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Editorial: Underlying neural mechanisms of non-invasion brain stimulation in the treatment of psychiatric disorders: evidence from neuroimaging studies; volume II
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DOI：10.3389/fpsyt.2026.1952112.png)
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Abstract
En 中文
Non-invasive brain stimulation (NIBS) comprises a heterogeneous family of techniques; including repetitive transcranial magnetic stimulation (rTMS); transcranial direct current stimulation (tDCS); transcranial alternating current stimulation (tACS); and transcutaneous auricular vagus nerve stimulation (taVNS). These approaches differ in their physical principles; spatial and temporal resolution; depth of stimulation; and proposed mechanisms of action; yet all can modulate neural activity without neurosurgical intervention. Over recent decades; NIBS has evolved from an experimental probe of cortical excitability into an established or emerging therapeutic modality for psychiatric disorders. This transition was initially driven by multisite trials establishing the antidepressant efficacy of rTMS (1); and subsequently reinforced by large comparative trials and evidence-based guidelines that refined stimulation parameters; treatment schedules; and clinical indications (2; 3). Nevertheless; the strength of clinical evidence remains uneven across stimulation modalities and diagnostic categories; underscoring the necessity to clarify not only whether NIBS is effective; but also how; where; and in whom it confers therapeutic benefit.The physiological effects of NIBS extend beyond local changes in cortical excitability beneath the stimulation site. Stimulation-induced activity can propagate through structurally and functionally connected pathways; producing distributed modulations on neural oscillations; cerebral perfusion; functional integration; and large-scale network dynamics (4; 5). Such a distributed mode of action makes neuroimaging particularly valuable for characterizing how NIBS engages targeted circuits and induces changes across connected brain systems. Structural magnetic resonance imaging (MRI) and diffusion imaging characterize individual anatomy and the white-matter pathways that constrain stimulation propagation; whereas functional MRI and arterial spin labeling quantify local and remote changes in activity; connectivity; and perfusion.Electroencephalography and near-infrared spectroscopy provide complementary temporal resolution on electrophysiological and hemodynamic responses. Neuroimaging can therefore serve key translation functions by identifying candidate treatment circuits; guiding individualized targets; verifying target engagement; characterizing treatment-induced plasticity; and delineating predictive biomarkers of clinical response.showing that therapeutic efficacy depends on the functional alignment between accessible cortical targets and deeper symptom-relevant regions; as opposed to standardized superficial coordinates alone (6; 7). Subsequent contributions examine how stimulation-induced plasticity is expressed across large-scale networks and how these changes relate to symptomatic or cognitive improvement. In a comprehensive synthesis; Sun and colleagues integrate evidence across five interacting domains encompassing anti-inflammatory; autonomic; neurotransmitter; neuroimaging; and gut-brain mechanisms; and propose that taVNS may improve depression by reorganizing coupling among the default-mode; cognitivecontrol; salience; reward; sensorimotor; and visual networks. Their synthesis further emphasizes that these mechanisms are unlikely to operate independently and that multimodal; multi-omics; and machine-learning approaches will be required to determine which biological changes are mechanistically relevant and clinically predictive. In older adults with mild cognitive impairment ; Guo et al. found that participants who reverted to cognitively normal status after ten days of rTMS had milder baseline impairment and better-preserved connectivity within the default-mode; executive-control; and frontoparietal networks than those who remained non-reverters. Improvements in immediate and delayed recall; together with baseline connectivity measures; accurately distinguished individuals who subsequently reverted to normal cognition. These findings suggest that preserved network organization may define a window of greater responsiveness and support further investigation of rTMS earlier in the trajectory of cognitive decline.At the oscillatory level; Debnath et al. show that 5 Hz tACS over the left DLPFC selectively shortened response times during high-load working-memory conditions and increased post-stimulation theta power. The alignment among the stimulation frequency; electrophysiological response; and load-dependent behavioral effect provides primary evidence that frequency-specific neural entrainment may represent one mechanism through which tACS modulates cognitive function. Complementing these clinical and cognitive investigations; Caiani et al. performed computational electric-field modeling in thirty healthy adults and found that incorporating white-matter anisotropy from diffusion imaging substantially altered predicted field strength; orientation; and focality. Moreover; the spatial extent of the modeled electric field was related to the strength of structural connections involving the stimulated region. These results demonstrate that the biological dose delivered is constrained not only by electrode placement and current intensity; but by the individual microstructural architecture; necessitating anatomically realistic field modeling for interpreting interindividual variation in physiological and clinical responses.The volume also evaluates the broader evidential and conceptual foundations of NIBS research. A systematic review and meta-analysis of 28 randomized trials by Li et al. found that tDCS produced no significant overall improvement in ADHD symptoms or executive function. Exploratory subgroup analyses; however; suggested that anodal montage targeting the right ventromedial prefrontal cortex might selectively improve inhibitory control and working memory. These findings provide an appropriately cautious counterpoint to favorable results from smaller single-site studies; illustrating how montage-specific effects may coexist with a null overall treatment estimate. Author contributions XYJ: Writing -original draft; Writing -review and editing. MS-K: Writing -review and editing.
Keywords:
psychiatric disorders
neuroimaging
non-invasive brain stimulation
neural plasticity
brain function and structure
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3.2
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1.8W
Citations:
4.8W
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Cited Papers