Intermittent Theta Burst Stimulation of the Dorsomedial Prefrontal Cortex Enhances Expectancy-Driven Placebo Mood Effects in Depression: Evidence from a Randomized Clinical Trial

Highlights

• Intermittent theta burst stimulation (iTBS) over the dorsomedial prefrontal cortex (dmPFC) enhances default mode network (DMN) activity related to expectancy-driven placebo effects in depression.
• Causal modulation of DMN activity via iTBS potentiates mood improvement linked to antidepressant placebo responses, providing mechanistic insight into treatment expectation processes.
• Continuous TBS (cTBS) and sham stimulation show distinct effects on expectancy ratings, highlighting the complexity of DMN-cortex interplays in anticipation and mood regulation.
• Findings support dorsal medial PFC-DMN circuit plasticity as a promising target to augment antidepressant treatment response through expectancy shaping.

Background