The centerpiece of the October issue of The American Journal of Psychiatry is a special issue on neuromodulation and precision therapeutics, assembled with guest editor William McDonald, M.D., professor of psychiatry and behavioral sciences at Emory University School of Medicine. McDonald joins Ned Kalin, the journal’s editor-in-chief, on this month’s AJP Audio podcast to discuss the collection. The special issue arrives at a moment when neuromodulation, once a niche corner of psychiatry, has become one of its most active frontiers, encompassing transcranial magnetic stimulation, electroconvulsive therapy, vagus nerve stimulation, and emerging techniques that promise to steer electrical activity in deep brain circuits without surgery.

One of the issue’s framing contributions describes the current wave of brain stimulation therapeutic interventions in neuropsychiatry as a Cambrian explosion, an evocative metaphor borrowed from evolutionary biology to convey the sheer diversity of approaches now proliferating. Alongside it, a second perspective article examines artificial intelligence as the computational framework for adaptive closed-loop neuromodulation in psychiatry. Closed-loop systems, which sense neural activity and adjust stimulation parameters in real time, are widely viewed as the next step beyond fixed-protocol stimulation, and the article argues that machine learning provides the mathematical machinery needed to make such adaptive control clinically reliable.

The special issue also features original clinical trials that test whether precision targeting can improve outcomes. One randomized, sham-controlled trial investigates bilateral theta-burst stimulation of dorsolateral prefrontal cortex regions for late-life depression, a population in which treatment-resistant mood disorders carry substantial disability and medical burden. A companion study reports convergent network localization of brain stimulation targets for trait anxiety, an approach that uses converging evidence about brain networks to identify where stimulation might most effectively modulate a given symptom dimension. AJP Deputy Editor Daniel Pine, M.D., highlights both studies in accompanying videos for the journal’s readership.

Two further trials push the precision theme further. The first, the CORRECT-BD trial, compares clinical and cognitive outcomes of right unilateral ultrabrief electroconvulsive therapy against magnetic seizure therapy for bipolar depression, a comparison that speaks directly to a longstanding clinical concern: preserving cognition while retaining the robust antidepressant efficacy of seizure-based treatments. The second is an individualized, connectivity-guided versus conventional targeting trial of accelerated theta-burst stimulation in depression, a randomized, double-blind, parallel-design study that asks whether personalizing stimulation targets to each patient’s brain connectivity outperforms standard coordinate-based targeting.

The issue also revisits one of the most consequential and debated studies in the field. The RECOVER trial of vagus nerve stimulation in markedly treatment-resistant depression is examined in an article on its critical findings, lessons learned, and future directions, with lead author Charles R. Conway, M.D., discussing the results on the AJP Audio podcast. Additional contributions survey precision neuromodulation with a focus on temporal interference stimulation, a technique designed to reach deep brain structures noninvasively by interfering two high-frequency fields at a targeted point. A commentary argues for advancing brain stimulation toward first-line psychiatric therapy through wearable disposable electrotherapy, while another article addresses implantable neuromodulation devices in psychiatry, weighing human fidelity and the implementation challenges that stand between promising devices and routine clinical use.

The October issue of Psychiatric Services shifts the lens from circuits to systems, publishing research on how mental health care is organized, measured, and delivered. Highlights include the Mental Wellness Tool, a brief screener designed to detect mental disorders, substance use disorders, and suicide risk in a single instrument, and a set of recommendations from a participatory policymaking symposium on emergency psychiatric evaluation of people under arrest, an area where clinical practice, law enforcement, and civil rights intersect. Other articles examine VA health care utilization among U.S. veterans through the influence of social determinants of health, and a methodological piece on suicide surveillance and Simpson’s Paradox warns that aggregating data can obscure critical patterns that appear only when populations are disaggregated.

Access and equity questions recur throughout the issue. One study documents wait times and documentation requirements for child psychiatric care across payer and facility types, quantifying the administrative friction families face when seeking help for children. Another reports on public support for state laws requiring addiction programs to offer FDA-approved medications for opioid use disorder, a finding with direct relevance to ongoing policy debates about whether treatment programs should be legally obligated to provide evidence-based pharmacotherapy. Together, these papers illustrate how service-level research complements clinical neuroscience by identifying where the system itself becomes a barrier to care.

The American Journal of Psychotherapy contributes a third perspective, centered on the human relationship at the heart of psychiatric treatment. Articles examine gender and age differences in psychotherapy use among U.S. adults with depression and anxiety, and explore the effects of psychotherapies for posttraumatic stress disorder on anger, an often-overlooked symptom in trauma treatment research. Clinical technique is addressed in a paper on the RFP-C triangle of conflict, which considers how attending to countertransference can help clinicians listen more effectively to children with disruptive behaviors. Cultural adaptation is the focus of an article on interpersonal psychotherapy in the Chinese cultural context, while a study of group acceptance and commitment therapy for adolescent anxiety reports on initial acceptability and outcomes of a group format aimed at expanding access for young patients.

Psychiatric Research and Clinical Practice rounds out the collection with translational and real-world studies. A viewpoint article considers fostering social connection, tracing progress and opportunities within the VA and beyond, a topic of growing public health interest given evidence linking isolation to morbidity. A comparative study assesses the risks of pregnancy complications in women prescribed psychostimulants or atomoxetine during pregnancy following pre-pregnancy stimulant use, addressing a population long underrepresented in psychopharmacology research. The journal also publishes a real-world effectiveness and cost-differential analysis of intranasal esketamine versus intramuscular ketamine, two rapid-acting treatments for depression whose relative value outside controlled trials remains a pressing question for clinicians and payers. Finally, a real-world pilot evaluates the collaborative care model for adults with cognitive impairment and neuropsychiatric symptoms in primary care, testing whether an integrated care framework developed for depression can extend to patients with complex neuropsychiatric needs. Journalists seeking access to the publications can contact the American Psychiatric Association press office at press@psych.org.

Subject of Research: Neuromodulation, precision therapeutics, esketamine, and mental health services research featured across APA journals

Article Title: October 2026 Issues of APA Journals feature new research on neuromodulation and precision therapeutics, esketamine, and more

Article References: October 2026 Issues of APA Journals feature new research on neuromodulation and precision therapeutics, esketamine, and more. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: neuromodulation, precision therapeutics, brain stimulation, esketamine, theta-burst stimulation, vagus nerve stimulation, electroconvulsive therapy, depression, psychotherapy, psychiatric services, American Psychiatric Association, mental health care

Insomnia, characterized by persistent difficulties in falling asleep or maintaining restorative sleep, has long challenged clinicians, with pharmacological solutions posing risks of dependency and adverse effects. The emerging neurotechnological approaches, particularly those targeting the neural substrates of sleep-wake regulation, have kindled hope for safer, more effective therapies. The research undertaken by Zhu and colleagues specifically investigates whether applying continuous theta burst stimulation—a patterned form of transcranial magnetic stimulation—can recalibrate aberrant brain rhythms in patients whose insomnia remains resistant to conventional treatments.

Theta bursts, rhythmic neural oscillations around 5 Hz, are intricately involved in sleep processes, particularly in promoting transitions between sleep stages. The authors applied cTBS protocols to key cortical areas hypothesized to influence sleep architecture, aiming to restore natural oscillatory dynamics. Using detailed electrophysiological recordings, including electroencephalography (EEG), they characterized how these modulations altered the frequency and amplitude of brain waves previously linked to impaired sleep patterns.

Crucially, their findings display that cTBS not only shifted the dominant frequency of cortical oscillations toward physiologically favorable bands but also enhanced the synchronization of neural networks involved in sleep onset and maintenance. The intervention suppressed aberrant high-frequency beta activities often observed in insomnia patients, which correspond to hyperarousal states disrupting sleep initiation. This neuroplastic modulation suggests a direct mechanistic link between targeted brain stimulation and alleviation of insomnia symptoms.

The study meticulously outlines the stimulation parameters, intensity, and cortical targeting strategies, establishing a replicable framework for clinical application. The team emphasizes the significance of personalized stimulation protocols, as individual variability in baseline oscillatory states necessitates tailored intervention for maximal therapeutic benefit. By integrating advanced neuroimaging and neurophysiological monitoring, the approach transcends symptom management, instead aiming to recalibrate the underlying functional brain dynamics.

Investigators also conducted comprehensive polysomnography before and after the treatment course, observing marked improvements in total sleep time, sleep efficiency, and rapid eye movement (REM) sleep proportions. These objective enhancements dovetail with subjective reports from participants, who noted reductions in sleep latency and nocturnal awakenings. The dual validation underscores the translational potential of cTBS as a viable non-pharmacologic option in clinical settings.

While the precise neurobiological mechanisms underpinning cTBS effects remain an active area of inquiry, the modulation of thalamocortical circuits and changes in inhibitory-excitatory balance appear central. The oscillatory entrainment achieved by cTBS may restore disrupted connectivity patterns, enabling the brain to transition more smoothly between wakefulness and sleep states. The temporal precision and intensity of the theta burst delivery are likely critical variables shaping these neural outcomes.

Safety assessments further corroborate the minimal adverse event profile of cTBS, with no serious side effects recorded. Mild transient headaches and scalp discomfort were the most frequently reported symptoms, underscoring the technique’s tolerability compared to pharmacological interventions. This safety margin encourages its broader exploration across diverse insomnia populations, including those with comorbid neuropsychiatric conditions where medication risks are heightened.

Importantly, the study sheds light on the temporal durability of cTBS effects, noting sustained benefits persisting weeks beyond treatment cessation. This durability suggests that cTBS induces lasting neuroplastic adaptations rather than transient suppression of pathological oscillations. Such long-term remodeling of neural circuits may herald a paradigm shift in sleep disorder therapeutics, moving toward enduring symptom remission.

The implications extend beyond primary insomnia, as disruptions in brain oscillations characterize many neuropsychiatric and neurological disorders with secondary sleep disturbances. Cognitive dysfunction, mood disorders, and neurodegenerative diseases often exhibit sleep impairments that exacerbate symptomatology. The modulation of brain oscillatory activity by cTBS thus holds promise for a spectrum of conditions where sleep is both a symptom and a contributing factor to disease progression.

This pivotal research also highlights the convergence of neuroengineering, sleep medicine, and psychiatry, illustrating how interdisciplinary approaches can yield impactful clinical innovations. By harnessing the brain’s intrinsic rhythms and selectively enhancing physiologic oscillations, neuromodulation therapies like cTBS offer personalized, non-pharmacologic avenues to restoring health and wellbeing.

Future investigations aim to optimize cTBS protocols through integration with closed-loop systems capable of adapting stimulation in real time based on ongoing neural activity. Combining such neurofeedback paradigms with multimodal imaging could refine target identification and maximize therapeutic efficacy. Moreover, longitudinal studies exploring combinatorial treatments alongside behavioral interventions stand to amplify treatment outcomes.

In conclusion, the work by Zhu and colleagues marks a seminal contribution to insomnia research, illustrating that continuous theta burst stimulation can effectively modulate dysfunctional brain oscillations and improve sleep quality in patients. This promising modality challenges traditional approaches, providing new hope for those grappling with chronic sleep disorders and expanding the therapeutic frontier of non-invasive brain stimulation technologies.

Subject of Research: Modulation of brain oscillations by continuous theta burst stimulation in patients with insomnia

Article Title: Modulation of brain oscillations by continuous theta burst stimulation in patients with insomnia

Article References:
Zhu, X., Jiang, L., Shi, L. et al. Modulation of brain oscillations by continuous theta burst stimulation in patients with insomnia. Transl Psychiatry 15, 416 (2025). https://doi.org/10.1038/s41398-025-03605-y

Image Credits: AI Generated

DOI: https://doi.org/10.1038/s41398-025-03605-y

Theta burst stimulation, a novel and non-invasive brain stimulation technique, has garnered significant attention in neuroscience due to its ability to modulate neuronal activity with high temporal efficiency. In this latest study, investigators applied TBS to the left dorsolateral prefrontal cortex (DLPFC)—a brain region deeply implicated in executive function and working memory deficits commonly observed in schizophrenia. By focusing on this critical hub, the researchers aimed to uncover whether artificially enhancing cortical excitability translates into measurable improvements in cognitive performance.

The study enrolled one hundred individuals diagnosed with stable chronic schizophrenia. Participants were randomly assigned into two cohorts: an experimental group receiving authentic TBS treatment and a control group subjected to sham stimulation, which mimics the procedure without delivering actual therapeutic pulses. Over a four-week intervention period, both groups underwent systematic cognitive assessments, utilizing standardized instruments such as the Mini-Mental State Examination (MMSE) and the Mattis Dementia Rating Scale Second Edition (MDRS-2). These tools offer nuanced insights into domains including attention, memory, initiation, and conceptual reasoning.

Crucially, the use of functional near-infrared spectroscopy allowed for precise measurement of cerebral blood oxygenation during cognitive tasks. Participants performed a verbal fluency task (VFT)—a challenging exercise that requires active retrieval and generation of words, tapping into the cognitive circuits targeted by TBS. This real-time monitoring of hemoglobin signal fluctuations, particularly in oxygenated and deoxygenated forms, provided a window into the brain’s metabolic responses to the stimulation.

Data analysis revealed a compelling interaction between treatment group and time, demonstrating that the experimental group exhibited significant enhancements across multiple cognitive parameters compared to the sham group. Total scores on both MMSE and MDRS-2 increased, with pronounced gains in domains of attention and memory. Within-subject comparisons further underscored the efficacy of TBS, revealing marked cognitive improvements from baseline to post-treatment. These findings suggest that TBS facilitates neural plasticity mechanisms conducive to restoring impaired cognitive functions.

From a neurophysiological perspective, the fNIRS measurements uncovered notable decreases in deoxyhemoglobin concentrations specifically within channel 47, corresponding anatomically to the left DLPFC. This shift implies enhanced oxygen consumption and cerebral metabolism in the stimulated cortex, corroborating the hypothesis that TBS energizes targeted brain areas by boosting local blood flow and neural activity. Such findings position TBS not merely as a symptomatic intervention but as a modality capable of modulating cortical physiology at a foundational level.

Intriguingly, the investigators also explored demographic influences on treatment response. Regression analyses illuminated age as a significant predictor of cognitive gains measured by MDRS-2 scores, implying that younger patients may derive greater benefit from TBS. This age-dependent effect underscores the necessity of personalized medicine approaches in neuropsychiatric care, prompting future research to delineate optimal treatment windows and dosage schemas tailored to patient characteristics.

This study emerges amid a growing body of literature probing the efficacy of neuromodulation in psychiatric disorders. While transcranial magnetic stimulation (TMS) and its variants have been widely studied, the unique patterned bursts characteristic of TBS appear to induce more robust and enduring synaptic changes. By applying this technique to chronic schizophrenia, a condition traditionally refractory to many treatments, the research breaks new ground in rehabilitation potentials.

Moreover, the integration of fNIRS technology represents a methodological advance, enabling the simultaneous capture of cognitive outcomes and underlying hemodynamic alterations. This dual-layer approach allows for mechanistic insights that bridge behavioral observations and cerebral physiology, offering a comprehensive understanding of how TBS modulates brain function in vivo.

Despite promising results, the authors caution that further large-scale trials and longitudinal follow-ups are essential to validate and extend these findings. The durability of cognitive improvements, potential side effects, and combinatory effects with pharmacotherapy remain important areas for future investigation. Nevertheless, the data offer a hopeful avenue for enhancing the quality of life and functional independence of patients grappling with chronic schizophrenia.

In conclusion, by harnessing the power of theta burst stimulation and advancing neuroimaging techniques, this study marks a pivotal step towards effective cognitive enhancement in schizophrenia. It illuminates how precisely timed bursts of electromagnetic energy can recalibrate disturbed neural circuits, catalyze neurovascular responses, and ultimately uplift cognitive faculties compromised by the disease. As neuroscience inches closer to decoding the complex brain dynamics of schizophrenia, interventions like TBS could herald a new epoch of targeted, evidence-based therapies poised to transform psychiatric care.

Subject of Research: The effect of theta burst stimulation on cognitive function and cerebral blood oxygenation in patients with chronic schizophrenia.

Article Title: Effects of theta burst stimulation on cognitive function and characteristics of blood oxygen alterations based on near-infrared spectroscopy in chronic schizophrenia.

Article References:
Gao, C., Li, G., Zhang, X. et al. Effects of theta burst stimulation on cognitive function and characteristics of blood oxygen alterations based on near-infrared spectroscopy in chronic schizophrenia. BMC Psychiatry 25, 784 (2025). https://doi.org/10.1186/s12888-025-07240-1

Image Credits: AI Generated

DOI: https://doi.org/10.1186/s12888-025-07240-1