State-Primed modulation: sequential enhancement of transcranial magnetic stimulation efficacy for psychiatric disorders

Abstract

Transcranial magnetic stimulation (TMS) is a well-recognized effective treatment for various psychiatric disorders, but its efficacy is substantially influenced by the ongoing internal states of neural activity. This article is a narrative viewpoint and does not aim to provide a systematic or exhaustive review of the literature. Based on emerging evidence and prior work from our group, this article proposes the potential clinical value of sequential rTMS-based multimodal treatment strategies in severe psychiatric disorders. Relevant studies were identified through targeted searches of major databases (e.g., PubMed and Web of Science) using keywords related to transcranial magnetic stimulation, state dependence, preconditioning, priming, and multimodal neuromodulation. Priority was given to representative randomized clinical trials, mechanistic studies, and reports of sequential or combined intervention paradigms across different psychiatric disorders. The purpose of this viewpoint is not to establish definitive clinical recommendations, but to propose a conceptual and translational framework for understanding how state-dependent modulation may optimize TMS efficacy across psychiatric disorders.