Background:: Repetitive transcranial magnetic stimulation (rTMS) has attracted attention for treating treatment-resistant major depressive disorder (MDD) because of its effectiveness and low invasiveness. Recent neuroimaging studies suggest that the effects of rTMS in MDD may be based on improvements in abnormal brain networks. However, oscillatory network changes after rTMS remain unclear. This study aimed to detect oscillatory electroencephalography (EEG) markers that reflect the therapeutic effects of rTMS. Methods:: We treated 15 treatment-resistant MDD patients with high-frequency (10 Hz) rTMS over the left prefrontal cortex for 6 weeks. The power spectral density at each electrode and the phase lag index between all electrode pairs were compared before and after rTMS using clinical EEG data. The relationships between EEG indices, depressive symptoms, and cognitive function were also examined. Results:: Depressive symptoms were significantly improved after rTMS. Additionally, functional connectivity between the left frontal–temporal and occipital regions in the theta band and gamma power in the anterior–central area were increased in both hemispheres after rTMS. Increased functional connectivity in the theta band was correlated with improved cognitive function, while increased gamma power was correlated with worsened depressive symptoms. Limitations:: The sample size was relatively small. Conclusion:: Our results demonstrated oscillatory changes in theta-band functional connectivity after rTMS in MDD patients. These findings, obtained using clinical EEG methods, provide evidence of the underlying neurophysiological effects of rTMS on MDD within the context of functional brain network changes, and may constitute a biomarker for evaluating MDD treatments.
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