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Briley PM, Webster L, Boutry C, Oh H, Auer DP, Liddle PF, Morriss R. Magnetic resonance imaging connectivity features associated with response to transcranial magnetic stimulation in major depressive disorder. Psychiatry Res Neuroimaging 2024; 342:111846. [PMID: 38908353 DOI: 10.1016/j.pscychresns.2024.111846] [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: 07/24/2023] [Revised: 03/23/2024] [Accepted: 06/11/2024] [Indexed: 06/24/2024]
Abstract
Transcranial magnetic stimulation (TMS) is an FDA-approved neuromodulation treatment for major depressive disorder (MDD), thought to work by altering dysfunctional brain connectivity pathways, or by indirectly modulating the activity of subcortical brain regions. Clinical response to TMS remains highly variable, highlighting the need for baseline predictors of response and for understanding brain changes associated with response. This systematic review examined brain connectivity features, and changes in connectivity features, associated with clinical improvement following TMS in MDD. Forty-one studies met inclusion criteria, including 1097 people with MDD. Most studies delivered one of two types of TMS to left dorsolateral prefrontal cortex and measured connectivity using resting-state functional MRI. The subgenual anterior cingulate cortex was the most well-studied brain region, particularly its connectivity with the TMS target or with the "executive control network" of brain regions. There was marked heterogeneity in findings. There is a need for greater understanding of how cortical TMS modulates connectivity with, and the activity of, subcortical regions, and how these effects change within and across treatment sessions.
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Affiliation(s)
- P M Briley
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Nottingham National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Nottingham, United Kingdom; Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom.
| | - L Webster
- Nottingham National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Nottingham, United Kingdom; Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom
| | - C Boutry
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom; NIHR Applied Research Collaboration East Midlands, University of Nottingham, Nottingham, United Kingdom
| | - H Oh
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Nottingham National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Nottingham, United Kingdom; Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, United Kingdom
| | - D P Auer
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Nottingham National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Nottingham, United Kingdom; Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, United Kingdom
| | - P F Liddle
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom
| | - R Morriss
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Nottingham National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Nottingham, United Kingdom; Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom; NIHR Applied Research Collaboration East Midlands, University of Nottingham, Nottingham, United Kingdom; NIHR Mental Health (MindTech) Health Technology Collaboration, University of Nottingham, Nottingham, United Kingdom
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Chen L, Klooster DCW, Tik M, Thomas EHX, Downar J, Fitzgerald PB, Williams NR, Baeken C. Accelerated Repetitive Transcranial Magnetic Stimulation to Treat Major Depression: The Past, Present, and Future. Harv Rev Psychiatry 2023; 31:142-161. [PMID: 37171474 PMCID: PMC10188211 DOI: 10.1097/hrp.0000000000000364] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is an effective and evidence-based therapy for treatment-resistant major depressive disorder. A conventional course of rTMS applies 20-30 daily sessions over 4-6 weeks. The schedule of rTMS delivery can be accelerated by applying multiple stimulation sessions per day, which reduces the duration of a treatment course with a predefined number of sessions. Accelerated rTMS reduces time demands, improves clinical efficiency, and potentially induces faster onset of antidepressant effects. However, considerable heterogeneity exists across study designs. Stimulation protocols vary in parameters such as the stimulation target, frequency, intensity, number of pulses applied per session or over a course of treatment, and duration of intersession intervals. In this article, clinician-researchers and neuroscientists who have extensive research experience in accelerated rTMS synthesize a consensus based on two decades of investigation and development, from early studies ("Past") to contemporaneous theta burst stimulation, a time-efficient form of rTMS gaining acceptance in clinical settings ("Present"). We propose descriptive nomenclature for accelerated rTMS, recommend avenues to optimize therapeutic and efficiency potential, and suggest using neuroimaging and electrophysiological biomarkers to individualize treatment protocols ("Future"). Overall, empirical studies show that accelerated rTMS protocols are well tolerated and not associated with serious adverse effects. Importantly, the antidepressant efficacy of accelerated rTMS appears comparable to conventional, once daily rTMS protocols. Whether accelerated rTMS induces antidepressant effects more quickly remains uncertain. On present evidence, treatment protocols incorporating high pulse dose and multiple treatments per day show promise and improved efficacy.
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Affiliation(s)
- Leo Chen
- From the Monash Alfred Psychiatry Research Centre, Department of Psychiatry, Central Clinical School, Monash University, Melbourne, Australia (Drs. Chen, Thomas); Ghent Experimental Psychiatry (GHEP) Lab, Department of Head and Skin (UZGent), Ghent University, Ghent, Belgium (Drs. Klooster, Baeken); Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford University, Stanford, CA (Drs. Tik, Williams); Institute of Medical Science and Department of Psychiatry, University of Toronto, Canada (Dr. Downar); School of Medicine and Psychology, he Australian National University, Canberra, Australia (Dr. Fitzgerald)
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3
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Caulfield KA, Fleischmann HH, George MS, McTeague LM. A transdiagnostic review of safety, efficacy, and parameter space in accelerated transcranial magnetic stimulation. J Psychiatr Res 2022; 152:384-396. [PMID: 35816982 PMCID: PMC10029148 DOI: 10.1016/j.jpsychires.2022.06.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/20/2022] [Accepted: 06/24/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Accelerated transcranial magnetic stimulation (aTMS) is an emerging delivery schedule of repetitive TMS (rTMS). TMS is "accelerated" by applying two or more stimulation sessions within a day. This three-part review comprehensively reports the safety/tolerability, efficacy, and stimulation parameters affecting response across disorders. METHODS We used the PubMed database to identify studies administering aTMS, which we defined as applying at least two rTMS sessions within one day. RESULTS Our targeted literature search identified 85 aTMS studies across 18 diagnostic and healthy control groups published from July 2001 to June 2022. Excluding overlapping populations, 63 studies delivered 43,873 aTMS sessions using low frequency, high frequency, and theta burst stimulation in 1543 participants. Regarding safety, aTMS studies had similar seizure and side effect incidence rates to those reported for once daily rTMS. One seizure was reported from aTMS (0.0023% of aTMS sessions, compared with 0.0075% in once daily rTMS). The most common side effects were acute headache (28.4%), fatigue (8.6%), and scalp discomfort (8.3%), with all others under 5%. We evaluated aTMS efficacy in 23 depression studies (the condition with the most studies), finding an average response rate of 42.4% and remission rate of 28.4% (range = 0-90.5% for both). Regarding parameters, aTMS studies ranged from 2 to 10 sessions per day over 2-30 treatment days, 10-640 min between sessions, and a total of 9-104 total accelerated TMS sessions per participant (including tapering sessions). Qualitatively, response rate tends to be higher with an increasing number of sessions per day, total sessions, and total pulses. DISCUSSION The literature to date suggests that aTMS is safe and well-tolerated across conditions. Taken together, these early studies suggest potential effectiveness even in highly treatment refractory conditions with the added potential to reduce patient burden while also expediting response time. Future studies are warranted to systematically investigate how key aTMS parameters affect treatment outcome and durability.
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Affiliation(s)
- Kevin A Caulfield
- Brain Stimulation Division, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA.
| | - Holly H Fleischmann
- Brain Stimulation Division, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA; Department of Psychology, University of Georgia, Athens, GA, USA
| | - Mark S George
- Brain Stimulation Division, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Lisa M McTeague
- Brain Stimulation Division, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson VA Medical Center, Charleston, SC, USA
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Yun JY, Kim YK. Graph theory approach for the structural-functional brain connectome of depression. Prog Neuropsychopharmacol Biol Psychiatry 2021; 111:110401. [PMID: 34265367 DOI: 10.1016/j.pnpbp.2021.110401] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 06/30/2021] [Accepted: 07/07/2021] [Indexed: 01/22/2023]
Abstract
To decipher the organizational styles of neural underpinning in major depressive disorder (MDD), the current article reviewed recent neuroimaging studies (published during 2015-2020) that applied graph theory approach to the diffusion tensor imaging data or functional brain activation data acquired during task-free resting state. The global network organization of resting-state functional connectivity network in MDD were diverse according to the onset age and medication status. Intra-modular functional connections were weaker in MDD compared to healthy controls (HC) for default mode and limbic networks. Weaker local graph metrics of default mode, frontoparietal, and salience network components in MDD compared to HC were also found. On the contrary, brain regions comprising the limbic, sensorimotor, and subcortical networks showed higher local graph metrics in MDD compared to HC. For the brain white matter-based structural connectivity network, the global network organization was comparable to HC in adult MDD but was attenuated in late-life depression. Local graph metrics of limbic, salience, default-mode, subcortical, insular, and frontoparietal network components in structural connectome were affected from the severity of depressive symptoms, burden of perceived stress, and treatment effects. Collectively, the current review illustrated changed global network organization of structural and functional brain connectomes in MDD compared to HC and were varied according to the onset age and medication status. Intra-modular functional connectivity within the default mode and limbic networks were weaker in MDD compared to HC. Local graph metrics of structural connectome for MDD reflected severity of depressive symptom and perceived stress, and were also changed after treatments. Further studies that explore the graph metrics-based neural correlates of clinical features, cognitive styles, treatment response and prognosis in MDD are required.
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Affiliation(s)
- Je-Yeon Yun
- Seoul National University Hospital, Seoul, Republic of Korea; Yeongeon Student Support Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Yong-Ku Kim
- Department of Psychiatry, College of Medicine, Korea University, Seoul, South Korea
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De Smet S, Baeken C, De Raedt R, Pulopulos MM, Razza LB, Van Damme S, De Witte S, Brunoni AR, Vanderhasselt MA. Effects of combined theta burst stimulation and transcranial direct current stimulation of the dorsolateral prefrontal cortex on stress. Clin Neurophysiol 2021; 132:1116-1125. [PMID: 33773176 DOI: 10.1016/j.clinph.2021.01.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/26/2020] [Accepted: 01/07/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Research suggests that the combination of different non-invasive brain stimulation techniques, such as intermittent theta-burst stimulation (iTBS) and transcranial direct current stimulation (tDCS), could enhance the effects of stimulation. Studies investigating the combination of tDCS and iTBS over the dorsolateral prefrontal cortex (DLPFC) are lacking. In this within-subjects study, we evaluated the additive effects of iTBS with tDCS on psychophysiological measures of stress. METHOD Sixty-eight healthy individuals were submitted to a bifrontaltDCS + iTBS and shamtDCS + iTBS protocol targeting the DLPFC with a one-week interval. The Maastricht Acute Stress Test was used to activate the stress system after stimulation. Stress reactivity and recovery were assessed using physiological and self-report measures. RESULTS The stressor evoked significant psychophysiological changes in both stimulation conditions. However, no evidence was found for differences between them in stress reactivity and recovery. Participants reported more pain and feelings of discomfort to the bifrontaltDCS + iTBS protocol. CONCLUSION In this study set-up, iTBS plus tDCS was not superior to iTBS in downregulating stress in healthy subjects. SIGNIFICANCE There is no evidence for an effect of combined tDCS-iTBS of the DLPFC on stress according to the parameters employed in our study. Future studies should explore other stimulation parameters, additive approaches and/or neurobiological markers.
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Affiliation(s)
- Stefanie De Smet
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium.
| | - Chris Baeken
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium; Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium; Department of Psychiatry, Brussels University Hospital, Brussels, Belgium; Department of Electrical Engineering, Eindhoven University of Technology, the Netherlands.
| | - Rudi De Raedt
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium.
| | - Matias M Pulopulos
- Department of Psychology and Sociology, University of Zaragoza, Aragon, Spain.
| | - Lais B Razza
- Laboratory of Neurosciences (LIM-27), Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo & Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
| | - Stefaan Van Damme
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium.
| | - Sara De Witte
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium.
| | - Andre R Brunoni
- Laboratory of Neurosciences (LIM-27), Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo & Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium; Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium.
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Garcia JO, Battelli L, Plow E, Cattaneo Z, Vettel J, Grossman ED. Understanding diaschisis models of attention dysfunction with rTMS. Sci Rep 2020; 10:14890. [PMID: 32913263 PMCID: PMC7483730 DOI: 10.1038/s41598-020-71692-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 07/27/2020] [Indexed: 01/18/2023] Open
Abstract
Visual attentive tracking requires a balance of excitation and inhibition across large-scale frontoparietal cortical networks. Using methods borrowed from network science, we characterize the induced changes in network dynamics following low frequency (1 Hz) repetitive transcranial magnetic stimulation (rTMS) as an inhibitory noninvasive brain stimulation protocol delivered over the intraparietal sulcus. When participants engaged in visual tracking, we observed a highly stable network configuration of six distinct communities, each with characteristic properties in node dynamics. Stimulation to parietal cortex had no significant impact on the dynamics of the parietal community, which already exhibited increased flexibility and promiscuity relative to the other communities. The impact of rTMS, however, was apparent distal from the stimulation site in lateral prefrontal cortex. rTMS temporarily induced stronger allegiance within and between nodal motifs (increased recruitment and integration) in dorsolateral and ventrolateral prefrontal cortex, which returned to baseline levels within 15 min. These findings illustrate the distributed nature by which inhibitory rTMS perturbs network communities and is preliminary evidence for downstream cortical interactions when using noninvasive brain stimulation for behavioral augmentations.
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Affiliation(s)
- Javier O Garcia
- US CCDC Army Research Laboratory, 459 Mulberry Pt Rd., Aberdeen Proving Ground, MD, 21005, USA. .,University of Pennsylvania, Philadelphia, PA, USA.
| | - Lorella Battelli
- Center for Neuroscience and Cognitive Systems@UniTn, Istituto Italiano di Tecnologia, Via Bettini 31, 38068, Rovereto, TN, Italy.,Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Ela Plow
- Department of Biomedical Engineering and Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Zaira Cattaneo
- Department of Psychology, University of Milano-Bicocca, 20126, Milan, Italy.,IRCCS Mondino Foundation, Pavia, Italy
| | - Jean Vettel
- US CCDC Army Research Laboratory, 459 Mulberry Pt Rd., Aberdeen Proving Ground, MD, 21005, USA.,University of Pennsylvania, Philadelphia, PA, USA.,University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Emily D Grossman
- Department of Cognitive Sciences, University of California Irvine, Irvine, CA, 92697, USA
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Thomas PJ, Panchamukhi S, Nathan J, Francis J, Langenecker S, Gorka S, Leow A, Klumpp H, Phan KL, Ajilore OA. Graph theoretical measures of the uncinate fasciculus subnetwork as predictors and correlates of treatment response in a transdiagnostic psychiatric cohort. Psychiatry Res Neuroimaging 2020; 299:111064. [PMID: 32163837 PMCID: PMC7183891 DOI: 10.1016/j.pscychresns.2020.111064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 01/01/2023]
Abstract
The internalizing psychopathologies (IP) are a highly prevalent group of disorders for which little data exists to guide treatment selection. We examine whether graph theoretical metrics from white matter connectomes may serve as biomarkers of disease and predictors of treatment response. We focus on the uncinate fasciculus subnetwork, which has been previously implicated in these disorders. We compared baseline graph measures from a transdiagnostic IP cohort with controls. Patients were randomized to either SSRI or cognitive behavioral therapy and we determined if graph theory metrics change following treatment, and whether these changes correlated with treatment response. Lastly, we investigated whether baseline metrics correlated with treatment response. Several baseline nodal graph metrics differed at baseline. Of note, right amygdala betweenness centrality was increased in patients relative to controls. In addition, white matter integrity of the uncinate fasciculus was decreased at baseline in patients versus controls. The SSRI and CBT cohorts had increased left frontal superior orbital betweenness centrality and left frontal medial orbital clustering coefficient, respectively, suggesting the presence of treatment specific neural correlates of treatment response. This study provides insight on shared white matter network features of IPs and elucidates potential biomarkers of treatment response that may be modality-specific.
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Affiliation(s)
- Paul J Thomas
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA; Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA
| | | | | | - Jennifer Francis
- Department of Behavioral Sciences, Rush University, Chicago, IL, USA
| | | | - Stephanie Gorka
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Alex Leow
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA; Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA
| | - Heide Klumpp
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - K Luan Phan
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Olusola A Ajilore
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.
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8
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Abstract
PURPOSE OF REVIEW Poor treatment response is a hallmark of major depressive disorder. To tackle this problem, recent neuroimaging studies have sought to characterize antidepressant response in terms of pretreatment differences in intrinsic functional brain networks. Our aim is to review recent studies that predict antidepressant response using intrinsic network connectivity. We discuss current methodological limitations and directions for future antidepressant biomarker studies. RECENT FINDINGS Functional connectivity stemming from the subgenual and rostral anterior cingulate has shown particular consistency in predicting antidepressant response. Differences in this connectivity may prove fruitful in differentiating treatment responders to many antidepressant interventions. Future biomarker studies should integrate biological MDD subtypes to address the disorder's inherent clinical heterogeneity. These clinical and scientific advancements have the potential to address this population marked by limited treatment response. Methodological considerations, including patient selection, response criteria, and model overfitting, will require future investigation to ensure that biomarkers generalize for prospective prediction of treatment response.
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Affiliation(s)
- Katharine Dunlop
- Brain and Mind Research Institute, Weill Cornell Medicine, 413 East 69th Street, Box 240, New York, NY, 10021, USA.
| | - Aleksandr Talishinsky
- 000000041936877Xgrid.5386.8Brain and Mind Research Institute, Weill Cornell Medicine, 413 East 69th Street, Box 240, New York, NY 10021 USA
| | - Conor Liston
- 000000041936877Xgrid.5386.8Brain and Mind Research Institute, Weill Cornell Medicine, 413 East 69th Street, Box 240, New York, NY 10021 USA ,000000041936877Xgrid.5386.8Department of Psychiatry, Weill Cornell Medicine, New York, NY USA
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9
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Klooster DCW, Franklin SL, Besseling RMH, Jansen JFA, Caeyenberghs K, Duprat R, Aldenkamp AP, de Louw AJA, Boon PAJM, Baeken C. Focal application of accelerated iTBS results in global changes in graph measures. Hum Brain Mapp 2018; 40:432-450. [PMID: 30273448 PMCID: PMC6585849 DOI: 10.1002/hbm.24384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 08/07/2018] [Accepted: 08/26/2018] [Indexed: 12/21/2022] Open
Abstract
Graph analysis was used to study the effects of accelerated intermittent theta burst stimulation (aiTBS) on the brain's network topology in medication‐resistant depressed patients. Anatomical and resting‐state functional MRI (rs‐fMRI) was recorded at baseline and after sham and verum stimulation. Depression severity was assessed using the Hamilton Depression Rating Scale (HDRS). Using various graph measures, the different effects of sham and verum aiTBS were calculated. It was also investigated whether changes in graph measures were correlated to clinical responses. Furthermore, by correlating baseline graph measures with the changes in HDRS in terms of percentage, the potential of graph measures as biomarker was studied. Although no differences were observed between the effects of verum and sham stimulation on whole‐brain graph measures and changes in graph measures did not correlate with clinical response, the baseline values of clustering coefficient and global efficiency showed to be predictive of the clinical response to verum aiTBS. Nodal effects were found throughout the whole brain. The distribution of these effects could not be linked to the strength of the functional connectivity between the stimulation site and the node. This study showed that the effects of aiTBS on graph measures distribute beyond the actual stimulation site. However, additional research into the complex interactions between different areas in the brain is necessary to understand the effects of aiTBS in more detail.
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Affiliation(s)
- Deborah C W Klooster
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Kempenhaeghe Academic Center for Epileptology, Heeze, the Netherlands.,Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Suzanne L Franklin
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - René M H Besseling
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Kempenhaeghe Academic Center for Epileptology, Heeze, the Netherlands.,Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Jaap F A Jansen
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Romain Duprat
- Department of Neurology, Ghent University Hospital, Ghent, Belgium.,University of Pennsylvania, Pennsylvania, Philadelphia
| | - Albert P Aldenkamp
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Kempenhaeghe Academic Center for Epileptology, Heeze, the Netherlands.,Department of Neurology, Ghent University Hospital, Ghent, Belgium.,Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Anton J A de Louw
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Kempenhaeghe Academic Center for Epileptology, Heeze, the Netherlands.,Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Paul A J M Boon
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Kempenhaeghe Academic Center for Epileptology, Heeze, the Netherlands.,Department of Neurology, Ghent University Hospital, Ghent, Belgium.,Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Chris Baeken
- University Hospital Brussels, Jette, Belgium.,Ghent University, Ghent Experimental Psychiatry GHEP Lab, Ghent, Belgium
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