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AJP CME - May 2020 - Distinct Symptom-Specific Treatment Targets for Circuit-Based Neuromodulation

Activity Type:

  • Journal CME

Release Date: 5/1/2020

Expiration Date: 4/30/2022

  • AMA PRA Category 1: 1
  • Participation: 1



Objective: Treatment of different depression symptoms may require different brain stimulation targets with different underlying brain circuits. The authors sought to identify such targets, which could improve the efficacy of therapeutic brain stimulation and facilitate personalized therapy.

Methods: The authors retrospectively analyzed two independent cohorts of patients who received left prefrontal transcranial magnetic stimulation (TMS) for treatment of depression (discovery sample, N=30; active replication sample, N=81; sham replication sample, N=87). Each patient’s TMS site was mapped to underlying brain circuits using functional connectivity MRI from a large connectome database (N=1,000). Circuits associated with improvement in each depression symptom were identified and then clustered based on similarity. The authors tested for reproducibility across data sets and whether symptom-specific targets derived from one data set could predict symptom improvement in the other independent cohort.


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Educational Objective

The participant will point out specific targets used in transcranial magnetic stimulation to treat specific symptoms of depression.

Target Audience

This program is designed for all psychiatrists in clinical practice, residents in Graduate Medical Education programs, medical students interested in psychiatry, and other physicians who wish to advance their current knowledge of clinical medicine.

Estimated Time to Complete

Duration: 1 hour
Begin Date: May 1, 2020
End Date: April 30, 2022

How to Earn Credit

In order to earn CME credit, subscribers should read through the material presented in the article. After reading the article, complete the quiz and submit your evaluation and study hours (up to 1 AMA PRA Category 1 Credit™).  A score of 60% or higher is required to receive credit.


The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The APA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Faculty and Planner Disclosures

Title: Distinct Symptom-Specific Treatment Targets for Circuit-Based Neuromodulation

Authors: Shan H. Siddiqi, M.D., Stephan F. Taylor, M.D., Danielle Cooke, B.S., Alvaro Pascual-Leone, M.D., Ph.D., Mark S. George, M.D., Michael D. Fox, M.D., Ph.D.

Affiliations: Department of Psychiatry (S.H.S.) and Department of Neurology (A.P.-L., M.D.F.), Harvard Medical School, Boston; Berenson-Allen Center for Noninvasive Brain Stimulation (S.H.S., D.C., M.D.F.), and Cognitive Neurology Unit, Department of Neurology (S.H.S.), Beth Israel Deaconess Medical Center, Boston; Division of Neurotherapeutics, McLean Hospital, Belmont, Mass. (S.H.S.); Department of Psychiatry, Washington University School of Medicine, St. Louis (S.H.S.); Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md. (S.H.S.); Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor (S.F.T.); Hinda and Arthur Marcus Institute for Aging Research and Center for Memory Health, Hebrew SeniorLife, Boston (A.P.-L.); Guttmann Institute, Autonomous University of Barcelona, Barcelona, Spain (A.P.-L.); Brain Stimulation Lab, Department of Psychiatry, Medical University of South Carolina, Charleston (M.S.G.); Ralph H. Johnson VA Medical Center, Charleston, S.C. (M.S.G.); Department of Neurology, Massachusetts General Hospital, Boston (M.D.F.); Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Mass. (M.D.F.).

Disclosures: Dr. Siddiqi is a consultant for the Kaizen Brain Center and for SigNeuro and owns intellectual property on the use of brain connectivity to guide brain stimulation. Dr. Taylor has received grant support from Boehringer-Ingelheim, Neuronetics, and Otsuka/Vanguard Research Group. Dr. Pascual-Leone serves on the medical and scientific advisory boards of Magstim, Nexstim, and Neuroelectrics, and he is listed as an inventor on several issued and pending patents on the real-time integration of transcranial magnetic stimulation with electroencephalography and MRI, and on various aspects of brain stimulation methods. Dr. Fox owns intellectual property on the use of brain connectivity to guide brain stimulation. Ms. Cooke and Dr. George report no financial relationships with commercial interests.

Discussion of unapproved or investigational use of products*: No.

*APA policy requires disclosure by CME authors of unapproved or investigational use of products discussed in CME programs. Off-label use of medications by individual physicians is permitted and common. Decisions about off-label use can be guided by scientific literature and clinical experience.

Program Planners

Ned H. Kalin, M.D. (Editor-in-Chief, AJP); Carolyn Rodriguez, M.D., Ph.D. (Deputy Editor, AJP); Michael D. Roy (Editorial Director, AJP); Michael A. Pogachar (Online Content Manager, Journals). Dr. Kalin has served as a consultant to the Board of Scientific Advisors, the Pritzker Neuropsychiatric Disorders Research Consortium, and the Skyland Trail Advisory Board and as Councilor, Society of Biological Psychiatry. Dr. Rodriguez has served as a consultant to Allergan, Blackthorn, Epiodyne, and Rugen. Mr. Roy and Mr. Pogachar report no financial relationships with commercial interests.

Hardware/Software Requirements

This internet-based CME activity is best experienced using Internet Explorer 8+, Mozilla Firefox 3+, Safari 4+. This Web site requires that JavaScript and session cookies be enabled. Certain activities may require additional software to view multimedia, presentation, or printable versions of the content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Adobe Acrobat, Microsoft PowerPoint, and Windows Media Player.


Optimal System Configuration:

  • Flash Player: Adobe Flash Player 10.1+ 
  • Browser: Firefox 3+, Internet Explorer 8.0+, Safari 4.0+, or Google Chrome 7.0+ 
  • Operating System: Windows XP+ or Mac OS X 10.4+ 
  • Internet Connection: 1 Mbps or higher
  • Screen Resolution: 1024 x 768 pixels.

Minimum Requirements:

  • Windows PC:500-MHz Pentium II; Windows XP or higher; 128 MB RAM; Video Card at least 64MB of video memory; Sound Card at least 16-bit; Macromedia Flash Player 10 or higher, audio playback with speakers for programs with video content; Firefox 1.1+, Internet Explorer 7.0+, Safari 1.0+, Google Chrome, or Opera
  • Macintosh: Mac OS X 10.3 or higher with latest updates installed; 1.83MHz Intel Core Duo or faster; RAM: 128MB or more; Video Card: at least 64MB of video memory; Sound Card: at least 16-bit

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