Impact of rTMS on the glymphatic system in patients with first-episode depression before and after treatment

Motivation: The neuropathological mechanisms of repetitive transcranial magnetic stimulation (rTMS) for the treatment of depression are unclear. Goal(s): The aim of this study was to explore the effects of rTMS on the brain glymphatic system using Diffusion MR Technique in patients with first-episode depression before and after treatment. Approach: Diffusion tensor image analysis along the perivascular space (DTI-ALPS) as a non-invasive method for evaluating the activity of the glymphatic system in human brain by using diffusion images. Results: The left ALPS index of patients with first-episode depression is lower than that of healthy people, and it is increased after rTMS treatment. Impact: This study demonstrated the DTI-ALPS method to assess lymphatic system activity in first-episode depression patients before and after rTMS treatment. The abnormality of ALPS index may provide a potential biomarker for explaining depression, and rTMS can cause changes in ALPS.