ArticlesThe Relationship of Transcranial Magnetic Stimulation With Sleep and PlasticityCENTORINO, MICHAEL B. MD; BAJOR, LAURA A. DO, FAPA; GOOTAM, PRAVEEN K. MD; NAKASE-RICHARDSON, RISA PhD, FACRM; KOZEL, F. ANDREW MD, MSCRAuthor Information CENTORINO, GOOTAM, KOZEL: Mental Health and Behavioral Sciences, James A. Haley Veterans’ Administration Hospital and Clinics, and Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL BAJOR: Mental Health and Behavioral Sciences, James A. Haley Veterans’ Administration Hospital and Clinics, Tampa, FL, and Department of Psychiatry, Harvard Medical School, Boston, MA NAKASE-RICHARDSON: Mental Health and Behavioral Sciences, James A. Haley Veterans’ Administration Hospital and Clinics, Morsani College of Medicine, Division of Pulmonary and Sleep Medicine, University of South Florida, and Defense and Veteran Brain Injury Center, Tampa, FL The authors declare no conflicts of interest. Please send correspondence to: Michael B. Centorino, MD, James A. Haley Veterans’ Hospital, Mental Health & Behavioral Sciences (116A), 13000 Bruce B. Downs Boulevard, Tampa, FL 33612 (e-mail: [email protected]). Journal of Psychiatric Practice: November 2020 - Volume 26 - Issue 6 - p 434-443 doi: 10.1097/PRA.0000000000000506 Buy Metrics Abstract Neuroplasticity is an area of expanding interest in psychiatry. Plasticity and metaplasticity are processes contributing to the scaling up and down of neuronal connections, and they are involved with changes in learning, memory, mood, and sleep. Effective mood treatments, including repetitive transcranial magnetic stimulation (rTMS), are reputed to work via changes in neuronal circuitry. This article explores the interrelatedness of sleep, plasticity, and rTMS treatment. A PubMed-based literature review was conducted to identify all available studies examining the relationship of rTMS, plasticity, and sleep. Key words used in this search included “TMS,” “transcranial magnetic stimulation,” “plasticity,” “metaplasticity,” “sleep,” and “insomnia.” Depressed mood tends to be associated with impaired neural plasticity, while antidepressant treatments can augment neural plasticity. rTMS impacts plasticity, yielding long-lasting effects, with differing impacts on the waking and sleeping brain. Higher quality sleep promotes plasticity and learning. Reports on the sleep impact of high-frequency and low-frequency rTMS are mixed. The efficacy of rTMS may rely on brain plasticity manipulation, enhanced via the stimulation of neural circuits. Total sleep time and sleep continuity are sleep qualities that are likely necessary but insufficient for the homeostatic plasticity driven by slow-wave sleep. Understanding the relationship between sleep and rTMS treatment is likely critical to enhancing outcomes. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.