Age-, sex-, and education-matched healthy controls (N=33) also completed the cognitive tasks at the same intervals as the MDD patients. Results: Sustained antidepressant effect was observed following rTMS in MDD patients. Hot and cold cognition remained unaltered over the course of treatment. A pre-treatment baseline cognitive phenotype of those who achieve remission of their depressive symptoms with rTMS was identified, characterized by greater sustained attention, speed in correct identification of facial expressions, and free recall of words. Conclusion: Our findings further validate the cognitive safety and clinical efficacy of rTMS as an intervention for MDD. Future research is required to further characterize the utility of pre-rTMS cognitive phenotyping in identified remitters, to aid in patient selection and treatment prognostication.
Keywords: Major Depressive Disorder, rTMS, cognitive dysfunction, DLPFC, attentionalbias, eye tracking
Received: 01 Sep 2025; Accepted: 17 Nov 2025.
Copyright: © 2025 Derakhshan, Giacobbe, Feinstein, Lipsman, Levitt, Eizenman and Rabin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Dorsa Derakhshan, dorsa.derakhshan@alumni.utoronto.ca
Peter Giacobbe, peter.giacobbe@sunnybrook.ca
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