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Al-Sharif NB, Zavaliangos-Petropulu A, Narr KL. A review of diffusion MRI in mood disorders: mechanisms and predictors of treatment response. Neuropsychopharmacology 2024:10.1038/s41386-024-01894-3. [PMID: 38902355 DOI: 10.1038/s41386-024-01894-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/15/2024] [Accepted: 05/21/2024] [Indexed: 06/22/2024]
Abstract
By measuring the molecular diffusion of water molecules in brain tissue, diffusion MRI (dMRI) provides unique insight into the microstructure and structural connections of the brain in living subjects. Since its inception, the application of dMRI in clinical research has expanded our understanding of the possible biological bases of psychiatric disorders and successful responses to different therapeutic interventions. Here, we review the past decade of diffusion imaging-based investigations with a specific focus on studies examining the mechanisms and predictors of therapeutic response in people with mood disorders. We present a brief overview of the general application of dMRI and key methodological developments in the field that afford increasingly detailed information concerning the macro- and micro-structural properties and connectivity patterns of white matter (WM) pathways and their perturbation over time in patients followed prospectively while undergoing treatment. This is followed by a more in-depth summary of particular studies using dMRI approaches to examine mechanisms and predictors of clinical outcomes in patients with unipolar or bipolar depression receiving pharmacological, neurostimulation, or behavioral treatments. Limitations associated with dMRI research in general and with treatment studies in mood disorders specifically are discussed, as are directions for future research. Despite limitations and the associated discrepancies in findings across individual studies, evolving research strongly indicates that the field is on the precipice of identifying and validating dMRI biomarkers that could lead to more successful personalized treatment approaches and could serve as targets for evaluating the neural effects of novel treatments.
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Affiliation(s)
- Noor B Al-Sharif
- Departments of Neurology and Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
| | - Artemis Zavaliangos-Petropulu
- Departments of Neurology and Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Katherine L Narr
- Departments of Neurology and Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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2
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Hernández-Sauret A, Martin de la Torre O, Redolar-Ripoll D. Use of transcranial magnetic stimulation (TMS) for studying cognitive control in depressed patients: A systematic review. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2024:10.3758/s13415-024-01193-w. [PMID: 38773020 DOI: 10.3758/s13415-024-01193-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 05/23/2024]
Abstract
Major depressive disorder (MDD) is a debilitating mental disorder and the leading cause of disease burden. Major depressive disorder is associated with emotional impairment and cognitive deficit. Cognitive control, which is the ability to use perceptions, knowledge, and information about goals and motivations to shape the selection of goal-directed actions or thoughts, is a primary function of the prefrontal cortex (PFC). Psychotropic medications are one of the main treatments for MDD, but they are not effective for all patients. An alternative treatment is transcranial magnetic stimulation (TMS). Previous studies have provided mixed results on the cognitive-enhancing effects of TMS treatment in patients with MDD. Some studies have found significant improvement, while others have not. There is a lack of understanding of the specific effects of different TMS protocols and stimulation parameters on cognitive control in MDD. Thus, this review aims to synthesize the effectiveness of the TMS methods and a qualitative assessment of their potential benefits in improving cognitive functioning in patients with MDD. We reviewed 21 studies in which participants underwent a treatment of any transcranial magnetic stimulation protocol, such as repetitive TMS or theta-burst stimulation. One of the primary outcome measures was any change in the cognitive control process. Overall, the findings indicate that transcranial magnetic stimulation (TMS) may enhance cognitive function in patients with MDD. Most of the reviewed studies supported the notion of cognitive improvement following TMS treatment. Notably, improvements were predominantly observed in inhibition, attention, set shifting/flexibility, and memory domains. However, fewer significant improvements were detected in evaluations of visuospatial function and recognition, executive function, phonemic fluency, and speed of information processing. This review found evidence supporting the use of TMS as a treatment for cognitive deficits in patients with MDD. The results are promising, but further research is needed to clarify the specific TMS protocol and stimulation locations that are most effective.
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Affiliation(s)
- Ana Hernández-Sauret
- Cognitive Neurolab, Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Rambla del Poblenou 156, Barcelona, Spain.
- Instituto Brain360, Unidad Neuromodulación y Neuroimagen, Calle Maó 9, Barcelona, Spain.
| | - Ona Martin de la Torre
- Cognitive Neurolab, Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Rambla del Poblenou 156, Barcelona, Spain
- Instituto Brain360, Unidad Neuromodulación y Neuroimagen, Calle Maó 9, Barcelona, Spain
| | - Diego Redolar-Ripoll
- Cognitive Neurolab, Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Rambla del Poblenou 156, Barcelona, Spain
- Instituto Brain360, Unidad Neuromodulación y Neuroimagen, Calle Maó 9, Barcelona, Spain
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3
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Guo W, Liu B, Wei X, Ju Y, Wang M, Dong Q, Lu X, Sun J, Zhang L, Guo H, Zhao F, Li W, Li Z, Liao M, Zhang L, Liu J, Zhang Y, Li L. The longitudinal change pattern of cognitive subtypes in medication-free patients with major depressive disorder: a cluster analysis. Psychiatry Res 2023; 327:115413. [PMID: 37579539 DOI: 10.1016/j.psychres.2023.115413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/24/2023] [Accepted: 08/11/2023] [Indexed: 08/16/2023]
Abstract
This study aimed to investigate whether there are different cognitive subtypes in patients with major depressive disorder (MDD) and the change pattern of cognitive clusters across the course of MDD. A battery of comprehensive cognitive tests was used to assess the executive function, processing speed, attention, and memory of 153 medication-free patients and 142 healthy controls (HCs). After 6 months of treatment with antidepressants, 87 patients completed cognitive tests again. K-means cluster analysis was performed to determine the cognitive subtypes. A preserved cognition cluster and an impaired cognition cluster were identified in the acute episode phase and the 6-month follow-up phase. 80.5% of the patients remained in their original subgroup after 6 months of treatment. The impaired cognition cluster during the 6-month follow-up period could be predicted by impaired cognition during the episode phase, disease state (remission or non-remission), current illness duration, and education level. This study supporting the heterogeneity of cognitive performance across the course of disease in patients with MDD using cluster analysis. It was found that cognitive impairment during depressive episodes was predictive of poorer cognitive performance even after treatment with antidepressants. Therefore, interventions targeting cognitive function from the early stages of MDD is essential.
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Affiliation(s)
- Weilong Guo
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Bangshan Liu
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Xiyu Wei
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Yumeng Ju
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Mi Wang
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Qiangli Dong
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Xiaowen Lu
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Jinrong Sun
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Liang Zhang
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Hua Guo
- Zhumadian Psychiatric Hospital, Zhumadian, Henan, 463000, China
| | - Futao Zhao
- Zhumadian Psychiatric Hospital, Zhumadian, Henan, 463000, China
| | - Weihui Li
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Zexuan Li
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Mei Liao
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Li Zhang
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Jin Liu
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
| | - Yan Zhang
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
| | - Lingjiang Li
- National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
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4
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Pan WG, Hu XY, Zhu DD, Li L, Bao F, Ren L, Mao PX, Ma X, Ren YP, Tang YL. The cognitive effects of adjunctive repetitive transcranial magnetic stimulation for late-onset depression: a randomized controlled trial with 4 week follow-up. Front Psychiatry 2023; 14:1240261. [PMID: 37614650 PMCID: PMC10442575 DOI: 10.3389/fpsyt.2023.1240261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/27/2023] [Indexed: 08/25/2023] Open
Abstract
Objectives Cognitive impairment is common and linked to poor outcomes in patients with late-onset depression (LOD). The cognitive effects of repetitive transcranial magnetic stimulation (rTMS) for LOD are not well understood. This study aimed to investigate the effects of rTMS on cognitive function in elderly patients with LOD. Methods In total, 58 elderly patients (aged 60 to 75 years) with depression were enrolled and randomly assigned to an active rTMS group or a sham group. The participants received active or sham rTMS over the left dorsolateral prefrontal cortex for 4 weeks, 5 days a week, at a frequency of 10 Hz rTMS and 120% of the motor threshold (MT). Cognitive function was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) at baseline, the end of the 4 week treatment period, and at the 4 week follow-up. Results The active rTMS group showed significant improvements in immediate memory and attention scores on the RBANS compared to the sham group. However, no significant differences were observed between the two groups in other cognitive domains assessed by the RBANS. No serious adverse events related to rTMS treatment were observed. Conclusion Treatment with 120% MT rTMS was associated with improvement in cognitive defects related to the active phase of LOD. These findings suggest that rTMS could provide early improvements in cognitive function in clinical settings for elderly patients with LOD.Clinical trial registration: https://www.chictr.org.cn/showproj.html?proj=40698, identifier ChiCTR1900024445.
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Affiliation(s)
- Wei-gang Pan
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xiao-yue Hu
- Department of Psychiatry, Xicheng District Pingan Hospital, Beijing, China
| | - Dan-di Zhu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Li Li
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Feng Bao
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Li Ren
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Pei-xian Mao
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Xin Ma
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yan-ping Ren
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yi-lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GE, United States
- Mental Health Service Line, Atlanta VA Medical Center, Decatur, GE, United States
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Cheng CM, Jeng JS. Psychiatric rehabilitation and cognitive deficit for treatment-resistant depression. PROGRESS IN BRAIN RESEARCH 2023; 281:91-113. [PMID: 37806718 DOI: 10.1016/bs.pbr.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
Patients with TRD often experience persistent impairment of affective, psychosocial, and cognitive function, which impedes their recovery. The continuation of pharmacotherapy for patients with TRD remains the cornerstone of functional recovery. Cognitive dysfunction is prevalent in patients with MDD and may make patients' depressive symptoms and psychosocial functioning worse, even in the remitted stage of illness. Deficits can manifest not only in specific cognitive domains but also in global cognitive function, which may reflect underlying persistent pathophysiological changes. Compared with nontreatment-resistant patients with MDD, patients with TRD exhibit greater subjective and objective cognitive impairment, which possibly contributes to a greater adverse impact on daily functioning. Cognitive and psychosocial remission should be a goal in treating MDD. How to appropriately and individualized perform pharmacological intervention, psychotherapy, neuromodulation, cognitive remediation or other rehabilitation treatment programs is a critical step to achieve our goal. Integrating multiple interventions that engage multiple physiological systems with a multidisciplinary team warrants increased attention, and personalized therapeutic programs may facilitate the complete restoration of patients' everyday functioning.
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Affiliation(s)
- Chih-Ming Cheng
- Attending Psychiatrist, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Lecturer, Division of Psychiatry, College of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.
| | - Jia-Shyun Jeng
- Attending Psychiatrist, Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
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6
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Alcon CA, Wang-Price S. Non-invasive brain stimulation and pain neuroscience education in the cognitive-affective treatment of chronic low back pain: Evidence and future directions. FRONTIERS IN PAIN RESEARCH 2022; 3:959609. [PMID: 36438443 PMCID: PMC9686004 DOI: 10.3389/fpain.2022.959609] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/24/2022] [Indexed: 11/12/2022] Open
Abstract
Chronic low back pain (CLBP) is among the leading causes of disability worldwide. Beyond the physical and functional limitations, people's beliefs, cognitions, and perceptions of their pain can negatively influence their prognosis. Altered cognitive and affective behaviors, such as pain catastrophizing and kinesiophobia, are correlated with changes in the brain and share a dynamic and bidirectional relationship. Similarly, in the presence of persistent pain, attentional control mechanisms, which serve to organize relevant task information are impaired. These deficits demonstrate that pain may be a predominant focus of attentional resources, leaving limited reserve for other cognitively demanding tasks. Cognitive dysfunction may limit one's capacity to evaluate, interpret, and revise the maladaptive thoughts and behaviors associated with catastrophizing and fear. As such, interventions targeting the brain and resultant behaviors are compelling. Pain neuroscience education (PNE), a cognitive intervention used to reconceptualize a person's pain experiences, has been shown to reduce the effects of pain catastrophizing and kinesiophobia. However, cognitive deficits associated with chronic pain may impact the efficacy of such interventions. Non-invasive brain stimulation (NIBS), such as transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS) has been shown to be effective in the treatment of anxiety, depression, and pain. In addition, as with the treatment of most physical and psychological diagnoses, an active multimodal approach is considered to be optimal. Therefore, combining the neuromodulatory effects of NIBS with a cognitive intervention such as PNE could be promising. This review highlights the cognitive-affective deficits associated with CLBP while focusing on current evidence for cognition-based therapies and NIBS.
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Affiliation(s)
- Cory A. Alcon
- Department of Physical Therapy, High Point University, High Point, NC, United States
- School of Physical Therapy, Texas Woman’s University, Dallas, TX, United States
- Correspondence: Cory A. Alcon
| | - Sharon Wang-Price
- School of Physical Therapy, Texas Woman’s University, Dallas, TX, United States
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7
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Daglas-Georgiou R, Bryce S, Smith G, Kaur M, Cheng N, De Rozario M, Wood SJ, Allott K. Treatments for objective and subjective cognitive functioning in young people with depression: Systematic review of current evidence. Early Interv Psychiatry 2022; 16:1057-1074. [PMID: 34825492 DOI: 10.1111/eip.13248] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 08/31/2021] [Accepted: 11/07/2021] [Indexed: 11/26/2022]
Abstract
AIM Cognitive deficits are recognized features of depressive disorders in youth aged 12-25. These deficits are distressing, predict functional impairment and limit the effectiveness of psychological therapies. Cognitive enhancement using behavioural, biochemical or physical treatments may be useful in young people with depression, but studies have not been synthesized. The aim was to systematically review the evidence for treatments for objective and subjective cognitive functioning, and their acceptability and functional outcomes in people aged 12-25 with depression. METHOD Three electronic databases were searched for articles using pre-specified criteria. Pharmacological treatments were not eligible. Risk of bias was rated using the Cochrane Collaboration's revised risk-of-bias tool. Dual full-text article screening, data extraction and quality ratings were completed. RESULTS Twelve studies were included for review (median participant age: 20.39 years), five of which were randomized-controlled trials (RCTs). Sample sizes were generally small (median = 23; range: 9-46). Eight studies investigated behavioural treatments including aerobic exercise, cognitive training and education or strategy-based methods. Four studies examined repetitive transcranial magnetic brain stimulation (rTMS). Most behavioural treatments revealed preliminary evidence of improved cognitive function in youth depression. Consent rates were greatest for exercise- and education-based approaches, which may indicate higher acceptability levels. Findings from rTMS trials were mixed, with only half showing cognitive improvement. Functional outcomes were reported by three behavioural treatment trials and one rTMS trial, with functional improvement reported only in the former. Some concern of risk of bias was found in each RCT. CONCLUSION Behavioural treatments, such as exercise, cognitive training and education/strategy-focused techniques, show encouraging results and appear to be acceptable methods of addressing cognitive deficits in youth depression based on participation rates. Brain stimulation and biochemical treatments (e.g., nutrient-based treatment) require further investigation.
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Affiliation(s)
- Rothanthi Daglas-Georgiou
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Shayden Bryce
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Gabriel Smith
- Faculty of Science, The University of Melbourne, Parkville, Victoria, Australia
| | - Manreena Kaur
- Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia.,School of Psychiatry, University of New South Wales, Kensington, Australia.,Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Department of Psychiatry, Monash University, Melbourne, Australia
| | - Nicholas Cheng
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Magdalene De Rozario
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Stephen J Wood
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.,School of Psychology, University of Birmingham, Edgbaston, UK
| | - Kelly Allott
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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Bahun I, Ivezic E, Đogas VV, Filipcic IS, Filipcic I. A pilot study of accelerated deep transcranial magnetic stimulation effects on cognitive functioning in patients diagnosed with treatment resistant major depressive disorder. Psychiatry Res 2022; 316:114750. [PMID: 35944371 DOI: 10.1016/j.psychres.2022.114750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to assess cognitive functioning in patients diagnosed with major depressive disorder (MDD) treated with two different accelerated deep transcranial magnetic stimulation (dTMS) modalities as an add-on to stable pharmacotherapy.A total of 32 adult psychiatric inpatients diagnosed with treatment resistant MDD were allocated by stratified randomization into two groups: a group treated with dTMS twice a day during 2 weeks, and a group treated with dTMS twice a day during 3 weeks. Clinical psychologists assessed participants´ cognitive functions (memory, visuospatial functioning, executive functions, psychomotor speed, verbal fluency) via a battery of instruments, after the inclusion, and by the end of treatment.Our findings showed mild to moderate improvements in the majority of administered tests measuring different cognitive functions, meaning that patients achieved significantly better results by the end of the treatment compared to baseline, regardless of the duration of the treatment (2 or 3 weeks). No adverse effects on cognition were observed. The results seem promising in the context of treating the cognitive symptoms associated with functional recovery of patients suffering from depression.
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Affiliation(s)
- Ivana Bahun
- University Psychiatric Clinic Sveti Ivan, Jankomir 11, Zagreb 10090, Croatia
| | - Ena Ivezic
- University Psychiatric Clinic Sveti Ivan, Jankomir 11, Zagreb 10090, Croatia; Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.
| | | | - Ivona Simunovic Filipcic
- Department of Psychiatry and Psychological Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Igor Filipcic
- University Psychiatric Clinic Sveti Ivan, Jankomir 11, Zagreb 10090, Croatia; Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
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Tateishi H, Setoyama D, Kato TA, Kang D, Matsushima J, Nogami K, Mawatari S, Kojima R, Fujii Y, Sakemura Y, Shiraishi T, Imamura Y, Maekawa T, Asami T, Mizoguchi Y, Monji A. Changes in the metabolites of cerebrospinal fluid induced by rTMS in treatment-resistant depression: A pilot study. Psychiatry Res 2022; 313:114636. [PMID: 35594657 DOI: 10.1016/j.psychres.2022.114636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 04/04/2022] [Accepted: 05/12/2022] [Indexed: 02/08/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) improves depressive symptoms in treatment-resistant depression (TRD). This study aimed to analyze changes in cerebrospinal fluid (CSF) metabolites in patients with TRD after rTMS. Five patients with TRD were enrolled in a high frequency (10-Hz) rTMS study. The concentration of 72 CSF metabolites were measured at baseline and at the end of the 6-week rTMS treatment. rTMS significantly increased CSF niacinamide, kynurenine, and creatinine levels and significantly decreased CSF cystine levels, but not the levels of the other 68 CSF metabolites. This is the first CSF metabolomics study on patients with TRD who underwent rTMS.
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Affiliation(s)
- Hiroshi Tateishi
- Department of Psychiatry, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan.
| | - Daiki Setoyama
- Department of Clinical Chemistry and Laboratory Medicine, Graduate School of Medical Sciences, Kyushu University, Maidashi Higashi-ku 3-1-1, Fukuoka, 812-8582, Japan
| | - Takahiro A Kato
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Maidashi Higashi-ku 3-1-1, Fukuoka, 812-8582, Japan.
| | - Dongchon Kang
- Department of Clinical Chemistry and Laboratory Medicine, Graduate School of Medical Sciences, Kyushu University, Maidashi Higashi-ku 3-1-1, Fukuoka, 812-8582, Japan
| | - Jun Matsushima
- Department of Psychiatry, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan
| | - Kojiro Nogami
- Department of Psychiatry, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan
| | - Seiji Mawatari
- Department of Psychiatry, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan
| | - Ryohei Kojima
- Department of Psychiatry, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan
| | - Yuka Fujii
- Department of Psychiatry, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan
| | - Yuta Sakemura
- Department of Psychiatry, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan
| | - Takumi Shiraishi
- Department of Psychiatry, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan
| | - Yoshiomi Imamura
- Department of Psychiatry, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan
| | - Toshihiko Maekawa
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Maidashi Higashi-ku 3-1-1, Fukuoka, 812-8582, Japan
| | - Toyoko Asami
- Department of Rehabilitation Medicine, Saga University Hospital, Nabeshima 5-1-1, Saga, 849-8501, Japan
| | - Yoshito Mizoguchi
- Department of Psychiatry, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan
| | - Akira Monji
- Department of Psychiatry, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan
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10
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Gregory EC, Torres IJ, Blumberger DM, Downar J, Daskalakis ZJ, Vila-Rodriguez F. Repetitive Transcranial Magnetic Stimulation Shows Longitudinal Improvements in Memory in Patients With Treatment-Resistant Depression. Neuromodulation 2022; 25:596-605. [DOI: 10.1016/j.neurom.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/27/2021] [Accepted: 09/13/2021] [Indexed: 10/19/2022]
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11
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Mehta S, Downar J, Mulsant BH, Voineskos D, Daskalakis ZJ, Weissman CR, Vila-Rodriguez F, Blumberger DM. Effect of high frequency versus theta-burst repetitive transcranial magnetic stimulation on suicidality in patients with treatment-resistant depression. Acta Psychiatr Scand 2022; 145:529-538. [PMID: 35188677 PMCID: PMC9007836 DOI: 10.1111/acps.13412] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/08/2022] [Accepted: 02/01/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate the effect of 10 Hz repetitive transcranial magnetic stimulation (rTMS) and intermittent theta-burst stimulation (iTBS) on suicidality in patients with treatment-resistant depression (TRD). METHODS We used data from a three-site randomized clinical trial comparing 10 Hz rTMS and iTBS applied to the left dorsolateral prefrontal cortex (DLPFC) in patients with TRD. We compared the effect of 10Hz rTMS and iTBS on suicidality as measured by the suicide item of the Hamilton Depression Rating Scale 17-item (HDRS-17). RESULTS Suicidality remitted in 71 (43.7%) participants randomized to 10Hz stimulation and 91 (49.1%) participants randomized to iTBS, without a significant difference between the proportions in the two groups (Χ2 = 0.674, df = 1, p = 0.4117). There was a significant correlation between change in suicidality and change in depression severity for both modalities (10 Hz, Pearson's r = 0.564; iTBS, Pearson's r = 0.502), with a significantly larger decrease in depression severity for those in whom suicidality remitted compared to those in whom it did not (t = 10.912, df = 276.8, p < 0.001). CONCLUSIONS Both 10 Hz and iTBS rTMS were effective in reducing suicidality in TRD. Future trials of iTBS for depression should include discrete measures of suicidality.
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Affiliation(s)
- Shobha Mehta
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, M5J 1H4, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, M5T 1R8, Canada
| | - Jonathan Downar
- Department of Psychiatry, University of Toronto, Toronto, Ontario, M5T 1R8, Canada,Centre for Mental Health and Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Benoit H. Mulsant
- Department of Psychiatry, University of Toronto, Toronto, Ontario, M5T 1R8, Canada,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, M5T 1R8, Canada
| | - Daphne Voineskos
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, M5J 1H4, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, M5T 1R8, Canada,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, M5T 1R8, Canada
| | - Zafiris J. Daskalakis
- Department of Psychiatry, University of California San Diego, La Jolla, California, 92093-0021, United States
| | - Cory R. Weissman
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, M5J 1H4, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, M5T 1R8, Canada
| | - Fidel Vila-Rodriguez
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, V6T 1Z4, Canada,Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Vancouver, British Columbia, V6T 2A1, Canada
| | - Daniel M. Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, M5J 1H4, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, M5T 1R8, Canada,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, M5T 1R8, Canada
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12
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Pabst A, Proksch S, Médé B, Comstock DC, Ross JM, Balasubramaniam R. A systematic review and meta-analysis of the efficacy of intermittent theta burst stimulation (iTBS) on cognitive enhancement. Neurosci Biobehav Rev 2022; 135:104587. [PMID: 35202646 DOI: 10.1016/j.neubiorev.2022.104587] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 02/02/2022] [Accepted: 02/14/2022] [Indexed: 12/21/2022]
Abstract
Intermittent theta-burst stimulation (iTBS) has been used to focally regulate excitability of neural cortex over the past decade - however there is little consensus on the generalizability of effects reported in individual studies. Many studies use small sample sizes (N < 30), and there is a considerable amount of methodological heterogeneity in application of the stimulation itself. This systematic meta-analysis aims to consolidate the extant literature and determine if up-regulatory theta-burst stimulation reliably enhances cognition through measurable behavior. Results show that iTBS - when compared to suitable control conditions - may enhance cognition when outlier studies are removed, but also that there is a significant amount of heterogeneity across studies. Significant contributors to between-study heterogeneity include location of stimulation and method of navigation to the stimulation site. Surprisingly, the type of cognitive domain investigated was not a significant contributor of heterogeneity. The findings of this meta-analysis demonstrate that standardization of iTBS is urgent and necessary to determine if neuroenhancement of particular cognitive faculties are reliable and robust, and measurable through observable behavior.
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Affiliation(s)
- Alexandria Pabst
- Department of Cognitive and Information Sciences, University of California, Merced, 5200 North Lake Road, Merced, CA 95343, USA; Accenture Labs, 415 Mission Street, San Francisco, CA 94105, USA.
| | - Shannon Proksch
- Department of Cognitive and Information Sciences, University of California, Merced, 5200 North Lake Road, Merced, CA 95343, USA.
| | - Butovens Médé
- Department of Cognitive and Information Sciences, University of California, Merced, 5200 North Lake Road, Merced, CA 95343, USA.
| | - Daniel C Comstock
- Department of Cognitive and Information Sciences, University of California, Merced, 5200 North Lake Road, Merced, CA 95343, USA; Center for Mind and Brain, University of California, Davis, 267 Cousteau Place, Davis, CA 95618, USA.
| | - Jessica Marie Ross
- Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA; Veterans Affairs Palo Alto Healthcare System, Stanford University, 3801 Miranda Ave, Palo Alto, CA 94304, USA.
| | - Ramesh Balasubramaniam
- Department of Cognitive and Information Sciences, University of California, Merced, 5200 North Lake Road, Merced, CA 95343, USA.
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13
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Tateishi H, Mizoguchi Y, Monji A. Is the Therapeutic Mechanism of Repetitive Transcranial Magnetic Stimulation in Cognitive Dysfunctions of Depression Related to the Neuroinflammatory Processes in Depression? Front Psychiatry 2022; 13:834425. [PMID: 35280153 PMCID: PMC8907472 DOI: 10.3389/fpsyt.2022.834425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/28/2022] [Indexed: 12/27/2022] Open
Abstract
The lifetime prevalence of depression is reported to be >10%, and it is an important illness that causes various disabilities over a long period of life. Neuroinflammation process is often reported to be closely linked to the pathophysiology of depression. Approximately one-third of depression is known to be treatment-resistant depression (TRD), in which the symptoms are refractory to adequate treatment. Cognitive dysfunction is one of the most important symptoms of depression that impedes the rehabilitation of patients with depression. Repetitive transcranial magnetic stimulation (rTMS) is a minimally invasive and effective treatment for TRD and is also known to be effective in cognitive dysfunction in depression. Since the details of the therapeutic mechanism of rTMS are still unknown, we have been conducting studies to clarify the therapeutic mechanism of rTMS, especially focusing on cognitive dysfunction in depression. In the present review, we present our latest results and discuss them from the standpoint of the neuroinflammation hypothesis of depression, while citing relevant literature.
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Affiliation(s)
- Hiroshi Tateishi
- Department of Psychiatry, Faculty of Medicine, Saga University, Saga, Japan
| | - Yoshito Mizoguchi
- Department of Psychiatry, Faculty of Medicine, Saga University, Saga, Japan
| | - Akira Monji
- Department of Psychiatry, Faculty of Medicine, Saga University, Saga, Japan
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14
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Chen X, Zhang T, Shan X, Yang Q, Zhang P, Zhu H, Jiang F, Liu C, Li Y, Li W, Xu J, Shen H. High-frequency repetitive transcranial magnetic stimulation alleviates the cognitive side effects of electroconvulsive therapy in major depression. Front Psychiatry 2022; 13:1002809. [PMID: 36262627 PMCID: PMC9575950 DOI: 10.3389/fpsyt.2022.1002809] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/12/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The retrospective study aimed to explore the difference in mood outcomes and cognitive function between high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) over dorsolateral prefrontal cortex (DLPFC) and electroconvulsive therapy in major depression disorder (MDD) patients and to examine the improvement of HF-rTMS on cognitive impairment evoked by electroconvulsive therapy (ECT). MATERIALS AND METHODS A total of 116 participants with MDD, who completed a 4-week follow-up assessment, were enrolled. The cohort consisted of 26 cases classed as control, 46 participants administrated with HF-rTMS (HF-rTMS group), 22 patients treated with ECT (ECT group), and 23 cases treated with HF-rTMS and ECT at the course of hospitalization (HF-rTMS + ECT group). Medication was kept constant as well in all participants. The 17-item Hamilton Depression Rating Scale for Depression (HAMD-17) and 14-item Hamilton Anxiety Rating Scale (HAMA-14) were used to assess depression and anxiety, respectively. Montreal Cognitive Assessment (MoCA) was to elevate cognitive function. RESULTS No statistical significance was found for baseline in sociodemographic, characteristics of depression, anxiety and cognition, and psychopharmaceutic dosages among control, HF-rTMS, ECT, and HF-rTMS + ECT groups (p > 0.05). Compared with baseline level, total scores of HAMD-17 and HAMA-14 significantly decreased at the end of 4 weeks after treatment (p < 0.001). Furthermore, the decline in scores of HAMD-17 and its sleep disorder and retardation factors from baseline to post-treatment was greater in HF-rTMS, ECT, and HF-rTMS + ECT group than in control (p < 0.05), and there was a significant difference between control and HF-rTMS group in the decline of psychological factor of HAMA-14 (p < 0.01). ECT treatment evoked total score of MoCA to decrease significantly at the end of 4-week after intervention (p < 0.001), and the decline in scores of MoCA and its delayed recall and language performances from baseline to post-treatment was greater in ECT than control, HF-rTMS, and HF-rTMS + ECT (p < 0.05). CONCLUSION High-frequency repetitive transcranial magnetic stimulation improved psychological anxiety and ameliorated the cognition impairment evoked by ECT though it had the same anti-depressant efficacy as ECT.
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Affiliation(s)
- Xing Chen
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Tongtong Zhang
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Xiaoyan Shan
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Qun Yang
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Peiyun Zhang
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Haijiao Zhu
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Fei Jiang
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Chao Liu
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Yanzhong Li
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Weijun Li
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Jian Xu
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Hongmei Shen
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China.,Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong, China
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15
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Bonotis K, Anargyros K, Liaskopoulos N, Barlogianni AM. Evaluation of memory performance in patients with brain disorders following rTMS treatment. A systematic review. Clin Neurophysiol 2021; 135:126-153. [DOI: 10.1016/j.clinph.2021.11.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 10/24/2021] [Accepted: 11/29/2021] [Indexed: 12/01/2022]
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16
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Increasing Physical Activity among Breast Cancer Survivors by Modulating Temporal Orientation with rTMS: Feasibility and Potential Efficacy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910052. [PMID: 34639353 PMCID: PMC8508508 DOI: 10.3390/ijerph181910052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 12/03/2022]
Abstract
Maintaining adequate amounts of physical activity is a critical component of survivorship care for women with breast cancer. Increased physical activity is associated with increases in well-being, quality of life, and longevity, but women with cancer face unique, cancer-related factors that might affect physical activity. Consistent with the Competing Neurobehavioral Decision Systems model of decision making, we proposed to decrease delay discounting and increase physical activity by stimulating the executive function system via high-frequency repetitive transcranial magnetic stimulation (HF rTMS) of the left dorsolateral prefrontal cortex (LDLPFC). This randomized, sham-controlled, double-blinded trial examined the feasibility and potential efficacy of this approach to increase physical activity in breast cancer survivors. We hypothesized that active rTMS would significantly increase the mean number of steps per day and decrease delay discounting. Participants (n = 30) were primarily middle-aged (M = 53.7, SD = 7.9) and white with a mean BMI and body mass indices below 40. Indicators of feasibility and limited efficacy testing were positive. Although repeated-measures ANOVA revealed no significant changes in delay discounting, generalized estimating equations (GEE) found that participants in the active condition increased their mean daily steps by 400 steps per day, while those in the sham condition decreased this by nearly 600 steps per day. These findings indicate that the continued investigation of HF rTMS for increasing physical activity among women with breast cancer is justified.
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17
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Peripheral endocannabinoid serum level in association with repetitive transcranial magnetic stimulation (rTMS) treatment in patients with major depressive disorder. Sci Rep 2021; 11:8867. [PMID: 33893327 PMCID: PMC8065048 DOI: 10.1038/s41598-021-87840-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/31/2021] [Indexed: 11/29/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is an effective and well tolerable biological intervention in major depressive disorder (MDD) contributing to rapid symptom improvement. Molecular mechanisms underpinning the therapeutic effects of rTMS have still not been clarified. Recently published animal data implicated relevant associations with changes in endocannabinoid (eCB) brain levels during rTMS treatment, human studies, however, have not been published. In our study we assessed the detailed phenotypic spectrum of MDD and serum 2-arachidnoylglycerol (2-AG) and anandamide (AEA) levels in 18 patients with treatment-resistant depression before, immediately following, and two weeks after completion of a 10-day rTMS treatment. We found significant associations between serum 2-AG level changes from pretreatment to 2 weeks after treatment and symptom reduction. The greater the increase of 2-AG levels, the greater the improvement of depressive (p = 0.031), anxious (p = 0.007) and anhedonia symptoms (p = 0.047). Here we report for the first time a significant association of human circulating eCB and antidepressant effect of rTMS. Our data may indicate that direct stimulation of targeted brain areas can rapidly alleviate depressive complaints via activation of the eCB system.
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18
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Application of transcranial magnetic stimulation for major depression: Coil design and neuroanatomical variability considerations. Eur Neuropsychopharmacol 2021; 45:73-88. [PMID: 31285123 DOI: 10.1016/j.euroneuro.2019.06.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 04/22/2019] [Accepted: 06/10/2019] [Indexed: 12/18/2022]
Abstract
High-frequency repeated transcranial magnetic stimulation (rTMS) as a treatment for major depressive disorder (MDD) has received FDA clearance for both the figure-of-8 coil (figure-8 coil) and the H1 coil. The FDA-cleared MDD protocols for both coils include high frequency (10-18 Hz) stimulation targeting the dorsolateral prefrontal cortex (dlPFC) at an intensity that is 120% of the right-hand resting motor threshold. Despite these similar parameters, the two coils generate distinct electrical fields (e-fields) which result in differences in the cortical stimulation they produce. Due to the differences in coil designs, the H1 coil induces a stimulation e-field that is broader and deeper than the one induced by the figure-8 coil. In this paper we review theoretical and clinical implications of these differences between the two coils and compare evidence of their safety and efficacy in treating MDD. We present the design principles of the coils, the challenges of identifying, finding, and stimulating the optimal brain target of each individual (both from functional and connectivity perspectives), and the possible implication of stimulating outside that target. There is only one study that performed a direct comparison between clinical effectiveness of the two coils, using the standard FDA-approved protocols in MDD patients. This study indicated clinical superiority of the H1 coil but did not measure long-term effects. Post-marketing data suggest that both coils have a similar safety profile in clinical practice, whereas effect size comparisons of the two respective FDA pivotal trials suggests that the H1 coil may have an advantage in efficacy. We conclude that further head-to-head experiments are needed, especially ones that will compare long-term effects and usage of similar temporal stimulation parameters and similar number of pulses.
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19
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Serafini G, Canepa G, Aguglia A, Amerio A, Bianchi D, Magnani L, Dell'Osso B, Pompili M, Fitzgerald PB, Amore M. Effects of repetitive transcranial magnetic stimulation on suicidal behavior: A systematic review. Prog Neuropsychopharmacol Biol Psychiatry 2021; 105:109981. [PMID: 32485190 DOI: 10.1016/j.pnpbp.2020.109981] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/20/2020] [Accepted: 05/20/2020] [Indexed: 01/29/2023]
Abstract
The efficacy and tolerability of repetitive transcranial magnetic stimulation (rTMS) in major depression is well-known and documented by existing studies. However, whether rTMS may be effective on suicidal behavior is unclear and needs to be further investigated. This systematic review is aimed to investigate the available literature about the effects of rTMS on suicidal behavior and provide a comprehensive overview of the available evidence. A systematic search regarding the association between rTMS and suicidal behavior was carried out. All relevant articles concerning this association were comprehensively searched on PubMed, Scopus, Science Direct, and PsycInfo databases. After a careful search, 16 articles (7 sham-controlled studies, 5 uncontrolled studies, 4 case-series) met inclusion criteria and were selected in this systematic review. Overall, the left dorsolateral prefrontal cortex (DLPFC) was identified as the most frequent stimulation target by most studies. Unfortunately, actually it is not clear whether suicidal behavior reduction may be mediated, at least in some cases, by depression attenuation. While some methodological heterogeneity was found in terms of stimulation parameters (e.g., frequency, number of sessions, intensity of stimulation), most of the analyzed articles showed that rTMS is a safe, applicable, well tolerated and reproducible method in treating suicidal behavior. The most effective treatment seems to be the bilateral rTMS as well as the combination with antidepressants. Further longitudinal studies are required in order to replicate the mentioned study results.
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Affiliation(s)
- Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Giovanna Canepa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Mood Disorders Program, Tufts Medical Center, Boston, MA 02111, USA
| | - Davide Bianchi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Luca Magnani
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Bernardo Dell'Osso
- Department of Mental Health, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy; Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford University, CA, USA; CRC "Aldo Ravelli" Center for Neurotechnology and Brain Therapeutic, University of Milan, Milan, Italy; Centro per lo studio dei meccanismi molecolari alla base delle patologie neuro-psico-geriatriche, University of Milan, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Suicide Prevention Center, Sant'Andrea Hospital, University of Rome, Rome, Italy
| | - Paul B Fitzgerald
- Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Monash Universitty Department of Psychiatry, Camberwell, VIC, Australia
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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20
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Rossi S, Antal A, Bestmann S, Bikson M, Brewer C, Brockmöller J, Carpenter LL, Cincotta M, Chen R, Daskalakis JD, Di Lazzaro V, Fox MD, George MS, Gilbert D, Kimiskidis VK, Koch G, Ilmoniemi RJ, Lefaucheur JP, Leocani L, Lisanby SH, Miniussi C, Padberg F, Pascual-Leone A, Paulus W, Peterchev AV, Quartarone A, Rotenberg A, Rothwell J, Rossini PM, Santarnecchi E, Shafi MM, Siebner HR, Ugawa Y, Wassermann EM, Zangen A, Ziemann U, Hallett M. Safety and recommendations for TMS use in healthy subjects and patient populations, with updates on training, ethical and regulatory issues: Expert Guidelines. Clin Neurophysiol 2021; 132:269-306. [PMID: 33243615 PMCID: PMC9094636 DOI: 10.1016/j.clinph.2020.10.003] [Citation(s) in RCA: 533] [Impact Index Per Article: 177.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 12/11/2022]
Abstract
This article is based on a consensus conference, promoted and supported by the International Federation of Clinical Neurophysiology (IFCN), which took place in Siena (Italy) in October 2018. The meeting intended to update the ten-year-old safety guidelines for the application of transcranial magnetic stimulation (TMS) in research and clinical settings (Rossi et al., 2009). Therefore, only emerging and new issues are covered in detail, leaving still valid the 2009 recommendations regarding the description of conventional or patterned TMS protocols, the screening of subjects/patients, the need of neurophysiological monitoring for new protocols, the utilization of reference thresholds of stimulation, the managing of seizures and the list of minor side effects. New issues discussed in detail from the meeting up to April 2020 are safety issues of recently developed stimulation devices and pulse configurations; duties and responsibility of device makers; novel scenarios of TMS applications such as in the neuroimaging context or imaging-guided and robot-guided TMS; TMS interleaved with transcranial electrical stimulation; safety during paired associative stimulation interventions; and risks of using TMS to induce therapeutic seizures (magnetic seizure therapy). An update on the possible induction of seizures, theoretically the most serious risk of TMS, is provided. It has become apparent that such a risk is low, even in patients taking drugs acting on the central nervous system, at least with the use of traditional stimulation parameters and focal coils for which large data sets are available. Finally, new operational guidelines are provided for safety in planning future trials based on traditional and patterned TMS protocols, as well as a summary of the minimal training requirements for operators, and a note on ethics of neuroenhancement.
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Affiliation(s)
- Simone Rossi
- Department of Scienze Mediche, Chirurgiche e Neuroscienze, Unit of Neurology and Clinical Neurophysiology, Brain Investigation and Neuromodulation Lab (SI-BIN Lab), University of Siena, Italy.
| | - Andrea Antal
- Department of Clinical Neurophysiology, University Medical Center, Georg-August University of Goettingen, Germany; Institue of Medical Psychology, Otto-Guericke University Magdeburg, Germany
| | - Sven Bestmann
- Department of Movement and Clinical Neurosciences, UCL Queen Square Institute of Neurology, London, UK and Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York, New York, NY, USA
| | - Carmen Brewer
- National Institute on Deafness and Other Communication Disorders, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Jürgen Brockmöller
- Department of Clinical Pharmacology, University Medical Center, Georg-August University of Goettingen, Germany
| | - Linda L Carpenter
- Butler Hospital, Brown University Department of Psychiatry and Human Behavior, Providence, RI, USA
| | - Massimo Cincotta
- Unit of Neurology of Florence - Central Tuscany Local Health Authority, Florence, Italy
| | - Robert Chen
- Krembil Research Institute and Division of Neurology, Department of Medicine, University of Toronto, Canada
| | - Jeff D Daskalakis
- Center for Addiction and Mental Health (CAMH), University of Toronto, Canada
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico, Roma, Italy
| | - Michael D Fox
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Mark S George
- Medical University of South Carolina, Charleston, SC, USA
| | - Donald Gilbert
- Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Vasilios K Kimiskidis
- Laboratory of Clinical Neurophysiology, Aristotle University of Thessaloniki, AHEPA University Hospital, Greece
| | | | - Risto J Ilmoniemi
- Department of Neuroscience and Biomedical Engineering (NBE), Aalto University School of Science, Aalto, Finland
| | - Jean Pascal Lefaucheur
- EA 4391, ENT Team, Faculty of Medicine, Paris Est Creteil University (UPEC), Créteil, France; Clinical Neurophysiology Unit, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, (APHP), Créteil, France
| | - Letizia Leocani
- Department of Neurology, Institute of Experimental Neurology (INSPE), IRCCS-San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | - Sarah H Lisanby
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, MD, USA; Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Carlo Miniussi
- Center for Mind/Brain Sciences - CIMeC, University of Trento, Rovereto, Italy
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research and Center for Memory Health, Hebrew SeniorLife, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA; Guttmann Brain Health Institut, Institut Guttmann, Universitat Autonoma Barcelona, Spain
| | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center, Georg-August University of Goettingen, Germany
| | - Angel V Peterchev
- Departments of Psychiatry & Behavioral Sciences, Biomedical Engineering, Electrical & Computer Engineering, and Neurosurgery, Duke University, Durham, NC, USA
| | - Angelo Quartarone
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Alexander Rotenberg
- Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - John Rothwell
- Department of Movement and Clinical Neurosciences, UCL Queen Square Institute of Neurology, London, UK and Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK
| | - Paolo M Rossini
- Department of Neuroscience and Rehabilitation, IRCCS San Raffaele-Pisana, Roma, Italy
| | - Emiliano Santarnecchi
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Mouhsin M Shafi
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Hartwig R Siebner
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark; Institute for Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Yoshikatzu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Eric M Wassermann
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Abraham Zangen
- Zlotowski Center of Neuroscience, Ben Gurion University, Beer Sheva, Israel
| | - Ulf Ziemann
- Department of Neurology & Stroke, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Germany
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA.
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Rostami R, Kazemi R, Jabbari A, Madani AS, Rostami H, Taherpour MA, Molavi P, Jaafari N, Kuo MF, Vicario CM, Nitsche MA, Salehinejad MA. Efficacy and clinical predictors of response to rTMS treatment in pharmacoresistant obsessive-compulsive disorder (OCD): a retrospective study. BMC Psychiatry 2020; 20:372. [PMID: 32677923 PMCID: PMC7364645 DOI: 10.1186/s12888-020-02769-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 06/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Application of repetitive transcranial magnetic stimulation (rTMS) for treating obsessive-compulsive disorder (OCD) has been promising and approved by the Food and Drug Administration in 2018, but effects differ between patients. Knowledge about clinical predictors of rTMS response may help to increase clinical efficacy but is not available so far. METHODS In a retrospective study, we investigated the efficacy of rTMS over the dorsolateral prefrontal cortex (DLPFC) or supplementary motor area (SMA) in 65 pharmaco-resistant OCD outpatients recruited for rTMS treatment from July 2015 to May 2017. Patients received either SMA rTMS (n = 38) or bilateral DLPFC rTMS (n = 27) in case of reporting higher affective and depressive symptoms in addition to the primary OCD symptoms. OCD symptoms and depression/anxiety states were measured at baseline (before the 1st session) and after the 20th session of rTMS. Additionally, we performed a binary logistic regression analysis on the demographic and clinical variables based on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) 3-factor and 2-factor models and individual items to investigate potential predictors of rTMS response. RESULTS Patients' scores in Y-BOCS and Beck anxiety/depression inventories were significantly decreased following rTMS treatment. 46.2% of all patients responded to rTMS, based on the criterion of at least a 30% reduction in Y-BOCS scores. There was no significant difference between response rates of patients in DLPFC and SMA groups. No significant demographic predictors of rTMS efficacy were identified. The factors "obsession severity", "resistance" and "disturbance" and the "interference due to obsessions" and "resistance against compulsions" items of the Y-BOCS significantly predicted response to rTMS. CONCLUSIONS In patients with less intrusive/interfering thoughts, and low scores in the "obsession severity", "disturbance", and "resistance" factors, rTMS might have superior effects. Identifying clinical and non-clinical predictors of response is relevant to personalize and adapt rTMS protocols in pharmaco-resistant OCD patients. Interpretation of rTMS efficacy should be done with caution due to the lack of a sham intervention condition.
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Affiliation(s)
- Reza Rostami
- Department of Psychology, University of Tehran, Tehran, Iran.
- Atieh Clinical Neuroscience Centre, Tehran, Iran.
| | - Reza Kazemi
- Department of Psychology, University of Tehran, Tehran, Iran
- Atieh Clinical Neuroscience Centre, Tehran, Iran
| | - Arezoo Jabbari
- Department of Psychology, University of Tehran, Tehran, Iran
- Atieh Clinical Neuroscience Centre, Tehran, Iran
| | - Azam Sadat Madani
- Atieh Clinical Neuroscience Centre, Tehran, Iran
- Department of Psychology, University of Shahed, Tehran, Iran
| | | | | | - Parviz Molavi
- Department of Psychiatry, Fatemi Hospital, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Nematollah Jaafari
- Unité de Recherche Clinique Intersectorielle en Psychiatrie Pierre Deniker, Centre Hospitalier Henri Laborit, 86021, Poitiers, France
- Univ. Poitiers & CHU Poitiers, INSERM U1084, Laboratoire Expérimental et Clinique en Neurosciences, 86021, Poitiers, France
| | - Min-Fang Kuo
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Carmelo M Vicario
- University of Messina, Department of Cognitive Science, Messina, Italy
| | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.
- Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany.
| | - Mohammad Ali Salehinejad
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
- Ruhr-University Bochum, International Graduate School of Neuroscience, Bochum, Germany
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22
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Changes in interleukin-1 beta induced by rTMS are significantly correlated with partial improvement of cognitive dysfunction in treatment-resistant depression: a pilot study. Psychiatry Res 2020; 289:112995. [PMID: 32371273 DOI: 10.1016/j.psychres.2020.112995] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/08/2020] [Accepted: 04/08/2020] [Indexed: 12/25/2022]
Abstract
The impairment experienced by many individuals with depression is closely related to the cognitive symptoms of the disorder. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive brain stimulation method that provides a promising technique for improving cognitive symptoms in treatment-resistant depression (TRD). It has recently been demonstrated that TRD is associated with increased inflammatory process. In the present study, we investigated whether a relationship exists between changes in cognitive function and those in inflammatory cytokines before and after rTMS treatment. Eleven patients with TRD were enrolled in a high-frequency (10 Hz) rTMS study. Cognitive function, depressive symptoms and serum concentration of inflammatory cytokines (interleukin (IL)-1β, IL-6 and tumor necrosis factor-α) were measured at baseline and at the endpoint of rTMS treatment. rTMS treatment significantly improved depressive symptom scores and some subscales of cognitive dysfunction. The present study has demonstrated that partial changes in cognitive function and changes in IL-1β were significantly correlated. The partial improvement of cognitive dysfunction by rTMS in the present study might be attributable to the reduction of peripheral IL-1β levels. The present results should be replicated for verification in future studies.
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Carl E, Liskiewicz A, Rivard C, Alberico R, Belal A, Mahoney MC, Quisenberry AJ, Bickel WK, Sheffer CE. Dosing parameters for the effects of high-frequency transcranial magnetic stimulation on smoking cessation: study protocol for a randomized factorial sham-controlled clinical trial. BMC Psychol 2020; 8:42. [PMID: 32357940 PMCID: PMC7193364 DOI: 10.1186/s40359-020-00403-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/05/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Despite the considerable success of comprehensive tobacco control efforts, tobacco use remains one of the greatest preventable causes of death and disease today. Over half of all smokers in the US make quit attempts every year, but over 90% relapse within 12 months, choosing the immediate reinforcement of smoking over the long-term benefits of quitting. Conceptual and empirical evidence supports continued investigation of high frequency repetitive transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex in reducing relapse and decreasing cigarette consumption. While this evidence is compelling, an optimal dosing strategy must be determined before a long-term efficacy trial can be conducted. The goal of this study is to determine a dosing strategy for 20 Hz rTMS that will produce the best long-term abstinence outcomes with the fewest undesirable effects. METHODS This is a fully crossed, double-blinded, sham-controlled, 3x2x2 randomized factorial study. The three factors are duration (stimulation days: 8, 12, and 16); intensity (900 or 1800 pulses per day); and sham control. Participants (n = 258) will consist of adults (18-65) who are motivated to quit smoking cigarettes and who will be followed for 6 months post-quit. Outcomes include latency to relapse, point prevalence abstinence rates, delay discounting rates, cognitive-behavioral skills acquisition, and multiple measures of potential undesirable effects that impact participant compliance. DISCUSSION This study integrates existing theoretical concepts and methodologies from neuropsychology, behavioral economics, brain stimulation, clinical psychology, and the evidence-based treatment of tobacco dependence in the development of a promising and innovative approach to treat tobacco dependence. This study will establish an optimal dosing regimen for efficacy testing. Findings are expected to have a significant influence on advancing this approach as well as informing future research on clinical approaches that combine rTMS with other evidence-based treatments for tobacco dependence and perhaps other addictions. TRIAL REGISTRATION Clinical Trials NCT03865472 (retrospectively registered). The first participant was fully enrolled on November 26, 2018. Registration was posted on March 7, 2019.
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Affiliation(s)
- Ellen Carl
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14203, USA.
| | | | - Cheryl Rivard
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14203, USA
| | - Ronald Alberico
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14203, USA
| | - Ahmed Belal
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14203, USA
| | - Martin C Mahoney
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14203, USA
| | | | - Warren K Bickel
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, 24016, USA
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Patel R, Silla F, Pierce S, Theule J, Girard TA. Cognitive functioning before and after repetitive transcranial magnetic stimulation (rTMS): A quantitative meta-analysis in healthy adults. Neuropsychologia 2020; 141:107395. [DOI: 10.1016/j.neuropsychologia.2020.107395] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 02/12/2020] [Accepted: 02/14/2020] [Indexed: 02/08/2023]
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Tateishi H, Nishihara M, Kawaguchi A, Matsushima J, Murakawa T, Haraguchi Y, Kunitake Y, Maekawa T, Kato TA, Asami T, Mizoguchi Y, Monji A. Improvement Of Frontal Lobe Dysfunction And White Matter Integrity By rTMS In Treatment-Resistant Depression. Neuropsychiatr Dis Treat 2019; 15:3079-3087. [PMID: 31806977 PMCID: PMC6842748 DOI: 10.2147/ndt.s228501] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/22/2019] [Indexed: 12/24/2022] Open
Abstract
AIM The impairment experienced by many individuals with depression is closely related to the cognitive symptoms of the disorder. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive brain stimulation method providing a promising technique for improving cognitive symptoms in treatment-resistant depression (TRD). In the present study, we investigated whether a relationship exists between improvements in frontal lobe dysfunction induced by rTMS and improvement of white matter integrity revealed by diffusion tensor imaging (DTI) in TRD patients receiving rTMS treatment. METHODS A total of 12 patients with TRD were enrolled in a high-frequency (10 Hz) rTMS study (August 2013-January 2019). Frontal lobe function and depressive symptoms were assessed at baseline and at the endpoint of rTMS treatment. Fractional anisotropy (FA), as a measure of white matter integrity obtained from DTI, was investigated using a region-of-interest (ROI) approach. RESULTS rTMS treatment significantly improved depressive symptom scores and some subscales of frontal lobe dysfunction. Category scores in the Word Fluency Test and scores on part 3 of the Color Stroop Test were improved independently of the improvement of depressive symptoms. In the ROI analysis, none of the FA increases in any region were correlated with improvement of any frontal lobe function (n = 12). CONCLUSION Although rTMS resulted in partial improvement of frontal lobe dysfunction as well as white matter integrity, we found no correlation between improved frontal lobe dysfunction and improved white matter integrity in TRD patients.
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Affiliation(s)
- Hiroshi Tateishi
- Department of Psychiatry, Saga University Hospital, Saga849-8501, Japan
| | - Masashi Nishihara
- Department of Radiology, Saga University Hospital, Saga849-8501, Japan
| | - Atsushi Kawaguchi
- Center of Comprehensive Community Medicine, Faculty of Medicine, Saga University, Saga849-8501, Japan
| | - Jun Matsushima
- Department of Psychiatry, Faculty of Medicine, Saga University, Saga849-8501, Japan
| | - Toru Murakawa
- Department of Psychiatry, Faculty of Medicine, Saga University, Saga849-8501, Japan
| | - Yoshinori Haraguchi
- Department of Psychiatry, Faculty of Medicine, Saga University, Saga849-8501, Japan
| | - Yutaka Kunitake
- Department of Psychiatry, Saga University Hospital, Saga849-8501, Japan
| | - Toshihiko Maekawa
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Maidashi Higashi-ku, Fukuoka842-8582, Japan
| | - Takahiro A Kato
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Maidashi Higashi-ku, Fukuoka842-8582, Japan
| | - Toyoko Asami
- Department of Rehabilitation Medicine, Saga University Hospital, Saga849-8501, Japan
| | - Yoshito Mizoguchi
- Department of Psychiatry, Faculty of Medicine, Saga University, Saga849-8501, Japan
| | - Akira Monji
- Department of Psychiatry, Faculty of Medicine, Saga University, Saga849-8501, Japan
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Vion-Bailly J, N'Djin WA, Suarez Castellanos IM, Mestas JL, Carpentier A, Chapelon JY. A causal study of the phenomenon of ultrasound neurostimulation applied to an in vivo invertebrate nervous model. Sci Rep 2019; 9:13738. [PMID: 31551448 PMCID: PMC6760187 DOI: 10.1038/s41598-019-50147-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 09/04/2019] [Indexed: 11/10/2022] Open
Abstract
Focused ultrasound are considered to be a promising tool for the treatment of neurological conditions, overcoming the limitations of current neurostimulation techniques in terms of spatial resolution and invasiveness. Much evidence to support the feasibility of ultrasound activation of neurons at the systemic level has already been provided, but to this day, the biophysical mechanisms underlying ultrasound neurostimulation are still widely unknown. In order to be able to establish a clear and robust causality between acoustic parameters of the excitation and neurobiological characteristics of the response, it is necessary to work at the cellular level, or alternatively on very simple animal models. The study reported here responds to three objectives. Firstly, to propose a simple nervous model for the study of the ultrasound neurostimulation phenomenon, associated with a clear and simple experimental protocol. Secondly, to compare the characteristics of this model’s nervous response to ultrasound neurostimulation with its nervous response to mechanical and electrical stimulation. Thirdly, to study the role played by certain acoustic parameters in the success rate of the phenomenon of ultrasound stimulation. The feasibility of generating action potentials (APs) in the giant axons of an earthworm’s ventral nerve cord, using pulsed ultrasound stimuli (f = 1.1 MHz, Ncycles = 175–1150, PRF = 25–125 Hz, Npulses = 20, PA = 2.5–7.3 MPa), was demonstrated. The time of generation (TOG) of APs associated with ultrasound stimulation was found to be significantly shorter and more stable than the TOG associated with mechanical stimulation (p < 0.001). By applying a causal approach to interpret the results of this study, it was concluded that, in this model, the nervous response to focused ultrasound is initiated along the afferent neurons, in between the mechanosensors and the synaptic connections with the giant axons. Additionally, early results are provided, highlighting a trend for the success rate of ultrasound neurostimulation and number of APs triggered per response to increase with increasing pulse repetition frequency (p < 0.05 and p < 0.001, respectively), increasing pulse duration and increasing pulse amplitude.
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Affiliation(s)
- Jérémy Vion-Bailly
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, F-69003, Lyon, France.
| | - W Apoutou N'Djin
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, F-69003, Lyon, France
| | | | - Jean-Louis Mestas
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, F-69003, Lyon, France
| | - Alexandre Carpentier
- Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Neurosurgery department, Paris, F-75013, France.,Sorbonne Université, Paris, F-75005, France
| | - Jean-Yves Chapelon
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, F-69003, Lyon, France
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Jaffe DH, Rive B, Denee TR. The burden of suicidal ideation across Europe: a cross-sectional survey in five countries. Neuropsychiatr Dis Treat 2019; 15:2257-2271. [PMID: 31496708 PMCID: PMC6689539 DOI: 10.2147/ndt.s204265] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/16/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Suicidal ideation (SI) is an associated risk of depression, affecting 30-40% of the depressed population. However, there is a paucity of studies investigating the impact of SI in Europe. This retrospective observational study examined the burden of SI among adults with major depressive disorder (MDD) in the 2017 National Health and Wellness Survey in five European countries: France, Germany, Italy, Spain, and the UK. METHODS Bivariate analyses evaluated group differences between respondents with MDD with and without SI according to demographic characteristics, self-reported health-related quality of life, work productivity and activity impairment (WPAI), and healthcare resource utilization (HRU). Generalized linear models examined group differences country-wise, after controlling for relevant confounders. RESULTS Among 52,060 respondents, 3,308 individuals were diagnosed with MDD, comprising SI (n=905) and non-SI (nSI) (n=2403) patients. Adjusted differences (ADs), compared to the general population, were observed using the Medical Outcomes Study Short Form Survey (SF-12v2) mental component summary scores (AD: SI=-20.02, nSI=-10.77), physical component summary scores (AD: SI=-4.49, nSI=-2.50), and EuroQoL-5 Dimensions (AD: SI=-0.34, nSI=-0.15) (for all, p<0.001). Significantly greater WPAI and higher HRU were associated with SI compared to nSI. CONCLUSION The results illustrate the unique impact of SI within the MDD population and the need to reduce the burden.
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Affiliation(s)
| | - Benoit Rive
- Janssen-Cilag S.A., Health Economics Market Access and Reimbursement Statistics
, Paris, France
| | - Tom R Denee
- Janssen-Cilag Limited, Health Economics Market Access and Reimbursement
, High Wycombe, UK
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28
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Bo Q, Tian L, Li F, Mao Z, Wang Z, Ma X, Wang C. Quality of life in euthymic patients with unipolar major depressive disorder and bipolar disorder. Neuropsychiatr Dis Treat 2019; 15:1649-1657. [PMID: 31296991 PMCID: PMC6598749 DOI: 10.2147/ndt.s201567] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/03/2019] [Indexed: 11/23/2022] Open
Abstract
Objective: This study aimed to compare quality of life (QOL) between patients with major depressive disorder (MDD) in remission and patients with bipolar disorder (BD) in remission, and to explore the relationship between QOL and demographic, clinical, and cognitive variables. Methods: This study included 49 euthymic patients with MDD, 59 euthymic patients with BD, and 52 healthy controls (HC). The 17-item Hamilton Depression Rating Scale (HAMD-17), Hamilton Anxiety Rating Scale (HAMA), and Young Mania Rating Scale (YMRS) were used to assess symptoms of depression, anxiety, and mania respectively. QOL was assessed with the Chinese version of the World Health Organization Quality of Life Scale Brief (WHOQOL-BREF). Cognitive function was assessed with the repeated neuropsychological assessment scale (RBANS). Results: Compared with HC, patients with MDD had lower overall and subdomain scores (except ENVIR) on the WHOQOL-BREF (p<0.05). The BD group had decreased overall WHOQOL-BREF scores and decreased PHYS and SOCIL subdomain scores (p<0.05). PSYCH scores were lower in patients with MDD, compared with patients with BD (p<0.05). Among patients with MDD, HAMD score was negatively correlated with all domains on the WHOQOL-BREF. Marital status was associated with an increase in subdomain scores on the PSYCH and ENVIR subdomains. In the BD group, attention on the RBANS correlated negatively with PSYCH score; age correlated negatively with SOCIL. Conclusions: QOL of patients with MDD and BD in remission is inferior to that of the normal population. QOL among MDD is inferior to that among BD. Marital status was associated with increased QOL among MDD, but not among BD. Residual symptoms related to depression or anxiety decreased QOL in both MDD and BD. More attention should be paid to the QOL of patients with mood disorders, especially MDD, even during euthymic periods.
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Affiliation(s)
- Qijing Bo
- The National Clinical Research Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing100088, People’s Republic of China
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, People’s Republic of China
- Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing 100088, People’s Republic of China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100069, People's Republic of China
| | - Lu Tian
- The National Clinical Research Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing100088, People’s Republic of China
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, People’s Republic of China
- Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing 100088, People’s Republic of China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100069, People's Republic of China
| | - Feng Li
- The National Clinical Research Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing100088, People’s Republic of China
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, People’s Republic of China
- Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing 100088, People’s Republic of China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100069, People's Republic of China
| | - Zhen Mao
- The National Clinical Research Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing100088, People’s Republic of China
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, People’s Republic of China
- Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing 100088, People’s Republic of China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100069, People's Republic of China
| | - Zhimin Wang
- The National Clinical Research Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing100088, People’s Republic of China
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, People’s Republic of China
- Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing 100088, People’s Republic of China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100069, People's Republic of China
| | - Xin Ma
- The National Clinical Research Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing100088, People’s Republic of China
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, People’s Republic of China
- Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing 100088, People’s Republic of China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100069, People's Republic of China
| | - Chuanyue Wang
- The National Clinical Research Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing100088, People’s Republic of China
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, People’s Republic of China
- Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing 100088, People’s Republic of China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100069, People's Republic of China
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Abstract
LEARNING OBJECTIVES After participating in this activity, learners should be better able to:• Characterize cognitive dysfunction in patients with major depressive disorder.• Evaluate approaches to treating cognitive dysfunction in patients with major depressive disorder. ABSTRACT Cognitive dysfunction is a core psychopathological domain in major depressive disorder (MDD) and is no longer considered to be a pseudo-specific phenomenon. Cognitive dysfunction in MDD is a principal determinant of patient-reported outcomes, which, hitherto, have been insufficiently targeted with existing multimodal treatments for MDD. The neural structures and substructures subserving cognitive function in MDD overlap with, yet are discrete from, those subserving emotion processing and affect regulation. Several modifiable factors influence the presence and extent of cognitive dysfunction in MDD, including clinical features (e.g., episode frequency and illness duration), comorbidity (e.g., obesity and diabetes), and iatrogenic artefact. Screening and measurement tools that comport with the clinical ecosystem are available to detect and measure cognitive function in MDD. Notwithstanding the availability of select antidepressants capable of exerting procognitive effects, most have not been sufficiently studied or rigorously evaluated. Promising pharmacological avenues, as well as psychosocial, behavioral, chronotherapeutic, and complementary alternative approaches, are currently being investigated.
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Ovsyannikov ES, Avdeev SN, Budnevsky AV, Shkatova YS. Influence of Anxiety/Depression on the Subjective Evaluation of Cough in Patients with Chronic Obstructive Pulmonary Disease and Obesity. ACTA ACUST UNITED AC 2019; 55:medicina55050134. [PMID: 31091811 PMCID: PMC6572558 DOI: 10.3390/medicina55050134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 03/12/2019] [Accepted: 05/10/2019] [Indexed: 12/03/2022]
Abstract
Background and objectives: Obesity and anxiety and/or depression are common comorbidities in patients with chronic obstructive pulmonary disease (COPD). For doctors treating COPD, cough has a certain importance as a symptom. The purpose of this study was to figure out how obesity and anxiety/depression may influence the subjective assessment of cough. Materials and Methods: 110 patients with COPD participated in the study. The patients were divided into two groups, one including obese patients, and the other including patients with normal body weight. All patients filled out the hospital anxiety and depression scale (HADS) questionnaire, evaluated the severity of their cough by using visual analogue scale (VAS) on the 1st and 10th day of treatment, and underwent a 12 h cough monitoring with a special cough monitoring device both on the 1st and the 10th day of treatment. Results: The severity of anxiety according to the HADS in patients with COPD and normal body weight was significantly higher than in patients with COPD and obesity, corresponding to 9.25 ± 1.37 and 8.20 ± 1.18 points, respectively (p = 0.0063). The patients with normal body weight and obesity, but without anxiety and depression, subjectively noted an improvement in their well-being on the 10th day of treatment (p = 0.0022, p = 0.0021, respectively). In subgroups with normal body weight and obesity with anxiety and/or depression, the mean values for VAS on day 10 did not change significantly (p = 0.1917, p = 0.1921, respectively). Also, patients from the subgroup with normal body weight and anxiety/depression had a significantly higher assessment of their cough on day 10 than obese patients with anxiety/depression (p = 0.0411). The VAS values correlated positively with the actual amount of cough (r = 0.42, p = 0.0122 and r = 0.44, p = 0.0054, respectively) in patients without anxiety and/or depression, while in patients with anxiety and/or depression, there was an inverse correlation between VAS values and cough (r = −0.38, p = 0.0034 and r = −0.40, p = 0.0231). Conclusions: It is important to diagnose and treat anxiety and depression in patients with COPD for a better prognosis and higher efficacy of medical treatments. While treating such patients, it is preferable to use a cough monitoring device for objective assessments, since the patients may exaggerate or underestimate their symptoms.
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Affiliation(s)
- Evgeniy S Ovsyannikov
- oronezh State Medical University; Department of Faculty Therapy, 394036 Voronezh, Russia.
| | - Sergey N Avdeev
- .M. Sechenov First Moscow State Medical University; Pulmonology Department, 119992 Moscow, Russia.
| | - Andrey V Budnevsky
- oronezh State Medical University; Department of Faculty Therapy, 394036 Voronezh, Russia.
| | - Yanina S Shkatova
- oronezh State Medical University; Department of Faculty Therapy, 394036 Voronezh, Russia.
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31
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Gruzdev SK, Yakovlev AA, Druzhkova TA, Guekht AB, Gulyaeva NV. The Missing Link: How Exosomes and miRNAs can Help in Bridging Psychiatry and Molecular Biology in the Context of Depression, Bipolar Disorder and Schizophrenia. Cell Mol Neurobiol 2019; 39:729-750. [PMID: 31089834 DOI: 10.1007/s10571-019-00684-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/03/2019] [Indexed: 12/21/2022]
Abstract
MicroRNAs (miRNAs) only recently have been recognized as promising molecules for both fundamental and clinical neuroscience. We provide a literature review of miRNA biomarker studies in three most prominent psychiatric disorders (depression, bipolar disorder and schizophrenia) with the particular focus on depression due to its social and healthcare importance. Our search resulted in 191 unique miRNAs across 35 human studies measuring miRNA levels in blood, serum or plasma. 30 miRNAs replicated in more than one study. Most miRNAs targeted neuroplasticity and neurodevelopment pathways. Various limitations do not allow us to make firm conclusions on clinical potential of studied miRNAs. Based on our results we discuss the rationale for future research investigations of exosomal mechanisms to overcome methodological caveats both in studying etiology and pathogenesis, and providing an objective back-up for clinical decisions.
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Affiliation(s)
- S K Gruzdev
- Institute of Medicine, RUDN University, Miklukho-Maklaya Str. 6, Moscow, Russia, 117198.
| | - A A Yakovlev
- Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Butlerova Str., 5A, Moscow, Russia, 117485.,Moscow Research & Clinical Center for Neuropsychiatry, Moscow Healthcare Department, Donskaya Str., 43, Moscow, Russia, 115419
| | - T A Druzhkova
- Moscow Research & Clinical Center for Neuropsychiatry, Moscow Healthcare Department, Donskaya Str., 43, Moscow, Russia, 115419
| | - A B Guekht
- Moscow Research & Clinical Center for Neuropsychiatry, Moscow Healthcare Department, Donskaya Str., 43, Moscow, Russia, 115419.,Russian National Research Medical University, Ostrovitianov Str. 1, Moscow, Russia, 117997
| | - N V Gulyaeva
- Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Butlerova Str., 5A, Moscow, Russia, 117485.,Moscow Research & Clinical Center for Neuropsychiatry, Moscow Healthcare Department, Donskaya Str., 43, Moscow, Russia, 115419
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32
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Ibrahim A, Koyuncu G, Koyuncu N, Suzer NE, Cakir OD, Karcioglu O. The effect of Benson relaxation method on anxiety in the emergency care. Medicine (Baltimore) 2019; 98:e15452. [PMID: 31124928 PMCID: PMC6571274 DOI: 10.1097/md.0000000000015452] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/29/2019] [Accepted: 04/08/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To analyze clinical and sociodemographic properties of the patients as measured by the "Hospital Anxiety and Depression Scale-HADS" including the subscale regarding anxiety (HAD-A) in emergency department (ED) and to detect the effect of a session of Benson relaxation method (BRM) on high anxiety level. METHODS Adult patients presented to the state hospital ED in seven days were recruited in this prospective study. Patients with high (≥8) scores were randomized to the treatment or control groups. They were asked to pursue BRM to alleviate anxiety. RESULTS Six hundred thirty-four patients were recruited (mean age 44.1 and 52% were female). Patients with acute exacerbation or with psychiatric illness, with a systemic disease and higher acuity level had higher HAD-A scores (P < .05). BRM group had a mean score change higher than controls (7.2 ± 2.9 vs 3.4 ± 2.6, t test, P = .026). CONCLUSIONS Patients who underwent BRM had larger decreases in HAD-A scores than others.
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Affiliation(s)
- Abdullah Ibrahim
- Specialist of Emergency Medicine, Department of Emergency Medicine, Haydarpaşa Numune Education and Research Hospital
| | - Gönül Koyuncu
- Physiotherapist, Specialist of Occupational Therapy, Department of Physiotherapy, Sultan Abdülhamit Education and Research Hospital
| | - Nazmiye Koyuncu
- Specialist of Emergency Medicine, Department of Emergency Medicine, Haydarpaşa Numune Education and Research Hospital, Istanbul
| | - Neslihan Ergun Suzer
- Specialist of Emergency Medicine, Department of Emergency Medicine, Kocaeli Gebze Fatih Devlet State Hospital, Izmit
| | - Oya Durmus Cakir
- Specialist of Emergency Medicine, Department of Emergency Medicine, Haydarpaşa Numune Education and Research Hospital
| | - Ozgür Karcioglu
- Specialist of Emergency Medicine, Department of Emergency Medicine, Istanbul Education and Research Hospital, Istanbul, Turkey
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Lee HJ, Lee DK, Song W. Relationships between Social Capital, Social Capital Satisfaction, Self-Esteem, and Depression among Elderly Urban Residents: Analysis of Secondary Survey Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16081445. [PMID: 31018623 PMCID: PMC6517880 DOI: 10.3390/ijerph16081445] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/19/2019] [Accepted: 04/20/2019] [Indexed: 12/11/2022]
Abstract
The role that psychological variables play in depression among elderly urban residents has received little research attention. Therefore, the purpose of this study was to examine the relationships between social capital, social capital satisfaction, self-esteem, and depression among elderly urban residents. We used the responses provided by 701 elderly persons to scales assessing social capital (i.e., network, trust), social capital satisfaction, self-esteem, and depression, as part of the Korea Welfare Panel Study (KOWEPS). We conducted a confirmatory factor analysis and tested the validity of a proposed statistical model using structural equation modeling (SEM). The results showed that trust in social capital, social capital satisfaction, and self-esteem were significantly related to depression. Further, social capital satisfaction and self-esteem fully and partially mediated the relationship between trust and depression, respectively. These findings serve as an empirical base upon which social welfare policies can be founded that benefit elderly urban residents with weak social capital, low social capital satisfaction, and poor self-esteem.
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Affiliation(s)
- Hyun Jin Lee
- Interdisciplinary Program in Landscape Architecture, Seoul National University, Seoul 08826, Korea.
| | - Dong Kun Lee
- Department of Landscape Architecture and Rural System Engineering, Research Institute of Agriculture and Life Sciences, Seoul National University, Seoul 08826, Korea.
| | - Wonkyong Song
- Department of Landscape Architecture, Dankook University, 119, Dandae-ro, Dongnam-gu, Cheonan, Chungnam 330-714, Korea.
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34
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Zhang L, Ma R, Yuan Y, Lian D, Qi X, Zheng N, Li K. The value of diffusion tensor imaging for differentiating autism spectrum disorder with language delay from developmental language disorder among toddlers. Medicine (Baltimore) 2019; 98:e15058. [PMID: 30946352 PMCID: PMC6456132 DOI: 10.1097/md.0000000000015058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Impaired language function is frequently observed as an initial sign in people with autism spectrum disorder (ASD). However, clinically, the early stages of ASD are difficult to distinguish from those of developmental language disorder (DLD). OBJECTIVE To evaluate the ability of diffusion tensor imaging (DTI) parameters for language-related white matter tracts (arcuate fasciculus) to differentiate ASD from DLD among toddlers. MATERIALS AND METHODS We included 16 ASD toddlers with language delay and 18 DLD toddlers in this study. Magnetic resonance imaging sequences included T2-weighted imaging (T2WI), T1 3-dimensional magnetization-prepared rapid acquisition gradient-echo (3D MP-RAGE), and DTI. Tractography was performed using Neuro 3D in the Siemens Syngo Workstation, and fractional anisotropy (FA), average fiber length (AFL), tract volume (TV), and number of voxels (NV) were automatically calculated. Data were then analyzed using IBM SPSS Statistics 22. RESULTS The ASD group exhibited significantly lower FA values, as well as significantly higher TV and NV values compared with the DLD group. With age as the covariate, analysis of covariance revealed different significances in TV and NV. Analysis of variance for AFL revealed no significant differences between the 2 groups. CONCLUSION DTI parameters of arcuate fasciculus were useful for differentiating ASD with language delay from DLD among toddlers. DTI has the potential to provide an objective and effective method for aiding early diagnosis, early intervention and improving long-term outcomes of ASD.
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Affiliation(s)
| | | | - Yanran Yuan
- Department of Children Rehabilitation, Jining No.1 People's Hospital
| | - Dandan Lian
- Department of Children Rehabilitation, Jining No.1 People's Hospital
| | | | | | - Kailong Li
- Department of Ultrasound Diagnosis, Affiliated Hospital of Jining Medical University, Jining, Shangdong Province, China
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Kiebs M, Hurlemann R, Mutz J. Cognitive effects of non-surgical brain stimulation for major depressive disorder: protocol for a systematic review and meta-analysis. BMJ Open 2019; 9:e023796. [PMID: 30782887 PMCID: PMC6377555 DOI: 10.1136/bmjopen-2018-023796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/28/2018] [Accepted: 12/05/2018] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Non-surgical brain stimulation techniques may be considered as alternative or add-on treatments for patients with major depressive disorder who failed to respond to pharmacological interventions. Electroconvulsive therapy has been shown to be highly effective in reducing depressive symptoms but stakeholders remain concerned about adverse cognitive effects. Repetitive transcranial magnetic stimulation and transcranial direct current stimulation may be associated with more benign adverse effect profiles and may indeed improve certain cognitive functions such as memory and attention. To guide clinical decision-making, we will carry out a systematic review and meta-analysis of the cognitive effects of eight non-surgical brain stimulation techniques. METHODS AND ANALYSIS A systematic literature search of the Embase, PubMed/MEDLINE and PsycINFO databases, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and OpenGrey will be performed. We will include both randomised clinical trials which report on at least one cognitive measure post treatment as well as non-randomised trials and pre-post intervention studies. There are no restrictions to the type of cognitive outcome measures, except that the tests are standardised and psychometrically validated. The Revised Cochrane tool for assessing risk of bias in randomised trials (RoB 2.0) will be used to evaluate included trials. Pre-post studies will be evaluated using the quality assessment tool developed by the US National Heart, Lung and Blood Institute. Meta-analysis, meta-regression, subgroup and sensitivity analyses will be conducted where sufficient data are available. ETHICS AND DISSEMINATION No ethical approval is needed to conduct this work. The findings will be submitted for publication in peer-reviewed journals and presented at scientific meetings. PROSPERO REGISTRATION NUMBER CRD42018118850.
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Affiliation(s)
- Maximilian Kiebs
- Department of Psychiatry and Division of Medical Psychology, University Hospital Bonn, Bonn, Germany
| | - René Hurlemann
- Department of Psychiatry and Division of Medical Psychology, University Hospital Bonn, Bonn, Germany
| | - Julian Mutz
- Faculty of Medicine, School of Public Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, Social Genetic and Developmental Psychiatry Centre, King's College London, London, UK
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Abstract
Cognitive dysfunction is a symptomatic domain identified across many mental disorders. Cognitive deficits in individuals with major depressive disorder (MDD) contribute significantly to occupational and functional disability. Notably, cognitive subdomains such as learning and memory, executive functioning, processing speed, and attention and concentration are significantly impaired during, and between, episodes in individuals with MDD. Most antidepressants have not been developed and/or evaluated for their ability to directly and independently ameliorate cognitive deficits. Multiple interacting neurobiological mechanisms (eg, neuroinflammation) are implicated as subserving cognitive deficits in MDD. A testable hypothesis, with preliminary support, posits that improving performance across cognitive domains in individuals with MDD may improve psychosocial function, workplace function, quality of life, and other patient-reported outcomes, independent of effects on core mood symptoms. Herein we aim to (1) provide a rationale for prioritizing cognitive deficits as a therapeutic target, (2) briefly discuss the neurobiological substrates subserving cognitive dysfunction, and (3) provide an update on current and future treatment avenues.
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37
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Feature Extraction in Motor Activity Signal: Towards a Depression Episodes Detection in Unipolar and Bipolar Patients. Diagnostics (Basel) 2019; 9:diagnostics9010008. [PMID: 30634621 PMCID: PMC6468429 DOI: 10.3390/diagnostics9010008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 12/27/2018] [Accepted: 01/07/2019] [Indexed: 01/04/2023] Open
Abstract
Depression is a mental disorder characterized by recurrent sadness and loss of interest in the enjoyment of the positive aspects of life, in addition to fatigue, causing inability to perform daily activities, which leads to a loss of quality of life. To monitor depression (unipolar and bipolar patients), traditional methods rely on reports from patients; nevertheless, bias is commonly present in them. To overcome this problem, Ecological Momentary Assessment (EMA) reports have been widely used, which include data of the behavior, feelings and other types of activities recorded almost in real time through the use of portable devices and smartphones containing motion sensors. In this work a methodology was proposed to detect depressive subjects from control subjects based in the data of their motor activity, recorded by a wearable device, obtained from the "Depresjon" database. From the motor activity signals, the extraction of statistical features was carried out to subsequently feed a random forest classifier. Results show a sensitivity value of 0.867, referring that those subjects with presence of depression have a degree of 86.7% of being correctly classified, while the specificity shows a value of 0.919, referring that those subjects with absence of depression have a degree of 91.9% of being classified with a correct response, using the motor activity signal provided from the wearable device. Based on these results, it is concluded that the motor activity allows distinguishing between the two classes, providing a preliminary and automated tool to specialists for the diagnosis of depression.
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Voigt J, Carpenter L, Leuchter A. A systematic literature review of the clinical efficacy of repetitive transcranial magnetic stimulation (rTMS) in non-treatment resistant patients with major depressive disorder. BMC Psychiatry 2019; 19:13. [PMID: 30621636 PMCID: PMC6325728 DOI: 10.1186/s12888-018-1989-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 12/18/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The clinical efficacy of repetitive transcranial magnetic stimulation (rTMS) in treatment resistant patients (at least 4 medication trials) appears to be well accepted and forms the coverage policies and rTMS's use in many of the largest US payers. However, less is known about rTMS's use in patients who have undergone ≤1 failed medication trial. The purpose of this analysis was to determine the clinical efficacy of rTMS in patients after ≤1 medication trials. METHODS A systematic review of the literature was undertaken to identify all articles which addressed the use of rTMS in ≤1 medication trial. All types of study designs were included and assessed for quality and strength of evidence using: GRADE and CEBM. Searches of peer reviewed articles were undertaken for the year 2000 to the present. All languages were considered. Electronic databases were searched and included: PubMed and EBSCO. Evidence assessment websites were also searched and included: Cochrane, NICE, AHRQ, and ICER. Additionally, the clinical guidelines for specialty societies which use rTMS was searched. Hand searches of the reference sections of identified articles was also undertaken. RESULTS Electronic and other sources identified 165 after duplicates were removed. Twenty two articles were assessed for eligibility and ultimately 10 articles were included in the systematic review and graded. Six articles were graded high quality (CEBM/GRADE: 1c/B) demonstrating that the use of rTMS was clinically efficacious in patients after ≤1 medication trial. Four additional trials demonstrated a positive effect of rTMS in patients after ≤1 medication trial but were of a lower quality. CONCLUSION The use of rTMS in patients after ≤1 medication trial should be considered. US payers should consider revising their coverage policies to include the use of rTMS in these patients.
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Affiliation(s)
- Jeffrey Voigt
- Medical Device Consultants of Ridgewood, LLC, 99 Glenwood Rd, Ridgewood, NJ, 07450, USA.
| | - Linda Carpenter
- 0000 0004 1936 9094grid.40263.33Department of Psychiatry and Human Behavior, Brown Institute for Brain Science, Brown University, 700 Butler Dr, Providence, RI 02906 USA
| | - Andrew Leuchter
- 0000 0000 9632 6718grid.19006.3eUniversity of California Los Angeles (UCLA), Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, UCLA, 760 Westwood Plaza, Room 37-452, Los Angeles, CA 90095 USA
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Zajecka JM, Stanford AD, Memisoglu A, Martin WF, Pathak S. Buprenorphine/samidorphan combination for the adjunctive treatment of major depressive disorder: results of a phase III clinical trial (FORWARD-3). Neuropsychiatr Dis Treat 2019; 15:795-808. [PMID: 31040679 PMCID: PMC6459143 DOI: 10.2147/ndt.s199245] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The endogenous opioid system is a fundamental regulator of mood in humans. Previously reported clinical trials have demonstrated the efficacy of the investigational agent buprenorphine/samidorphan (BUP/SAM) combination, an opioid-system modulator, for the adjunctive treatment of major depressive disorder. We present here a third phase III study of different design. METHODS Adult patients with major depressive disorder and inadequate response to antidepressant therapy were enrolled in this double-blind, placebo-controlled, placebo run-in study to evaluate the efficacy, safety, and tolerability of adjunctive BUP/SAM 2 mg/2 mg. Patients with baseline Hamilton Depression Rating Scale score $20 received double-blind placebo in addition to background antidepressant therapy for 4 weeks. Nonresponders were randomized to receive adjunctive BUP/SAM 2 mg/2 mg or placebo for 6 weeks. The primary end point was change in Montgomery-Åsberg Depression Rating Scale (MADRS)-10 total score from randomization at baseline to the end of the 6-week treatment period. RESULTS Least-squares mean change in MADRS-10 score at end of treatment was -4.8 (SE 0.67) in the BUP/SAM 2 mg/2 mg group and -4.6 (SE 0.66) in the placebo group (mean difference -0.3 [SE 0.95], P=0.782). There were no differences in MADRS-based response or remission rates. Overall, 42.9% of the BUP/SAM 2 mg/2 mg group and 34.5% of the placebo group experienced at least one treatment-emergent adverse event during the 6-week treatment period, most of which were mild or moderate in severity. There were no clinically important changes in laboratory parameters, weight, or vital signs and no evidence of abuse potential during treatment or opiate-withdrawal symptoms post treatment. CONCLUSION Efficacy results in FORWARD-3 measured by change in MADRS-10 score did not meet the primary end point, but postbaseline improvement in MADRS-10 in the BUP/SAM 2 mg/2 mg group was consistent with that seen in previously reported trials. BUP/SAM 2 mg/2 mg was well tolerated.
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Affiliation(s)
- John M Zajecka
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, USA, .,Psychiatric Medicine Associates, LLC, Skokie, IL, USA,
| | | | - Asli Memisoglu
- Department of Biostatistics, Alkermes, Inc., Waltham, MA, USA
| | | | - Sanjeev Pathak
- Department of Clinical Research, Alkermes, Inc., Waltham, MA, USA
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Sleep-wake, cognitive and clinical correlates of treatment outcome with repetitive transcranial magnetic stimulation for young adults with depression. Psychiatry Res 2019; 271:335-342. [PMID: 30529316 DOI: 10.1016/j.psychres.2018.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/31/2018] [Accepted: 12/01/2018] [Indexed: 01/29/2023]
Abstract
The utility of key phenotypes of depression in predicting response to repetitive transcranial magnetic stimulation (rTMS), namely sleep-wake behaviour, cognition and illness chronicity, has been understudied and not been extended to young samples. This study aimed to determine whether sleep-wake disturbance, cognition or depression chronicity are associated with rTMS outcome in young depressed adults. Sixteen depressed young adults diagnosed with mood disorders (aged 18-29 years) completed this open-label study. Neuronavigationally targeted high-frequency rTMS was administered at 110% of motor threshold on the left dorsolateral prefrontal cortex for 20 sessions over 4 weeks. Clinical, sleep-wake and cognitive assessments were undertaken pre- and post-treatment. Repeated-measures and correlational analyses determined pre- and post-treatment changes and predictors of treatment outcome. rTMS significantly reduced depression and anxiety. Better cognitive flexibility, verbal learning, later age of onset and greater number of depressive episodes were associated with better treatment outcome. There were no other significant/trend-level associations. rTMS had no effect on sleep-wake or cognitive measures. We provide the first evidence for the utility of cognitive flexibility and verbal learning in predicting rTMS outcome in depressed young adults. This research provides preliminary support for rTMS as an early intervention for depression and supports the need for sham-controlled trials.
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Zhang A, Li G, Yang C, Liu P, Wang Y, Kang L, Wang Y, Zhang K. Alterations of amplitude of low-frequency fluctuation in treatment-resistant versus non-treatment-resistant depression patients. Neuropsychiatr Dis Treat 2019; 15:2119-2128. [PMID: 31413577 PMCID: PMC6663073 DOI: 10.2147/ndt.s199456] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 05/14/2019] [Indexed: 11/23/2022] Open
Abstract
PURPOSE We used parcellation based on 264 putative functional areas to explore the difference of amplitude of low-frequency fluctuation (ALFF) between refractory depression and non-refractory depression patients. PATIENTS AND METHODS Sixty first episode drug-naive patients with major depressive disorder (MDD) and 20 healthy controls (HCs) were recruited in this study; the MDD group was divided into a refractory depression (TRD) group (n=15) and a non-refractory depression (non-TRD) group (n=18) according to the treatment effect following up for 2 years. All the subjects underwent magnetic resonance imaging scanning and performed the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and all the patients with MDD finished the 17-item Hamilton Depression Rating Scale (HAMD17). We used a parcellation based on 264 putative functional areas to explore the difference of ALFF measures in the three groups. The correlation between the abnormal ALFF value and characteristics of MDD was examined. RESULTS RBANS total scores and index scores in the HCs were significantly different from that of the MDD group. HAMD-17 in the TRD group was significantly higher than that of non-TRD group. Relative to HCs, MDD groups showed significantly lower ALFF within the right default mode network, which was positively correlated with the immediate memory and language in the MDD group. Compared with the non-TRD group, the TRD group showed higher ALFF in the right sensory/somatomotor hand, right auditory and left default mode network. CONCLUSION Dysfunction of the somatosensory areas, right auditory and left default mode network may be a marker for specific psychopathology symptoms of TRD.
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Affiliation(s)
- Aixia Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, People's Republic of China.,Shanxi Medical University , Taiyuan 030001, People's Republic of China
| | - Gaizhi Li
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, People's Republic of China
| | - Chunxia Yang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, People's Republic of China
| | - Penghong Liu
- Shanxi Medical University , Taiyuan 030001, People's Republic of China
| | - Yanfang Wang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, People's Republic of China
| | - Lijun Kang
- Shanxi Medical University , Taiyuan 030001, People's Republic of China
| | - Yuchen Wang
- Shanxi Medical University , Taiyuan 030001, People's Republic of China
| | - Kerang Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan 030001, People's Republic of China
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Rinaldi A, Rinaldi C, Coelho Pereira JA, Lotti Margotti M, Bittencourt MN, Barcessat ARP, Fontani V, Rinaldi S. Radio electric asymmetric conveyer neuromodulation in depression, anxiety, and stress. Neuropsychiatr Dis Treat 2019; 15:469-480. [PMID: 30858704 PMCID: PMC6387613 DOI: 10.2147/ndt.s195466] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess the efficacy of specific neuromodulation treatments performed with radio electric asymmetric conveyer (REAC) technology in the treatment of the symptomatic triad depression, anxiety, and stress by the use of a specific psychometric test such as the Depression Anxiety Stress Scale-42 items (DASS-42) version, which assesses simultaneously the severity of expression of this triad. PATIENTS AND METHODS The design of this study was planned to compare two populations that performed DASS-42 test twice within a similar period of time. The first population performed the first DASS test before the treatment and the second test about 3 months later, at the end of two specific REAC neuromodulation treatments, neuropostural optimization (NPO) and neuropsychophysical optimization (NPPO), that have previously shown an efficacy in the treatment of depression, anxiety and stress. The second population (untreated), used as the randomized control group, consisted of a similar group by gender and age, who performed the DASS-42 test in an online platform twice, with an interval of about 3 months between the first and second tests, similar to the interval between the two tests in the treated group. RESULTS The comparison between the treated group and the control group points out the REAC treatment efficacy in improving the quality of life. At the second DASS-42 test, self-administered about 3 months after the treatments, treated patients were positioned on average values of much milder severity in all the three clusters, depression, anxiety, and stress, while in untreated patients there was no significant difference between the mean values of the first and second DASS tests. CONCLUSION The results obtained in this study, evaluated with the DASS-42 test, confirm that REAC-NPO and REAC-NPPO neuromodulation treatments can be useful tools for the clinical treatment of depression, anxiety, and stress, as already proven by previous results evaluated with different psychometric tests.
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Affiliation(s)
- Arianna Rinaldi
- Department of Neuro Psycho Physio Pathology and Neuro Psycho Physical Optimization, Rinaldi Fontani Institute, Florence, Italy, .,Research Department, Rinaldi Fontani Foundation, Florence, Italy,
| | - Chiara Rinaldi
- Department of Neuro Psycho Physio Pathology and Neuro Psycho Physical Optimization, Rinaldi Fontani Institute, Florence, Italy, .,Research Department, Rinaldi Fontani Foundation, Florence, Italy,
| | | | - Matteo Lotti Margotti
- Department of Neuro Psycho Physio Pathology and Neuro Psycho Physical Optimization, Rinaldi Fontani Institute, Florence, Italy, .,Research Department, Rinaldi Fontani Foundation, Florence, Italy,
| | | | | | - Vania Fontani
- Department of Neuro Psycho Physio Pathology and Neuro Psycho Physical Optimization, Rinaldi Fontani Institute, Florence, Italy, .,Research Department, Rinaldi Fontani Foundation, Florence, Italy,
| | - Salvatore Rinaldi
- Department of Neuro Psycho Physio Pathology and Neuro Psycho Physical Optimization, Rinaldi Fontani Institute, Florence, Italy, .,Research Department, Rinaldi Fontani Foundation, Florence, Italy,
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Pinter A, Szatmari S, Horvath T, Penzlin AI, Barlinn K, Siepmann M, Siepmann T. Cardiac dysautonomia in depression - heart rate variability biofeedback as a potential add-on therapy. Neuropsychiatr Dis Treat 2019; 15:1287-1310. [PMID: 31190834 PMCID: PMC6529729 DOI: 10.2147/ndt.s200360] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 03/21/2019] [Indexed: 01/05/2023] Open
Abstract
Depressive disorders are among the most important health problems and are predicted to constitute the leading cause of disease burden by the year 2030. Aside significant impact on quality of life, psychosocial well-being and socioeconomic status of affected patients, depression is associated with impaired cardiovascular health and increased mortality. The link between affective and cardiovascular disease has largely been attributed to dysregulation of the autonomic nervous system resulting in a chronic shift toward increased sympathetic and decreased parasympathetic activity and, consecutively, cardiac dysautonomia. Among proposed surrogate parameters to capture and quantitatively analyze this shift, heart rate variability (HRV) and baroreflex sensitivity have emerged as reliable tools. Attenuation of these parameters is frequently seen in patients suffering from depression and is closely linked to cardiovascular morbidity and mortality. Therefore, diagnostic and therapeutic strategies were designed to assess and counteract cardiac dysautonomia. While psychopharmacological treatment can effectively improve affective symptoms of depression, its effect on cardiac dysautonomia is limited. HRV biofeedback is a non-invasive technique which is based on a metronomic breathing technique to increase parasympathetic tone. While some small studies observed beneficial effects of HRV biofeedback on dysautonomia in patients with depressive disorders, larger confirmatory trials are lacking. We reviewed the current literature on cardiac dysautonomia in patients suffering from depression with a focus on the underlying pathophysiology as well as diagnostic workup and treatment.
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Affiliation(s)
- Alexandra Pinter
- Division of Health Care Sciences, Dresden International University, Dresden, Germany.,Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Szabolcs Szatmari
- Division of Health Care Sciences, Dresden International University, Dresden, Germany.,Department of Neurology, Semmelweis University, Budapest, Hungary.,Janos Szentagothai Doctoral School of Neurosciences, Semmelweis University, Budapest, Hungary
| | - Tamas Horvath
- Department of Hydrodynamic Systems, Budapest University of Technology and Economics, Budapest, Hungary
| | - Ana Isabel Penzlin
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kristian Barlinn
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Martin Siepmann
- Department of Psychosomatic Medicine and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Timo Siepmann
- Division of Health Care Sciences, Dresden International University, Dresden, Germany.,Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
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Neurocognitive Effects of Repetitive Transcranial Magnetic Stimulation With a 2-Coil Device in Treatment-Resistant Major Depressive Disorder. J ECT 2018; 34:258-265. [PMID: 29613944 DOI: 10.1097/yct.0000000000000494] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Neurocognitive dysfunction is an understudied and undertreated aspect of psychiatric research and treatment. There is emerging evidence to suggest that repetitive transcranial magnetic stimulation (rTMS) may possess neurocognition-enhancing capabilities. METHODS This study examined the neurocognitive data from a randomized, double-blind, sham-controlled trial of an investigational 2-coil rTMS device in antidepressant treatment or treatment-intolerant major depressive disorder patients. This device has the potential to stimulate deeper areas of the brain than the Food and Drug Administration-approved TMS devices, which primarily stimulate cortical brain areas and may therefore have different neurocognitive adverse effects. Patients received 20 daily rTMS treatments (10-Hz stimulation; either active or sham) with coil centers positioned over the left dorsolateral prefrontal cortex and dorsomedial prefrontal cortex. Neurocognitive safety was evaluated at baseline and within 72 hours of final treatment session with a computerized battery assessing aspects of attention and memory in 84 participants. RESULTS There were no observed negative neurocognitive effects of the 2-coil rTMS device. A significant effect of active rTMS was observed on the quality of episodic memory. There were no observed effects for attention or working memory. Baseline quality of episodic memory predicted depression treatment response and remission, in that lower baseline episodic memory was associated with greater likelihood of depression response/remission. This was observed in logistic regression analyses controlling for treatment and baseline depressive symptoms. CONCLUSIONS The 2-coil rTMS device is a cognitively safe treatment for treatment-resistant depression that may possess episodic memory-enhancing capabilities. Furthermore, baseline episodic memory may reflect an important predictor of subsequent depression treatment response/remission to rTMS.
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Cognitive Functioning in Late-life Depression: A Critical Review of Sociodemographic, Neurobiological, and Treatment Correlates. Curr Behav Neurosci Rep 2018. [DOI: 10.1007/s40473-018-0159-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zhang J, Liu J, Li J, Zhang C, Qu M. Non-invasive brain stimulation for improving cognitive function in people with dementia and mild cognitive impairment. Hippokratia 2018. [DOI: 10.1002/14651858.cd013065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jing Zhang
- Xuanwu Hospital, Capital Medical University; Department of Neurology; No. 45, Changchun Street Beijing Beijing China 100053
| | - Jia Liu
- Xuanwu Hospital, Capital Medical University; Department of Neurology; No. 45, Changchun Street Beijing Beijing China 100053
| | - Jie Li
- People's Hospital of Deyang City; Department of Neurology; No.173, Taishan North Road Deyang Sichuan China 618000
| | - Canfei Zhang
- The First Affiliated Hospital of Henan University of Science and Technology; Department of Neurology; No. 24, Jinghua Road Luoyang Henan Province China 471003
| | - Miao Qu
- Xuanwu Hospital, Capital Medical University; Department of Neurology; No. 45, Changchun Street Beijing Beijing China 100053
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The Impact of Repetitive Transcranial Magnetic Stimulation on Oxidative Stress in Subjects With Medication-Resistant Depression. J ECT 2018; 34:127-131. [PMID: 29166316 DOI: 10.1097/yct.0000000000000467] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Recent studies have shown that oxidative stress is involved in the neurobiology of depression. We investigated the effects of repetitive transcranial magnetic stimulation (rTMS) on a novel oxidative stress marker, thiol-disulfide homeostasis, in subjects with medication-resistant major depression (MRD). METHODS Twenty-six subjects with MRD underwent 15 rTMS sessions. Sociodemographic and baseline and post-rTMS Montgomery-Asberg Depression Rating Scale (MADRS) data were collected. Serum levels of native thiol, total thiol, and disulfide and their pairwise ratios were measured in baseline and post-rTMS blood samples. RESULTS Serum levels of native and total thiol were significantly decreased after rTMS treatment (P < 0.05). Serum levels of thiol-disulfide and their ratios did not significantly differ (P > 0.05) between rTMS treatment responders (>50% reduction in MADRS score, n = 11) and rTMS treatment nonresponders (n = 15). The percentage MADRS score changes did not correlate with the changes in the levels of serum thiol-disulfide from baseline to post-rTMS treatment in any subject (P > 0.05). CONCLUSIONS Our results showed that rTMS treatment was effective in subjects with MRD and was associated with changes in serum thiol levels regardless of improvement in depression severity. Thus, the results did not support a possible therapeutic relationship between rTMS and thiol-disulfide homeostasis in subjects with MRD.
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Accelerated repetitive transcranial magnetic stimulation in the treatment of depression. Neuropsychopharmacology 2018; 43:1565-1572. [PMID: 29467437 PMCID: PMC5983543 DOI: 10.1038/s41386-018-0009-9] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/01/2017] [Accepted: 01/05/2018] [Indexed: 11/09/2022]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is increasingly used clinically in the treatment of patients with major depressive disorder (MDD). However, rTMS treatment response can be slow. Early research suggests that accelerated forms of rTMS may be effective but no research has directly evaluated a schedule of accelerated rTMS compared to standard rTMS. To assess the efficacy of accelerated rTMS compared to standard daily rTMS., 115 outpatients with MDD received either accelerated rTMS (n = 58) (i.e., 63,000 high frequency rTMS pulses delivered as 3 treatments per day over 3 days in week 1, 3 treatments over 2 days in week 2 and 3 treatments on a single day in week 3) or standard rTMS (n = 57) (i.e., 63,000 total high frequency rTMS pulses delivered over 5 days per week for 4 weeks) following randomization. There were no significant differences in remission or response rates (p > 0.05 for all analyses) or reduction in depression scores (Time by group interaction (F (5, 489.452) = 1.711, p = 0.130) between the accelerated and standard rTMS treatment groups. Accelerated treatment was associated with a higher rate of reported treatment discomfort. It is feasible to provide accelerated rTMS treatment for outpatients with depression and this is likely to produce meaningful antidepressant effects.
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Yang CC, Khalifa N, Völlm B. The effects of repetitive transcranial magnetic stimulation on empathy: a systematic review and meta-analysis. Psychol Med 2018; 48:737-750. [PMID: 28826416 DOI: 10.1017/s003329171700232x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Empathy is a multi-dimensional concept with affective and cognitive components, the latter often referred to as Theory of Mind (ToM). Impaired empathy is prevalent in people with neuropsychiatric disorders, such as personality disorder, psychopathy, and schizophrenia, highlighting the need to develop therapeutic interventions to address this. Repetitive transcranial magnetic stimulation (rTMS), a non-invasive therapeutic technique that has been effective in treating various neuropsychiatric conditions, can be potentially used to modulate empathy. To our knowledge, no systematic reviews or meta-analyses in this field have been conducted. The aim of the current study was to review the literature on the use of rTMS to modulate empathy in adults. Seven electronic databases (AMED, Cochrane library, EMBASE, Medline, Pubmed, PsycInfo, and Web of Science) were searched using appropriate search terms. Twenty-two studies were identified, all bar one study involved interventions in healthy rather than clinical populations, and 18 of them, providing results for 24 trials, were included in the meta-analyses. Results showed an overall small, but statistically significant, effect in favour of active rTMS in healthy individuals. Differential effects across cognitive and affective ToM were evident. Subgroup analyses for cognitive ToM revealed significant effect sizes on excitatory rTMS, offline paradigms, and non-randomised design trials. Subgroup analyses for affective ToM revealed significant effect sizes on excitatory rTMS, offline paradigms, and non-randomised design trials. Meta-regression revealed no significant sources of heterogeneity. In conclusion, rTMS may have discernible effects on different components of empathy. Further research is required to examine the effects of rTMS on empathy in clinical and non-clinical populations, using appropriate empathy tasks and rTMS protocols.
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Affiliation(s)
- C-C Yang
- Division of Psychiatry and Applied Psychology,School of Medicine,University of Nottingham,UK
| | - N Khalifa
- Division of Psychiatry and Applied Psychology,School of Medicine,University of Nottingham,UK
| | - B Völlm
- Division of Psychiatry and Applied Psychology,School of Medicine,University of Nottingham,UK
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50
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Ilieva IP, Alexopoulos GS, Dubin MJ, Morimoto SS, Victoria LW, Gunning FM. Age-Related Repetitive Transcranial Magnetic Stimulation Effects on Executive Function in Depression: A Systematic Review. Am J Geriatr Psychiatry 2018; 26:334-346. [PMID: 29111132 DOI: 10.1016/j.jagp.2017.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 08/27/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aims of the current review were to: 1) examine whether the rTMS effects on executive function increase as age advances; 2) to examine the potential of rTMS to remediate executive function in older depressed patients; and 3) to assess the relationship between the executive function and mood benefits from rTMS in depression. METHODS Randomized or matched-groups, blind, sham-controlled studies (12 studies, 347 participants) on excitatory rTMS applied to left DLPFC in depression were reviewed. RESULTS A series of meta-regressions found no evidence of greater rTMS effects on executive functions as age advances. Similarly, meta-analyses showed no significant rTMS effects on executive functions in older depressed individuals. However, meta-regression analyses showed that the size of the executive function benefits from rTMS in depression are positively related to the effect size of mood symptom reduction. Despite its correlational nature, this finding is consistent with the idea that improvement in executive function may play a critical role in depression recovery. CONCLUSIONS The authors consider these findings preliminary because of the modest number of available studies. Based on a qualitative review, the authors describe methodologic modifications that may increase rTMS efficacy for both executive functions and mood in late-life depression.
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Affiliation(s)
- Irena P Ilieva
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY; Institute of Geriatric Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY.
| | - George S Alexopoulos
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY; Institute of Geriatric Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY
| | - Marc J Dubin
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY; Feil Family Brain and Mind Research Institute, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY
| | - S Shizuko Morimoto
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY; Institute of Geriatric Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY
| | - Lindsay W Victoria
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY; Institute of Geriatric Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY
| | - Faith M Gunning
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY; Institute of Geriatric Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY
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