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Nunes A, Pavlova B, Cunningham JEA, Nuñez JJ, Quilty LC, Foster JA, Harkness KL, Ho K, Lam RW, Li QS, Milev R, Rotzinger S, Soares CN, Taylor VH, Turecki G, Kennedy SH, Frey BN, Rudzicz F, Uher R. Depression-Anxiety Coupling Strength as a predictor of relapse in major depressive disorder: A CAN-BIND wellness monitoring study report. J Affect Disord 2024; 361:189-197. [PMID: 38866253 DOI: 10.1016/j.jad.2024.06.023] [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: 02/05/2024] [Revised: 06/01/2024] [Accepted: 06/05/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND A critical challenge in the study and management of major depressive disorder (MDD) is predicting relapse. We examined the temporal correlation/coupling between depression and anxiety (called Depression-Anxiety Coupling Strength, DACS) as a predictor of relapse in patients with MDD. METHODS We followed 97 patients with remitted MDD for an average of 394 days. Patients completed weekly self-ratings of depression and anxiety symptoms using the Quick Inventory of Depressive Symptoms (QIDS-SR) and the Generalized Anxiety Disorder 7-item scale (GAD-7). Using these longitudinal ratings we computed DACS as random slopes in a linear mixed effects model reflecting individual-specific degree of correlation between depression and anxiety across time points. We then tested DACS as an independent variable in a Cox proportional hazards model to predict relapse. RESULTS A total of 28 patients (29 %) relapsed during the follow-up period. DACS significantly predicted confirmed relapse (hazard ratio [HR] 1.5, 95 % CI [1.01, 2.22], p = 0.043; Concordance 0.79 [SE 0.04]). This effect was independent of baseline depressive or anxiety symptoms or their average levels over the follow-up period, and was identifiable more than one month before relapse onset. LIMITATIONS Small sample size, in a single study. Narrow phenotype and comorbidity profiles. CONCLUSIONS DACS may offer opportunities for developing novel strategies for personalized monitoring, early detection, and intervention. Future studies should replicate our findings in larger, diverse patient populations, develop individual patient prediction models, and explore the underlying mechanisms that govern the relationship of DACS and relapse.
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Affiliation(s)
- Abraham Nunes
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Faculty of Computer Science, Dalhousie University, Halifax, Nova Scotia, Canada; Mood Disorders Program, Nova Scotia Health Authority, Halifax, NS, Canada.
| | - Barbara Pavlova
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Mood Disorders Program, Nova Scotia Health Authority, Halifax, NS, Canada
| | | | - John-Jose Nuñez
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lena C Quilty
- Campbell Family Mental Health Research Institute, CAMH, Toronto, ON, Canada
| | - Jane A Foster
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Mood Disorders Treatment and Research Centre, St. Joseph's Healthcare Hamilton, ON, Canada; Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Kate L Harkness
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Keith Ho
- Mood Disorders Treatment and Research Centre, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Qingqin S Li
- Neuroscience, Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Roumen Milev
- Department of Psychiatry, Providence Care, Queen's University, Kingston, ON, Canada
| | - Susan Rotzinger
- Mood Disorders Treatment and Research Centre, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Claudio N Soares
- Department of Psychiatry, Providence Care, Queen's University, Kingston, ON, Canada
| | - Valerie H Taylor
- Cumming School of Medicine, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Gustavo Turecki
- Douglas Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Benicio N Frey
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Mood Disorders Treatment and Research Centre, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Frank Rudzicz
- Faculty of Computer Science, Dalhousie University, Halifax, Nova Scotia, Canada; Vector Institute for Artificial Intelligence, Toronto, Ontario, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Mood Disorders Program, Nova Scotia Health Authority, Halifax, NS, Canada
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Jiao X, Hu Q, Tang Y, Zhang T, Zhang J, Wang X, Sun J, Wang J. Abnormal Global Cortical Responses in Drug-Naïve Patients With Schizophrenia Following Orbitofrontal Cortex Stimulation: A Concurrent Transcranial Magnetic Stimulation-Electroencephalography Study. Biol Psychiatry 2024; 96:342-351. [PMID: 38852897 DOI: 10.1016/j.biopsych.2024.05.024] [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: 06/07/2023] [Revised: 05/16/2024] [Accepted: 05/31/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Abnormalities in cortical excitability and plasticity have been considered to underlie the pathophysiology of schizophrenia. Transcranial magnetic stimulation combined with electroencephalography (TMS-EEG) can provide a direct evaluation of cortical responses to TMS. Here, we employed TMS-EEG to investigate cortical responses to orbitofrontal cortex (OFC) stimulation in schizophrenia. METHODS In total, we recruited 92 drug-naïve patients with first-episode schizophrenia and 51 age- and sex-matched healthy individuals. For each participant, one session of 1-Hz repetitive TMS (rTMS) was delivered to the right OFC, and TMS-EEG data were obtained to explore the change in cortical-evoked activities before and immediately after rTMS during the eyes-closed state. The MATRICS Consensus Cognitive Battery was used to assess neurocognitive performance. RESULTS The cortical responses indexed by global mean field amplitudes (i.e., P30, N45, and P60) were larger in patients with schizophrenia than in healthy control participants at baseline. Furthermore, after one session of 1-Hz rTMS over the right OFC, the N100 amplitude was significantly reduced in the healthy control group but not in the schizophrenia group. In the healthy control participants, there was a significant correlation between modulation of P60 amplitude by rTMS and working memory; however, this correlation was absent in patients with schizophrenia. CONCLUSIONS Aberrant global cortical responses following right OFC stimulation were found in patients with drug-naïve first-episode schizophrenia, supporting its significance in the primary pathophysiology of schizophrenia.
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Affiliation(s)
- Xiong Jiao
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Med.-X Engineering Research Center, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Qiang Hu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Psychiatry, Zhenjiang Mental Health Center, Jiangsu, China
| | - Yingying Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
| | - Tianhong Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Med.-X Engineering Research Center, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Xijin Wang
- The First Psychiatric Hospital of Harbin, Harbin, Heilongjiang Province, China
| | - Junfeng Sun
- Shanghai Med.-X Engineering Research Center, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China.
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Sciences, Shanghai, China; Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China.
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Hu YX, Shi JY, Xia GY, Liu LF, Li PF, Shan Q, Wang YM. Analysis of functional connectivity changes in attention networks and default mode networks in patients with depression and insomnia. Sleep Breath 2024; 28:1731-1742. [PMID: 38772968 DOI: 10.1007/s11325-024-03064-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/22/2024] [Accepted: 05/15/2024] [Indexed: 05/23/2024]
Abstract
PURPOSE Major Depressive Disorder (MDD) and Insomnia Disorder (ID) are prevalent psychiatric conditions often occurring concurrently, leading to substantial impairment in daily functioning. Understanding the neurobiological underpinnings of these disorders and their comorbidity is crucial for developing effective interventions. This study aims to analyze changes in functional connectivity within attention networks and default mode networks in patients with depression and insomnia. METHODS The functional connectivity alterations in individuals with MDD, ID, comorbid MDD and insomnia (iMDD), and healthy controls (HC) were assessed from a cohort of 174 participants. They underwent rs-fMRI scans, demographic assessments, and scale evaluations for depression and sleep quality. Functional connectivity analysis was conducted using region-of-interest (ROI) and whole-brain methods. RESULTS The MDD and iMDD groups exhibited higher Hamilton Depression Scale (HAMD) scores compared to HC and ID groups (P < 0.001). Both ID and MDD groups displayed enhanced connectivity between the left and right orbital frontal cortex compared to HC (P < 0.05), while the iMDD group showed reduced connectivity compared to HC and ID groups (P < 0.05). In the left insula, reduced connectivity with the right medial superior frontal gyrus was observed across patient groups compared to HC (P < 0.05), with the iMDD group showing increased connectivity compared to MDD (P < 0.05). Moreover, alterations in functional connectivity between the left thalamus and left temporal pole were found in iMDD compared to HC and MDD (P < 0.05). Correlation analyses revealed associations between abnormal connectivity and symptom severity in MDD and ID groups. CONCLUSIONS Our findings demonstrate distinct patterns of altered functional connectivity in individuals with MDD, ID, and iMDD compared to healthy controls. These findings contribute to a better understanding of the pathophysiology of depression and insomnia, which could be used as a reference for the diagnosis and treatments of these patients.
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Affiliation(s)
- Yong-Xue Hu
- Guizhou Medical University, Guiyang, 550004, Guizhou, China.
- Department of Psychology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, Guizhou, China.
| | - Jing-Yu Shi
- Department of Neurology, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, 550004, Guizhou, China
| | - Guang-Yuan Xia
- Department of Psychology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, Guizhou, China
| | - Long-Fei Liu
- Guizhou Medical University, Guiyang, 550004, Guizhou, China
- Department of Psychology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, Guizhou, China
| | - Pei-Fan Li
- Department of Psychology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, Guizhou, China
| | - Qing Shan
- Department of Psychology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, Guizhou, China
| | - Yi-Ming Wang
- Department of Psychology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, Guizhou, China.
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Heij J, van der Zwaag W, Knapen T, Caan MWA, Forstman B, Veltman DJ, van Wingen G, Aghajani M. Quantitative MRI at 7-Tesla reveals novel frontocortical myeloarchitecture anomalies in major depressive disorder. Transl Psychiatry 2024; 14:262. [PMID: 38902245 PMCID: PMC11190139 DOI: 10.1038/s41398-024-02976-y] [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: 08/09/2023] [Revised: 05/31/2024] [Accepted: 06/04/2024] [Indexed: 06/22/2024] Open
Abstract
Whereas meta-analytical data highlight abnormal frontocortical macrostructure (thickness/surface area/volume) in Major Depressive Disorder (MDD), the underlying microstructural processes remain uncharted, due to the use of conventional MRI scanners and acquisition techniques. We uniquely combined Ultra-High Field MRI at 7.0 Tesla with Quantitative Imaging to map intracortical myelin (proxied by longitudinal relaxation time T1) and iron concentration (proxied by transverse relaxation time T2*), microstructural processes deemed particularly germane to cortical macrostructure. Informed by meta-analytical evidence, we focused specifically on orbitofrontal and rostral anterior cingulate cortices among adult MDD patients (N = 48) and matched healthy controls (HC; N = 10). Analyses probed the association of MDD diagnosis and clinical profile (severity, medication use, comorbid anxiety disorders, childhood trauma) with aforementioned microstructural properties. MDD diagnosis (p's < 0.05, Cohen's D = 0.55-0.66) and symptom severity (p's < 0.01, r = 0.271-0.267) both related to decreased intracortical myelination (higher T1 values) within the lateral orbitofrontal cortex, a region tightly coupled to processing negative affect and feelings of sadness in MDD. No relations were found with local iron concentrations. These findings allow uniquely fine-grained insights on frontocortical microstructure in MDD, and cautiously point to intracortical demyelination as a possible driver of macroscale cortical disintegrity in MDD.
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Affiliation(s)
- Jurjen Heij
- Spinoza Centre for Neuroimaging, Amsterdam, The Netherlands
- Department of Computational Cognitive Neuroscience and Neuroimaging, NIN, Amsterdam, The Netherlands
- Department of Experimental and Applied Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Wietske van der Zwaag
- Spinoza Centre for Neuroimaging, Amsterdam, The Netherlands
- Department of Computational Cognitive Neuroscience and Neuroimaging, NIN, Amsterdam, The Netherlands
| | - Tomas Knapen
- Spinoza Centre for Neuroimaging, Amsterdam, The Netherlands
- Department of Computational Cognitive Neuroscience and Neuroimaging, NIN, Amsterdam, The Netherlands
- Department of Experimental and Applied Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Matthan W A Caan
- Department of Biomedical Engineering and Physics, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Birte Forstman
- Department of Brain & Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - Dick J Veltman
- Department of Psychiatry, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Guido van Wingen
- Department of Psychiatry, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Moji Aghajani
- Department of Psychiatry, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Institute of Education and Child Studies, Section Forensic Family & Youth Care, Leiden University, Leiden, The Netherlands.
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Kochanowski B, Kageki-Bonnert K, Pinkerton EA, Dougherty DD, Chou T. A Review of Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation Combined with Medication and Psychotherapy for Depression. Harv Rev Psychiatry 2024; 32:77-95. [PMID: 38728568 DOI: 10.1097/hrp.0000000000000396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
LEARNING OBJECTIVES After participating in this CME activity, the psychiatrist should be better able to:• Compare and contrast therapies used in combination with transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) for treating MDD. BACKGROUND Noninvasive neuromodulation, such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), has emerged as a major area for treating major depressive disorder (MDD). This review has two primary aims: (1) to review the current literature on combining TMS and tDCS with other therapies, such as psychotherapy and psychopharmacological interventions, and (2) to discuss the efficacy, feasibility, limitations, and future directions of these combined treatments for MDD. METHOD This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched three databases: PubMed, PsycInfo, and Cochrane Library. The last search date was December 5, 2023. RESULTS The initial search revealed 2,519 records. After screening and full-text review, 58 studies (7 TMS plus psychotherapy, 32 TMS plus medication, 7 tDCS plus psychotherapy, 12 tDCS plus medication) were included. CONCLUSIONS The current literature on tDCS and TMS paired with psychotherapy provides initial support for integrating mindfulness interventions with both TMS and tDCS. Adding TMS or tDCS to stable doses of ongoing medications can decrease MDD symptoms; however, benzodiazepines may interfere with TMS and tDCS response, and antipsychotics can interfere with TMS response. Pairing citalopram with TMS and sertraline with tDCS can lead to greater MDD symptom reduction compared to using these medications alone. Future studies need to enroll larger samples, include randomized controlled study designs, create more uniform protocols for combined treatment delivery, and explore mechanisms and predictors of change.
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Affiliation(s)
- Brian Kochanowski
- From Harvard Medical School, Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA
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Zhang B, Rolls ET, Wang X, Xie C, Cheng W, Feng J. Roles of the medial and lateral orbitofrontal cortex in major depression and its treatment. Mol Psychiatry 2024; 29:914-928. [PMID: 38212376 DOI: 10.1038/s41380-023-02380-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 12/06/2023] [Accepted: 12/13/2023] [Indexed: 01/13/2024]
Abstract
We describe evidence for dissociable roles of the medial and lateral orbitofrontal cortex (OFC) in major depressive disorder (MDD) from structure, functional activation, functional connectivity, metabolism, and neurochemical systems. The reward-related medial orbitofrontal cortex has lower connectivity and less reward sensitivity in MDD associated with anhedonia symptoms; and the non-reward related lateral OFC has higher functional connectivity and more sensitivity to non-reward/aversive stimuli in MDD associated with negative bias symptoms. Importantly, we propose that conventional antidepressants act to normalize the hyperactive lateral (but not medial) OFC to reduce negative bias in MDD; while other treatments are needed to operate on the medial OFC to reduce anhedonia, with emerging evidence suggesting that ketamine may act in this way. The orbitofrontal cortex is the key cortical region in emotion and reward, and the current review presents much new evidence about the different ways that the medial and lateral OFC are involved in MDD.
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Affiliation(s)
- Bei Zhang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, PR China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, PR China
| | - Edmund T Rolls
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, PR China.
- Oxford Centre for Computational Neuroscience, Oxford, UK.
- Department of Computer Science, University of Warwick, Coventry, UK.
| | - Xiang Wang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, PR China
- Medical Psychological Institute, Central South University, Changsha, PR China
- China National Clinical Research Center on Mental Disorders (Xiangya), Changsha, PR China
| | - Chao Xie
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, PR China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, PR China
| | - Wei Cheng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, PR China.
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, PR China.
- MOE Frontiers Center for Brain Science, Fudan University, Shanghai, PR China.
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, PR China.
| | - Jianfeng Feng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, PR China.
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, PR China.
- Department of Computer Science, University of Warwick, Coventry, UK.
- MOE Frontiers Center for Brain Science, Fudan University, Shanghai, PR China.
- Zhangjiang Fudan International Innovation Center, Shanghai, PR China.
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Kong S, Chen Y, Huang H, Yang W, Lyu D, Wang F, Huang Q, Zhang M, Chen S, Wei Z, Shi S, Fang Y, Hong W. Efficacy of transcranial direct current stimulation for treating anhedonia in patients with depression: A randomized, double-blind, sham-controlled clinical trial. J Affect Disord 2024; 350:264-273. [PMID: 38232776 DOI: 10.1016/j.jad.2024.01.041] [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: 10/30/2023] [Revised: 12/11/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Anhedonia, the core symptom of major depressive disorder (MDD), is highly prevalent in patients with depression. Anhedonia is associated with low efficacy of drug treatment, high suicide rates, and poor social function. Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation technology that uses constant, low-intensity direct current to treat MDD by regulating cortical activity and neuronal excitability. However, little is known about the efficacy of tDCS for treating anhedonia in patients with depression, and even the existing results of clinical trials are conflicting. In addition, there is no consensus on what brain regions should be targeted by tDCS during the treatment of anhedonia in patients with depression. OBJECTIVE This study aimed to evaluate the efficacy and safety of tDCS over the left dorsolateral prefrontal cortex (DLPFC) and right orbitofrontal cortex (OFC) in the improvement of anhedonia in patients with depression and finally identified suitable brain regions to be stimulated during treatment. METHODS This randomized, double-blind, sham-controlled clinical trial recruited 70 patients with anhedonia and depressive episodes. Patients were randomly assigned to three groups according to the stimulation site: right orbitofrontal cortex (OFC), left dorsolateral prefrontal cortex (DLPFC), and sham stimulation. Each group received twelve 20-min interventions (ten as primary treatment and two for consolidation). The primary outcome was a decrease in Snaith-Hamilton Pleasure Scale (SHAPS) scores after primary treatment. Evaluations were performed at baseline, post-treatment, and 8-week follow-up. RESULTS The depression mood of the three groups of patients at each time point was better than the baseline, but there was no significant difference in the efficacy between the groups (p>0.05). On the basis of the improvement of depression, this study found that tDCS of the DLPFC significantly improved anhedonia (p = 0.028) after primary treatment (2 weeks), and tDCS of the DLPFC and OFC significantly improved social functioning (p = 0.005) at 8-week follow-up. LIMITATIONS The sample size of this study was small, with only about 23/24 patients in each group completing the intervention assessments; due to the impact of the COVID-19 epidemic, data analysis was limited by the lack of patients during the follow-up period. CONCLUSIONS tDCS of the DLPFC significantly improves anhedonia in depressed patients and is thus a potential adjuvant therapy for anhedonia in these patients.
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Affiliation(s)
- Shuqi Kong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiming Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haijing Huang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shenzhen Institute of Advanced Technology, Chinese academy of Science, Shenzhen, China
| | - Weichieh Yang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dongbin Lyu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fan Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qinte Huang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mengke Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shentse Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zheyi Wei
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuxiang Shi
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiru Fang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Psychiatry & Affective Disorders Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China; CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, China.
| | - Wu Hong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China; Mental Health Branch, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China.
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Cash RFH, Zalesky A. Personalized and Circuit-Based Transcranial Magnetic Stimulation: Evidence, Controversies, and Opportunities. Biol Psychiatry 2024; 95:510-522. [PMID: 38040047 DOI: 10.1016/j.biopsych.2023.11.013] [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: 06/14/2023] [Revised: 11/13/2023] [Accepted: 11/18/2023] [Indexed: 12/03/2023]
Abstract
The development of neuroimaging methodologies to map brain connectivity has transformed our understanding of psychiatric disorders, the distributed effects of brain stimulation, and how transcranial magnetic stimulation can be best employed to target and ameliorate psychiatric symptoms. In parallel, neuroimaging research has revealed that higher-order brain regions such as the prefrontal cortex, which represent the most common therapeutic brain stimulation targets for psychiatric disorders, show some of the highest levels of interindividual variation in brain connectivity. These findings provide the rationale for personalized target site selection based on person-specific brain network architecture. Recent advances have made it possible to determine reproducible personalized targets with millimeter precision in clinically tractable acquisition times. These advances enable the potential advantages of spatially personalized transcranial magnetic stimulation targeting to be evaluated and translated to basic and clinical applications. In this review, we outline the motivation for target site personalization, preliminary support (mostly in depression), convergent evidence from other brain stimulation modalities, and generalizability beyond depression and the prefrontal cortex. We end by detailing methodological recommendations, controversies, and notable alternatives. Overall, while this research area appears highly promising, the value of personalized targeting remains unclear, and dedicated large prospective randomized clinical trials using validated methodology are critical.
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Affiliation(s)
- Robin F H Cash
- Melbourne Neuropsychiatry Centre and Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia.
| | - Andrew Zalesky
- Melbourne Neuropsychiatry Centre and Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
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Oliveira-Maia AJ, Bobrowska A, Constant E, Ito T, Kambarov Y, Luedke H, Mulhern-Haughey S, von Holt C. Treatment-Resistant Depression in Real-World Clinical Practice: A Systematic Literature Review of Data from 2012 to 2022. Adv Ther 2024; 41:34-64. [PMID: 37882883 PMCID: PMC10796703 DOI: 10.1007/s12325-023-02700-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/28/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE Real-world evidence in treatment-resistant depression (TRD; commonly defined as non-response to ≥ 2 consecutive treatments at adequate dosage and duration) is lacking. A systematic literature review was conducted to understand disease burden and treatment outcomes for patients with TRD, studied in a real-world setting over the last decade. DATA SOURCES A literature search was conducted in May 2022 in MEDLINE, Embase, The Cochrane Libraries and PsycINFO, comprising studies published from 2012 to 2022. Bibliographies of all relevant identified systematic reviews and relevant conference proceedings from 2020 to 2022 were manually hand-searched. STUDY SELECTION Real-world studies, including cohort, cross-sectional, case-control, chart review and registry studies, published in English and reporting outcomes in adults with TRD, were included. DATA EXTRACTION Extracted data included study and baseline disease characteristics, treatment type, treatment response, clinical outcomes and health-related quality of life. RESULTS Twenty studies were included. Criteria for TRD varied, but patients typically experienced long-lasting depression (range 1.4 to 16.5 years). Across studies, mean disease severity scores demonstrated moderate to severe depression, reflecting a high burden of disease at baseline. Remission rates were typically low but generally increased with longer follow-up durations. However, the heterogeneity of interventions, follow-up durations (range 2 weeks to 9.4 years) and assessment tools precluded their quantitative synthesis. Studies were frequently limited by low sample size (range 14 to 411 patients) and health-related quality of life was infrequently assessed. CONCLUSIONS There is a lack of clinical consensus regarding the definition, assessment and monitoring of TRD in real-world practice. Nevertheless, TRD carries a high burden of illness and there is an unmet need for faster and more effective treatments. To better understand the personal burden of affected patients, future studies would benefit from standardisation of severity assessment and measures of treatment effectiveness, as well as greater consideration of health-related quality of life.
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Affiliation(s)
- Albino J Oliveira-Maia
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, Lisbon, Portugal
- Faculdade de Ciências Médicas, NOVA Medical School, NMS, FCM, Universidade NOVA de Lisboa, Lisbon, Portugal
| | | | - Eric Constant
- Centre Hospitalier Spécialisé Notre-Dame des Anges, Liège, Belgium
- Université Catholique de Louvain, Brussels, Université de Liège, Liège, Belgium
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10
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Downar J, Siddiqi SH, Mitra A, Williams N, Liston C. Mechanisms of Action of TMS in the Treatment of Depression. Curr Top Behav Neurosci 2024; 66:233-277. [PMID: 38844713 DOI: 10.1007/7854_2024_483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2024]
Abstract
Transcranial magnetic stimulation (TMS) is entering increasingly widespread use in treating depression. The most common stimulation target, in the dorsolateral prefrontal cortex (DLPFC), emerged from early neuroimaging studies in depression. Recently, more rigorous casual methods have revealed whole-brain target networks and anti-networks based on the effects of focal brain lesions and focal brain stimulation on depression symptoms. Symptom improvement during therapeutic DLPFC-TMS appears to involve directional changes in signaling between the DLPFC, subgenual and dorsal anterior cingulate cortex, and salience-network regions. However, different networks may be involved in the therapeutic mechanisms for other TMS targets in depression, such as dorsomedial prefrontal cortex or orbitofrontal cortex. The durability of therapeutic effects for TMS involves synaptic neuroplasticity, and specifically may depend upon dopamine acting at the D1 receptor family, as well as NMDA-receptor-dependent synaptic plasticity mechanisms. Although TMS protocols are classically considered 'excitatory' or 'inhibitory', the actual effects in individuals appear quite variable, and might be better understood at the level of populations of synapses rather than individual synapses. Synaptic meta-plasticity may provide a built-in protective mechanism to avoid runaway facilitation or inhibition during treatment, and may account for the relatively small number of patients who worsen rather than improve with TMS. From an ethological perspective, the antidepressant effects of TMS may involve promoting a whole-brain attractor state associated with foraging/hunting behaviors, centered on the rostrolateral periaqueductal gray and salience network, and suppressing an attractor state associated with passive threat defense, centered on the ventrolateral periaqueductal gray and default-mode network.
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Affiliation(s)
- Jonathan Downar
- Department of Psychiatry, Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Shan H Siddiqi
- Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, MA, USA
- Department of Psychiatry, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anish Mitra
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Nolan Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Conor Liston
- Department of Psychiatry, Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
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11
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Hu Q, Jiao X, Zhou J, Tang Y, Zhang T, Song C, Wang J, Xiao Q, Ye J, Sun J, Wang X, Li C, Wang J. Low-frequency repetitive transcranial magnetic stimulation over the right orbitofrontal cortex for patients with first-episode schizophrenia: A randomized, double-blind, sham-controlled trial. Psychiatry Res 2023; 330:115600. [PMID: 37992513 DOI: 10.1016/j.psychres.2023.115600] [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: 04/01/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) has been used in the treatment of patients with schizophrenia. The conventional targets of rTMS treatment are the dorsolateral prefrontal cortex (DLPFC) and temporoparietal cortex (TPC). However, the efficacy of these two treatment strategies was quite heterogeneous. Structural and functional abnormalities of the orbitofrontal cortex (OFC) in schizophrenia are closely related to negative symptoms. We sought to determine whether 1 Hz rTMS over the right OFC is effective in treating patients with first-episode schizophrenia. In this study, eighty-nine patients with drug-naïve, first-episode schizophrenia were randomly divided into the rTMS (n = 47) or sham stimulation (n = 42) groups, with both groups receiving twenty sessions of 1 Hz rTMS treatment. The PANSS was assessed at baseline, day 10, and day 20, and MATRICS Consensus Cognitive Battery (MCCB) was implemented to assess the cognitive impairment at baseline and day 20. Results showed that patients in the active rTMS group had more improvement in clinical symptoms and cognitive deficits than patients in sham group at day 20. In conclusion, 1 Hz rTMS over OFC can improve psychotic symptoms and cognitive functions in schizophrenic patients. Our study provides a new alternative for the treatment of negative symptoms and cognitive deficits in schizophrenia.
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Affiliation(s)
- Qiang Hu
- Department of Psychiatry, Zhenjiang Mental Health Center, Jiangsu 212000, China
| | - Xiong Jiao
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Shanghai Med-X Engineering Research Center, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Jie Zhou
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Shanghai Med-X Engineering Research Center, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Yingying Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Tianhong Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Chuanfu Song
- Department of Psychiatry, The Fourth People's Hospital of Wuhu, Anhui 231200, China
| | - Junjie Wang
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou 215131, China
| | - Qiang Xiao
- The First Psychiatric Hospital of Harbin, Harbin 150000, China
| | - Junying Ye
- The First Psychiatric Hospital of Harbin, Harbin 150000, China
| | - Junfeng Sun
- Shanghai Med-X Engineering Research Center, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Xijin Wang
- The First Psychiatric Hospital of Harbin, Harbin 150000, China.
| | - Chunbo Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai 200031, China; Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China; Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China.
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai 200031, China; Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China.
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12
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Prentice A, Kolken Y, Tuttle C, van Neijenhof J, Pitch R, van Oostrom I, Kruiver V, Downar J, Sack AT, Arns M, van der Vinne N. 1Hz right orbitofrontal TMS benefits depressed patients unresponsive to dorsolateral prefrontal cortex TMS. Brain Stimul 2023; 16:1572-1575. [PMID: 37839775 DOI: 10.1016/j.brs.2023.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/06/2023] [Accepted: 10/08/2023] [Indexed: 10/17/2023] Open
Affiliation(s)
- Amourie Prentice
- Research Institute Brainclinics, Brainclinics Foundation, Bijleveldsingel 32, 6524 AD, Nijmegen, Netherlands; Synaeda Research, Synaeda Psycho Medisch Centrum, De Opgang 2-1, 9203 GD, Drachten, Netherlands; Dept. of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, Netherlands
| | - Ylka Kolken
- Research Institute Brainclinics, Brainclinics Foundation, Bijleveldsingel 32, 6524 AD, Nijmegen, Netherlands; Dept. of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, Netherlands
| | - Christina Tuttle
- Long Island Neurocare Therapy, 1739 N. Ocean Ave. Suite A, Medford, NY, 11763, Long Island, USA
| | | | - Richard Pitch
- Long Island Neurocare Therapy, 1739 N. Ocean Ave. Suite A, Medford, NY, 11763, Long Island, USA
| | - Iris van Oostrom
- Neurocare Clinics, Bijleveldsingel 34, 6524 AD, Nijmegen, Netherlands
| | - Vera Kruiver
- Neurocare Clinics, Bijleveldsingel 34, 6524 AD, Nijmegen, Netherlands
| | - Jonathan Downar
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, 1 King's College Cir, Toronto, Ontario, M5S 1A8, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, 250 College Street 8th Floor. Toronto, Ontario, M5T 1R8, Canada
| | - Alexander T Sack
- Dept. of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, Netherlands
| | - Martijn Arns
- Research Institute Brainclinics, Brainclinics Foundation, Bijleveldsingel 32, 6524 AD, Nijmegen, Netherlands; Synaeda Research, Synaeda Psycho Medisch Centrum, De Opgang 2-1, 9203 GD, Drachten, Netherlands; Dept. of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, Netherlands
| | - Nikita van der Vinne
- Research Institute Brainclinics, Brainclinics Foundation, Bijleveldsingel 32, 6524 AD, Nijmegen, Netherlands; Synaeda Research, Synaeda Psycho Medisch Centrum, De Opgang 2-1, 9203 GD, Drachten, Netherlands; Dept. of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, Netherlands.
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13
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Tadayonnejad R, Citrenbaum C, Ngo TDP, Corlier J, Wilke SA, Slan A, Distler MG, Hoftman G, Adelekun AE, Leuchter MK, Koek RJ, Ginder ND, Krantz D, Artin H, Strouse T, Bari AA, Leuchter AF. Right lateral orbitofrontal cortex inhibitory transcranial magnetic stimulation for treatment of refractory mood and depression. Brain Stimul 2023; 16:1374-1376. [PMID: 37716637 DOI: 10.1016/j.brs.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 09/18/2023] Open
Affiliation(s)
- Reza Tadayonnejad
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, USA; Department of Psychiatry & Biobehavioral Sciences, USA; Division of the Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA.
| | - Cole Citrenbaum
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, USA; Department of Psychiatry & Biobehavioral Sciences, USA
| | - Thuc Doan P Ngo
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, USA; Department of Psychiatry & Biobehavioral Sciences, USA
| | - Juliana Corlier
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, USA; Department of Psychiatry & Biobehavioral Sciences, USA
| | - Scott A Wilke
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, USA; Department of Psychiatry & Biobehavioral Sciences, USA
| | - Aaron Slan
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, USA; Department of Psychiatry & Biobehavioral Sciences, USA
| | - Margaret G Distler
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, USA; Department of Psychiatry & Biobehavioral Sciences, USA
| | - Gil Hoftman
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, USA; Department of Psychiatry & Biobehavioral Sciences, USA
| | - Adesewa E Adelekun
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, USA; Department of Psychiatry & Biobehavioral Sciences, USA
| | - Michael K Leuchter
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, USA; Department of Psychiatry & Biobehavioral Sciences, USA
| | - Ralph J Koek
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, USA; Department of Psychiatry & Biobehavioral Sciences, USA
| | - Nathaniel D Ginder
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, USA; Department of Psychiatry & Biobehavioral Sciences, USA
| | - David Krantz
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, USA; Department of Psychiatry & Biobehavioral Sciences, USA
| | - Hewa Artin
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, USA; Department of Psychiatry & Biobehavioral Sciences, USA
| | - Thomas Strouse
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, USA; Department of Psychiatry & Biobehavioral Sciences, USA
| | - Ausaf A Bari
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, USA; Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Andrew F Leuchter
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, USA; Department of Psychiatry & Biobehavioral Sciences, USA
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14
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Reinsberg C, Schecklmann M, Abdelnaim MA, Weber FC, Langguth B, Hebel T. Treatment of depression and borderline personality disorder with 1 Hz repetitive transcranial magnetic stimulation of the orbitofrontal cortex - A pilot study. World J Biol Psychiatry 2023; 24:595-602. [PMID: 36920303 DOI: 10.1080/15622975.2023.2186484] [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: 12/19/2022] [Revised: 01/28/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Abstract
Borderline personality disorder (BPD) is characterised by impairments in emotional regulation, impulse control and interpersonal interaction. Comorbid depression is common. The orbitofrontal cortex (OFC) plays a crucial role in the biological substrate of BPD. We investigated the effects of 1 Hz repetitive transcranial magnetic stimulation (rTMS) targeting the OFC on depressive symptoms and symptoms of BPD in 15 patients suffering from both conditions to assess feasibility and effectiveness. Target treatment intensity was 120% of resting motor threshold (RMT) and intended duration four weeks. Treatment improved both symptoms of depression as measured by the Hamilton Depression Rating Scale and of BPD as measured by Borderline Symptom List-23 and Barratt Impulsivity Scale. Drop-out rates were high with 7/15 patients not completing the full course of rTMS, but only two drop-outs were related to treatment. Only a minority of patients tolerated target treatment intensity. Despite the limitations, the results suggest efficacy of treatment and welcome further research.
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Affiliation(s)
- C Reinsberg
- University of Regensburg, Regensburg, Germany
| | - M Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - M A Abdelnaim
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - F C Weber
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - B Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - T Hebel
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
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15
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Deng ZD, Robins PL, Dannhauer M, Haugen LM, Port JD, Croarkin PE. Optimizing TMS Coil Placement Approaches for Targeting the Dorsolateral Prefrontal Cortex in Depressed Adolescents: An Electric Field Modeling Study. Biomedicines 2023; 11:2320. [PMID: 37626817 PMCID: PMC10452519 DOI: 10.3390/biomedicines11082320] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/18/2023] [Accepted: 07/23/2023] [Indexed: 08/27/2023] Open
Abstract
High-frequency repetitive transcranial magnetic stimulation (rTMS) to the left dorsolateral prefrontal cortex (L-DLPFC) shows promise as a treatment for treatment-resistant depression in adolescents. Conventional rTMS coil placement strategies include the 5 cm, the Beam F3, and the magnetic resonance imaging (MRI) neuronavigation methods. The purpose of this study was to use electric field (E-field) models to compare the three targeting approaches to a computational E-field optimization coil placement method in depressed adolescents. Ten depressed adolescents (4 females, age: 15.9±1.1) participated in an open-label rTMS treatment study and were offered MRI-guided rTMS five times per week over 6-8 weeks. Head models were generated based on individual MRI images, and E-fields were simulated for the four targeting approaches. Results showed a significant difference in the induced E-fields at the L-DLPFC between the four targeting methods (χ2=24.7, p<0.001). Post hoc pairwise comparisons showed that there was a significant difference between any two of the targeting methods (Holm adjusted p<0.05), with the 5 cm rule producing the weakest E-field (46.0±17.4V/m), followed by the F3 method (87.4±35.4V/m), followed by MRI-guided (112.1±14.6V/m), and followed by the computational approach (130.1±18.1V/m). Variance analysis showed that there was a significant difference in sample variance between the groups (K2=8.0, p<0.05), with F3 having the largest variance. Participants who completed the full course of treatment had median E-fields correlated with depression symptom improvement (r=-0.77, p<0.05). E-field models revealed limitations of scalp-based methods compared to MRI guidance, suggesting computational optimization could enhance dose delivery to the target.
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Affiliation(s)
- Zhi-De Deng
- Computational Neurostimulation Research Program, Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD 20892, USA; (P.L.R.); (M.D.)
| | - Pei L. Robins
- Computational Neurostimulation Research Program, Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD 20892, USA; (P.L.R.); (M.D.)
| | - Moritz Dannhauer
- Computational Neurostimulation Research Program, Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD 20892, USA; (P.L.R.); (M.D.)
| | - Laura M. Haugen
- Department of Neurosurgery, Mayo Clinic, Rochester, MN 55905, USA;
| | - John D. Port
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA;
- Mayo Clinic Depression Center, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA;
| | - Paul E. Croarkin
- Mayo Clinic Depression Center, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA;
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Boscutti A, Murphy N, Cho R, Selvaraj S. Noninvasive Brain Stimulation Techniques for Treatment-Resistant Depression: Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation. Psychiatr Clin North Am 2023; 46:307-329. [PMID: 37149347 DOI: 10.1016/j.psc.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Transcranial magnetic stimulation is a safe, effective, and well-tolerated intervention for depression; it is currently approved for treatment-resistant depression. This article summarizes the mechanism of action, evidence of clinical efficacy, and the clinical aspects of this intervention, including patient evaluation, stimulation parameters selection, and safety considerations. Transcranial direct current stimulation is another neuromodulation treatment for depression; although promising, the technique is not currently approved for clinical use in the United States. The final section outlines the open challenges and future directions of the field.
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Affiliation(s)
- Andrea Boscutti
- Louis. A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Nicholas Murphy
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, Houston, TX, USA; The Menninger Clinic, Houston, TX, USA
| | - Raymond Cho
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, Houston, TX, USA; The Menninger Clinic, Houston, TX, USA
| | - Sudhakar Selvaraj
- Louis. A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA.
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Thatikonda NS, Vinod P, Balachander S, Bhaskarpillai B, Arumugham SS, Reddy YJ. Efficacy of Repetitive Transcranial Magnetic Stimulation on Comorbid Anxiety and Depression Symptoms in Obsessive-Compulsive Disorder: A Meta-Analysis of Randomized Sham-Controlled Trials. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:407-417. [PMID: 35989677 PMCID: PMC10331254 DOI: 10.1177/07067437221121112] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To systematically evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in reducing comorbid anxiety and depressive symptoms in patients with obsessive-compulsive disorder (OCD). METHODS Three electronic databases were searched for randomized, sham-controlled clinical trials evaluating rTMS for the treatment of OCD. Hedge's g was calculated as the effect size for anxiety/depression symptom severity (primary outcome) and OCD severity (secondary outcome). Subgroup analyses and meta-regression analyses were carried out to evaluate the most promising target and whether a reduction in OCD severity moderates the change in anxiety or depression scores. RESULTS Twenty studies (n = 688) were included in the meta-analysis. rTMS had small-medium effect size on OCD (Hedge's g = 0.43; 95% confidence interval [CI]: [0.20, 0.65]; P < 0.001), anxiety (Hedge's g = 0.3; 95% CI: [0.11, 0.48]; P = 0.001) and depression (Hedge's g = 0.24; 95% CI: [0.07, 0.40]; P = 0.003) symptoms. Subgroup analysis showed that protocols targeting dorsolateral prefrontal cortex (DLPFC) were effective for 3 outcome measures. The change in anxiety, but not depression severity, was moderated by a change in OCD symptom scores. However, the findings are uncertain as a majority of the studies had some concerns or a high risk of bias. CONCLUSIONS Active rTMS protocol targeting DLPFC is effective in reducing the comorbid anxiety/depression symptoms along with OCD severity. The antidepressant effect is not moderated by the anti-obsessive effect of rTMS.
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Affiliation(s)
- Navya Spurthi Thatikonda
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Pratibha Vinod
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Srinivas Balachander
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | | | - Shyam Sundar Arumugham
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Y.C. Janardhan Reddy
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
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18
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Quidé Y, Norman-Nott N, Hesam-Shariati N, McAuley JH, Gustin SM. Depressive symptoms moderate functional connectivity within the emotional brain in chronic pain. BJPsych Open 2023; 9:e80. [PMID: 37161479 DOI: 10.1192/bjo.2023.61] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Depressive symptoms are often comorbid with chronic pain. These conditions share aberrant emotion processing and regulation, as well as having common brain networks. However, the relationship between depressive symptoms and chronic pain and the effects on emotional brain function are unclear. AIMS The present study aimed to disentangle the effects of chronic pain and depressive symptoms on functional connectivity between regions implicated in both these conditions. METHOD Twenty-six individuals with chronic pain (referred to as the pain group) and 32 healthy controls underwent resting-state functional magnetic resonance imaging and completed the Beck Depression Inventory. Main effects of group, depressive symptoms (total severity score) and their interaction on the functional connectivity of three seed regions (the left and right amygdalae and the medial prefrontal cortex; mPFC) with the rest of the brain were evaluated. In cases of significant interaction, moderation analyses were conducted. RESULTS The group × depressive symptoms interaction was significantly associated with changes in connectivity between the right amygdala and the mPFC (family-wise error-corrected P-threshold (pFWEc = 0.008). In the moderation analysis, the pain group showed weaker connectivity between these regions at lower levels of depressive symptoms (P = 0.020), and stronger connectivity at higher levels of depressive symptoms (P = 0.003), compared with the healthy controls. In addition, the strength of connectivity decreased in the healthy controls (P = 0.005) and increased in the pain group (P = 0.014) as the severity of depressive symptoms increased. CONCLUSIONS Depressive symptoms moderate the impact of chronic pain on emotional brain function, with potential implications for the choice of treatment for chronic pain.
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Affiliation(s)
- Yann Quidé
- NeuroRecovery Research Hub, School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia; and Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Nell Norman-Nott
- NeuroRecovery Research Hub, School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia; and Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Negin Hesam-Shariati
- NeuroRecovery Research Hub, School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia; and Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia; and School of Health Sciences, The University of New South Wales, Sydney, New South Wales, Australia
| | - Sylvia M Gustin
- NeuroRecovery Research Hub, School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia; and Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
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19
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Fulton SL, Bendl J, Gameiro-Ros I, Fullard JF, Al-Kachak A, Lepack AE, Stewart AF, Singh S, Poller WC, Bastle RM, Hauberg ME, Fakira AK, Chen M, Cuttoli RDD, Cathomas F, Ramakrishnan A, Gleason K, Shen L, Tamminga CA, Milosevic A, Russo SJ, Swirski F, Blitzer RD, Slesinger PA, Roussos P, Maze I. ZBTB7A regulates MDD-specific chromatin signatures and astrocyte-mediated stress vulnerability in orbitofrontal cortex. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.05.04.539425. [PMID: 37205394 PMCID: PMC10187272 DOI: 10.1101/2023.05.04.539425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Hyperexcitability in the orbitofrontal cortex (OFC) is a key clinical feature of anhedonic domains of Major Depressive Disorder (MDD). However, the cellular and molecular substrates underlying this dysfunction remain unknown. Here, cell-population-specific chromatin accessibility profiling in human OFC unexpectedly mapped genetic risk for MDD exclusively to non-neuronal cells, and transcriptomic analyses revealed significant glial dysregulation in this region. Characterization of MDD-specific cis-regulatory elements identified ZBTB7A - a transcriptional regulator of astrocyte reactivity - as an important mediator of MDD-specific chromatin accessibility and gene expression. Genetic manipulations in mouse OFC demonstrated that astrocytic Zbtb7a is both necessary and sufficient to promote behavioral deficits, cell-type-specific transcriptional and chromatin profiles, and OFC neuronal hyperexcitability induced by chronic stress - a major risk factor for MDD. These data thus highlight a critical role for OFC astrocytes in stress vulnerability and pinpoint ZBTB7A as a key dysregulated factor in MDD that mediates maladaptive astrocytic functions driving OFC hyperexcitability.
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Affiliation(s)
- Sasha L. Fulton
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jaroslav Bendl
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Center for Disease Neurogenomics, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Genetics and Genomic Science, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Isabel Gameiro-Ros
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John F. Fullard
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Center for Disease Neurogenomics, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Genetics and Genomic Science, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Amni Al-Kachak
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashley E. Lepack
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew F. Stewart
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sumnima Singh
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- The Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Wolfram C. Poller
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- The Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Ryan M. Bastle
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mads E. Hauberg
- Center for Disease Neurogenomics, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Amanda K. Fakira
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Min Chen
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Romain Durand-de Cuttoli
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Flurin Cathomas
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aarthi Ramakrishnan
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kelly Gleason
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Li Shen
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carol A. Tamminga
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ana Milosevic
- Laboratory of Molecular and Cellular Neuroscience, Rockefeller University, New York, New York, USA
| | - Scott J. Russo
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Filip Swirski
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- The Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Robert D. Blitzer
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Paul A. Slesinger
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Panos Roussos
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Center for Disease Neurogenomics, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Genetics and Genomic Science, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Center for Dementia Research, Nathan Kline Institute for Psychiatric Research, Orangeburg, New York, USA
- Mental Illness Research Education and Clinical Center (MIRECC), James J. Peters VA Medical Center, Bronx, New York, USA
| | - Ian Maze
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Howard Hughes Medical Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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20
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Gogulski J, Ross JM, Talbot A, Cline CC, Donati FL, Munot S, Kim N, Gibbs C, Bastin N, Yang J, Minasi C, Sarkar M, Truong J, Keller CJ. Personalized Repetitive Transcranial Magnetic Stimulation for Depression. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:351-360. [PMID: 36792455 DOI: 10.1016/j.bpsc.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/20/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
Personalized treatments are gaining momentum across all fields of medicine. Precision medicine can be applied to neuromodulatory techniques, in which focused brain stimulation treatments such as repetitive transcranial magnetic stimulation (rTMS) modulate brain circuits and alleviate clinical symptoms. rTMS is well tolerated and clinically effective for treatment-resistant depression and other neuropsychiatric disorders. Despite its wide stimulation parameter space (location, angle, pattern, frequency, and intensity can be adjusted), rTMS is currently applied in a one-size-fits-all manner, potentially contributing to its suboptimal clinical response (∼50%). In this review, we examine components of rTMS that can be optimized to account for interindividual variability in neural function and anatomy. We discuss current treatment options for treatment-resistant depression, the neural mechanisms thought to underlie treatment, targeting strategies, stimulation parameter selection, and adaptive closed-loop treatment. We conclude that a better understanding of the wide and modifiable parameter space of rTMS will greatly improve the clinical outcome.
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Affiliation(s)
- Juha Gogulski
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California; HUS Diagnostic Center, Clinical Neurophysiology, Clinical Neurosciences, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jessica M Ross
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California; Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, California
| | - Austin Talbot
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California; Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, California
| | - Christopher C Cline
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California; Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, California
| | - Francesco L Donati
- Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Saachi Munot
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California; Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, California
| | - Naryeong Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California; Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, California
| | - Ciara Gibbs
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Nikita Bastin
- Department of Radiology and Orthopedics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jessica Yang
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California; Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, California
| | - Christopher Minasi
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California; Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, California
| | - Manjima Sarkar
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California; Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, California
| | - Jade Truong
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California; Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, California
| | - Corey J Keller
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California; Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, California.
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21
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Noda Y, Sato A, Fujii K, Nagano Y, Iwasa M, Hirahata K, Kitahata R, Osawa R. A pilot study of the effect of transcranial magnetic stimulation treatment on cognitive dysfunction associated with post COVID-19 condition. Psychiatry Clin Neurosci 2023; 77:241-242. [PMID: 36594421 DOI: 10.1111/pcn.13527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/16/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Yoshihiro Noda
- Shinjuku-Yoyogi Mental Lab Clinic, Tokyo, Japan
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | | | | | | | - Mio Iwasa
- Shinjuku-Yoyogi Mental Lab Clinic, Tokyo, Japan
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22
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Noda Y, Sato A, Shichi M, Sato A, Fujii K, Iwasa M, Nagano Y, Kitahata R, Osawa R. Real world research on transcranial magnetic stimulation treatment strategies for neuropsychiatric symptoms with long-COVID in Japan. Asian J Psychiatr 2023; 81:103438. [PMID: 36610206 PMCID: PMC9795803 DOI: 10.1016/j.ajp.2022.103438] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 12/29/2022]
Abstract
The number of patients suffering from long-COVID is currently increasing rapidly, even after the acute symptoms of COVID-19 have improved. The objective of this study was to investigate the effects of a pilot transcranial magnetic stimulation (TMS) treatment on neuropsychiatric symptoms caused by long-COVID. In this study, we examined the efficacy of the TMS treatment protocol, which has been established to be effective in refractory depression, by applying it to patients who sought TMS treatment for neuropsychiatric symptoms caused by long-COVID at TMS clinics in Tokyo, Japan in the context of the real world TMS registry study in Japan. Of the 23 patients (13 females) with long-COVID included in this case series, the main neuropsychiatric symptoms were chronic fatigue (n = 12) and cognitive dysfunction (n = 11), but most patients also showed mild depressive symptoms. The mean score on the Montgomery-Åsberg Depression Rating Scale before TMS treatment was 21.2, which improved to 9.8 after treatment. Similarly, the score on the Performance Status, which assesses the degree of fatigue, improved from 5.4 to 4.2, and the score on the Perceived Deficits Questionnaire-Depression 5-item, which reflects cognitive function, improved from 10.0 to 6.3. Although a few patients complained of pain at the stimulation site during the TMS as a side effect, there were no serious adverse events. Despite the limitations of this open-label pilot study, the TMS protocol implemented in this study may have beneficial effects on neuropsychiatric symptoms caused by long-COVID, including depressive symptoms, chronic fatigue, and cognitive impairment. These preliminary findings warrant further validation in randomized controlled trials.
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Affiliation(s)
- Yoshihiro Noda
- Shinjuku-Yoyogi Mental Lab Clinic, Tokyo, Japan; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
| | | | | | | | | | - Mio Iwasa
- Shinjuku-Yoyogi Mental Lab Clinic, Tokyo, Japan
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23
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Deng ZD, Robins PL, Dannhauer M, Haugen LM, Port JD, Croarkin PE. Comparison of coil placement approaches targeting dorsolateral prefrontal cortex in depressed adolescents receiving repetitive transcranial magnetic stimulation: an electric field modeling study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.06.23285526. [PMID: 36798297 PMCID: PMC9934718 DOI: 10.1101/2023.02.06.23285526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Background A promising treatment option for adolescents with treatment-resistant depression is high-frequency repetitive transcranial magnetic stimulation (rTMS) delivered to the left dorsolateral prefrontal cortex (L-DLPFC). Conventional coil placement strategies for rTMS in adults include the 5-cm rule, the Beam F3 method, and the magnetic resonance imaging (MRI) neuronavigation method. The purpose of this study was to compare the three targeting approaches to a computational E-field optimization coil placement method in depressed adolescents. Methods Ten consenting and assenting depressed adolescents (4 females, age: 15.9 ± 1.1) participated in an open-label rTMS treatment study. Participants were offered MRI-guided rTMS 5 times per week over 6-8 weeks. To compute the induced E-field, a head model was generated based on MRI images, and a figure-8 TMS coil (Neuronetics) was placed over the L-DLPFC using the four targeting approaches. Results Results show that there was a significant difference in the induced E-field at the L-DLPFC between the four targeting methods ( χ 2 = 24.7, p < 0.001). Post hoc pairwise comparisons show that there was a significant difference between any two of the targeting methods (Holm adjusted p < 0.05), with the 5-cm rule producing the weakest E-field (46.0 ± 17.4 V/m), followed by the F3 method (87.4 ± 35.4 V/m), followed by the MRI-guided (112.1 ± 14.6 V/m), and followed by the computationally optimized method (130.1 ± 18.1 V/m). The Bartlett test of homogeneity of variances show that there was a significant difference in sample variance between the groups ( K 2 = 8.0, p < 0.05), with F3 having the largest variance. In participants who completed the full course of treatment, the median E-field strength in the L-DLPFC was correlated with the change in depression severity ( r = - 0.77, p < 0.05). Conclusions The E-field models revealed inadequacies of scalp-based targeting methods compared to MRI-guidance. Computational optimization may further enhance E-field dose delivery to the treatment target.
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Moses TE, Gray E, Mischel N, Greenwald MK. Effects of neuromodulation on cognitive and emotional responses to psychosocial stressors in healthy humans. Neurobiol Stress 2023; 22:100515. [PMID: 36691646 PMCID: PMC9860364 DOI: 10.1016/j.ynstr.2023.100515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/19/2022] [Accepted: 01/09/2023] [Indexed: 01/12/2023] Open
Abstract
Physiological and psychological stressors can exert wide-ranging effects on the human brain and behavior. Research has improved understanding of how the sympatho-adreno-medullary (SAM) and hypothalamic-pituitary-adrenocortical (HPA) axes respond to stressors and the differential responses that occur depending on stressor type. Although the physiological function of SAM and HPA responses is to promote survival and safety, exaggerated psychobiological reactivity can occur in psychiatric disorders. Exaggerated reactivity may occur more for certain types of stressors, specifically, psychosocial stressors. Understanding stressor effects and how the body regulates these responses can provide insight into ways that psychobiological reactivity can be modulated. Non-invasive neuromodulation is one way that responding to stressors may be altered; research into these interventions may provide further insights into the brain circuits that modulate stress reactivity. This review focuses on the effects of acute psychosocial stressors and how neuromodulation might be effective in altering stress reactivity. Although considerable research into stress interventions focuses on treating pathology, it is imperative to first understand these mechanisms in non-clinical populations; therefore, this review will emphasize populations with no known pathology and consider how these results may translate to those with psychiatric pathologies.
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Affiliation(s)
| | | | | | - Mark K. Greenwald
- Corresponding author. Department of Psychiatry and Behavioral Neurosciences, Tolan Park Medical Building, 3901 Chrysler Service Drive, Suite 2A, Detroit, MI, 48201, USA.
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25
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Tadayonnejad R, Wilson AC, Chu SA, Corlier J, Citrenbaum C, Ngo TDP, Hovhannisyan E, Ginder ND, Levitt JG, Wilke SA, Krantz D, Bari AA, Leuchter AF. Use of right orbitofrontal repetitive transcranial magnetic stimulation (rTMS) augmentation for treatment-refractory obsessive-compulsive disorder with comorbid major depressive disorder. Psychiatry Res 2022; 317:114856. [PMID: 36155277 DOI: 10.1016/j.psychres.2022.114856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 09/10/2022] [Accepted: 09/18/2022] [Indexed: 01/04/2023]
Abstract
We examined the safety and efficacy of repetitive Transcranial Magnetic Stimulation (rTMS) of the right orbitofrontal cortex (OFC) in patients with refractory obsessive-compulsive disorder (OCD) and comorbid Major Depressive Disorder. All participants (n = 26) received excitatory stimulation of the left dorsolateral prefrontal cortex followed by inhibitory stimulation of bilateral supplementary motor area for 10 sessions. In 18 patients with poor early OCD response, treatment was augmented with OFC inhibitory stimulation after the tenth treatment session. Augmentation with OFC stimulation was well-tolerated, and associated with further alleviation of both OCD and depression symptoms, particularly in individuals with more severe illnesses.
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Affiliation(s)
- Reza Tadayonnejad
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, United States; Department of Psychiatry & Biobehavioral Sciences, United States; Division of the Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, United States.
| | - Andrew C Wilson
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, United States; Department of Psychiatry & Biobehavioral Sciences, United States
| | - Stephanie Anne Chu
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, United States; Department of Psychiatry & Biobehavioral Sciences, United States
| | - Juliana Corlier
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, United States; Department of Psychiatry & Biobehavioral Sciences, United States
| | - Cole Citrenbaum
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, United States; Department of Psychiatry & Biobehavioral Sciences, United States
| | - Thuc Doan P Ngo
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, United States; Department of Psychiatry & Biobehavioral Sciences, United States
| | - Emmily Hovhannisyan
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, United States; Department of Psychiatry & Biobehavioral Sciences, United States
| | - Nathaniel D Ginder
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, United States; Department of Psychiatry & Biobehavioral Sciences, United States
| | - Jennifer G Levitt
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, United States; Department of Psychiatry & Biobehavioral Sciences, United States
| | - Scott A Wilke
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, United States; Department of Psychiatry & Biobehavioral Sciences, United States
| | - David Krantz
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, United States; Department of Psychiatry & Biobehavioral Sciences, United States
| | - Ausaf A Bari
- Department of Neurosurgery David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Andrew F Leuchter
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, United States; Department of Psychiatry & Biobehavioral Sciences, United States
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Shao R, Gao M, Lin C, Huang CM, Liu HL, Toh CH, Wu C, Tsai YF, Qi D, Lee SH, Lee TMC. Multimodal Neural Evidence on the Corticostriatal Underpinning of Suicidality in Late-Life Depression. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:905-915. [PMID: 34861420 DOI: 10.1016/j.bpsc.2021.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/13/2021] [Accepted: 11/20/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Suicidality involves thoughts (ideations and plans) and actions related to self-inflicted death. To improve management and prevention of suicidality, it is essential to understand the key neural mechanisms underlying suicidal thoughts and actions. Following empirically informed neural framework, we hypothesized that suicidal thoughts would be primarily characterized by alterations in the default mode network indicating disrupted self-related processing, whereas suicidal actions would be characterized by changes in the lateral prefrontal corticostriatal circuitries implicating compromised action control. METHODS We analyzed the gray matter volume and resting-state functional connectivity of 113 individuals with late-life depression, including 45 nonsuicidal patients, 33 with suicidal thoughts but no action, and 35 with past suicidal action. Between-group analyses revealed key neural features associated with suicidality. The functional directionality of the identified resting-state functional connectivity was examined using dynamic causal modeling to further elucidate its mechanistic nature. Post hoc classification analysis examined the contribution of the neural measures to suicide classification. RESULTS As expected, reduced gray matter volumes in the default mode network and lateral prefrontal regions characterized patients with suicidal thoughts and those with past suicidal actions compared with nonsuicidal patients. Furthermore, region-of-interest analyses revealed that the directionality and strength of the ventrolateral prefrontal cortex-caudate resting-state functional connectivity were related to suicidal thoughts and actions. The neural features significantly improved classification of suicidal thoughts and actions over that based on clinical and suicide questionnaire variables. CONCLUSIONS Gray matter reductions in the default mode network and lateral prefrontal regions and the ventrolateral prefrontal cortex-caudate connectivity alterations characterized suicidal thoughts and actions in patients with late-life depression.
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Affiliation(s)
- Robin Shao
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong; Laboratory of Neuropsychology & Human Neuroscience, The University of Hong Kong, Hong Kong
| | - Mengxia Gao
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong; Laboratory of Neuropsychology & Human Neuroscience, The University of Hong Kong, Hong Kong
| | - Chemin Lin
- Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, Taiwan; Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan County, Taiwan
| | - Chih-Mao Huang
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan; Center for Intelligent Drug Systems and Smart Bio-devices, National Chiao Tung University, Taipei, Taiwan
| | - Ho-Ling Liu
- Department of Imaging Physics, University of Texas M D Anderson Cancer Center, Houston, Texas
| | - Cheng-Hong Toh
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Linkou, Taoyuan County, Taiwan
| | - Changwei Wu
- Brain and Consciousness Research Center, Shuang-Ho Hospital, New Taipei, Taiwan; Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan
| | - Yun-Fang Tsai
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan; Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan
| | - Di Qi
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong; Laboratory of Neuropsychology & Human Neuroscience, The University of Hong Kong, Hong Kong
| | - Shwu-Hua Lee
- College of Medicine, Chang Gung University, Taoyuan County, Taiwan; Department of Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan County, Taiwan.
| | - Tatia M C Lee
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong; Laboratory of Neuropsychology & Human Neuroscience, The University of Hong Kong, Hong Kong; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangzhou, China.
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Mosilhy EA, Alshial EE, Eltaras MM, Rahman MMA, Helmy HI, Elazoul AH, Hamdy O, Mohammed HS. Non-invasive transcranial brain modulation for neurological disorders treatment: A narrative review. Life Sci 2022; 307:120869. [DOI: 10.1016/j.lfs.2022.120869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/30/2022]
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Kuniishi H, Nakatake Y, Sekiguchi M, Yamada M. Adolescent social isolation induces distinct changes in the medial and lateral OFC-BLA synapse and social and emotional alterations in adult mice. Neuropsychopharmacology 2022; 47:1597-1607. [PMID: 35697823 PMCID: PMC9283446 DOI: 10.1038/s41386-022-01358-6] [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: 02/18/2022] [Revised: 05/17/2022] [Accepted: 05/31/2022] [Indexed: 11/09/2022]
Abstract
Early-life social isolation is associated with social and emotional problems in adulthood. However, neural mechanisms underlying how social deprivation impairs social and emotional development are poorly understood. Recently, the orbitofrontal cortex (OFC) and basolateral amygdala (BLA) have been highlighted as key nodes for social and emotional functions. Hence, we hypothesize that early social deprivation disrupts the information processing in the OFC-BLA pathway and leads to social and emotional dysfunction. Here, we examined the effects of adolescent social isolation on the OFC-BLA synaptic transmission by optogenetic and whole-cell patch-clamp methods in adult mice. Adolescent social isolation decreased social preference and increased passive stress-coping behaviour in adulthood. Then, we examined excitatory synaptic transmissions to BLA from medial or lateral subregions of the OFC (mOFC or lOFC). Notably, adolescent social isolation decreased the AMPA/NMDA ratio in the mOFC-BLA synapse in adulthood, while the ratio was increased in the lOFC-BLA synapse. Furthermore, we optogenetically manipulated the mOFC-BLA or lOFC-BLA transmission in behaving mice and examined the effects on social and stress-coping behaviours. Optogenetic manipulation of the mOFC-BLA transmission altered social behaviour without affecting passive stress-coping behaviour, while optogenetic manipulation of the lOFC-BLA transmission altered passive stress-coping behaviour without affecting social behaviour. Our results suggest that adolescent social isolation induces distinct postsynaptic changes in the mOFC-BLA and lOFC-BLA synapses, and these changes may separately contribute to abnormalities in social and emotional development.
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Affiliation(s)
- Hiroshi Kuniishi
- Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan. .,United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Osaka University, Osaka, Japan. .,Division of Development of Mental Functions, Research Center for Child Mental Development, University of Fukui, Fukui, Japan.
| | - Yuko Nakatake
- grid.419280.60000 0004 1763 8916Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo Japan
| | - Masayuki Sekiguchi
- grid.419280.60000 0004 1763 8916Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo Japan ,grid.419280.60000 0004 1763 8916Department of Degenerative Neurological Diseases, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Tokyo Japan
| | - Mitsuhiko Yamada
- grid.419280.60000 0004 1763 8916Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo Japan
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Ge R, Humaira A, Gregory E, Alamian G, MacMillan EL, Barlow L, Todd R, Nestor S, Frangou S, Vila-Rodriguez F. Predictive Value of Acute Neuroplastic Response to rTMS in Treatment Outcome in Depression: A Concurrent TMS-fMRI Trial. Am J Psychiatry 2022; 179:500-508. [PMID: 35582784 DOI: 10.1176/appi.ajp.21050541] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study objective was to investigate the predictive value of functional connectivity changes induced by acute repetitive transcranial magnetic stimulation (rTMS) for clinical response in treatment-resistant depression. METHODS Cross-sectional changes in functional connectivity induced by a single concurrent rTMS-fMRI session were assessed in 38 outpatients with treatment-resistant depression (26 of them female; mean age, 41.87 years) who subsequently underwent a 4-week course of rTMS. rTMS was delivered at 1 Hz over the right dorsolateral prefrontal cortex. Acute rTMS-induced functional connectivity changes were computed and subjected to connectome-based predictive modeling to test their association with changes in score on the Montgomery-Åsberg Depression Rating Scale (MADRS) after rTMS treatment. RESULTS TMS-fMRI induced widespread, acute, and transient alterations in functional connectivity. The rTMS-induced connectivity changes predicted about 30% of the variance of improvement in the MADRS score. The most robust predictive associations involved connections between prefrontal regions and motor, parietal, and insular cortices and between bilateral regions of the thalamus. CONCLUSIONS Acute rTMS-induced connectivity changes in patients with treatment-resistant depression may index macro-level neuroplasticity, relevant to interindividual variability in rTMS treatment response. Large-scale network phenomena occurring during rTMS might be used to inform prospective clinical trials.
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Affiliation(s)
- Ruiyang Ge
- Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Vila-Rodriguez); Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Todd, Frangou, Vila-Rodriguez); UBC MRI Research Centre, Department of Radiology, University of British Columbia, Vancouver (Barlow, MacMillan); SFU ImageTech Lab, Simon Fraser University, Vancouver (MacMillan); Philips Canada, Mississauga, Ont. (MacMillan); Department of Psychiatry, University of Toronto, Toronto (Nestor); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Frangou)
| | - Afifa Humaira
- Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Vila-Rodriguez); Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Todd, Frangou, Vila-Rodriguez); UBC MRI Research Centre, Department of Radiology, University of British Columbia, Vancouver (Barlow, MacMillan); SFU ImageTech Lab, Simon Fraser University, Vancouver (MacMillan); Philips Canada, Mississauga, Ont. (MacMillan); Department of Psychiatry, University of Toronto, Toronto (Nestor); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Frangou)
| | - Elizabeth Gregory
- Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Vila-Rodriguez); Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Todd, Frangou, Vila-Rodriguez); UBC MRI Research Centre, Department of Radiology, University of British Columbia, Vancouver (Barlow, MacMillan); SFU ImageTech Lab, Simon Fraser University, Vancouver (MacMillan); Philips Canada, Mississauga, Ont. (MacMillan); Department of Psychiatry, University of Toronto, Toronto (Nestor); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Frangou)
| | - Golnoush Alamian
- Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Vila-Rodriguez); Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Todd, Frangou, Vila-Rodriguez); UBC MRI Research Centre, Department of Radiology, University of British Columbia, Vancouver (Barlow, MacMillan); SFU ImageTech Lab, Simon Fraser University, Vancouver (MacMillan); Philips Canada, Mississauga, Ont. (MacMillan); Department of Psychiatry, University of Toronto, Toronto (Nestor); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Frangou)
| | - Erin L MacMillan
- Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Vila-Rodriguez); Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Todd, Frangou, Vila-Rodriguez); UBC MRI Research Centre, Department of Radiology, University of British Columbia, Vancouver (Barlow, MacMillan); SFU ImageTech Lab, Simon Fraser University, Vancouver (MacMillan); Philips Canada, Mississauga, Ont. (MacMillan); Department of Psychiatry, University of Toronto, Toronto (Nestor); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Frangou)
| | - Laura Barlow
- Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Vila-Rodriguez); Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Todd, Frangou, Vila-Rodriguez); UBC MRI Research Centre, Department of Radiology, University of British Columbia, Vancouver (Barlow, MacMillan); SFU ImageTech Lab, Simon Fraser University, Vancouver (MacMillan); Philips Canada, Mississauga, Ont. (MacMillan); Department of Psychiatry, University of Toronto, Toronto (Nestor); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Frangou)
| | - Rebecca Todd
- Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Vila-Rodriguez); Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Todd, Frangou, Vila-Rodriguez); UBC MRI Research Centre, Department of Radiology, University of British Columbia, Vancouver (Barlow, MacMillan); SFU ImageTech Lab, Simon Fraser University, Vancouver (MacMillan); Philips Canada, Mississauga, Ont. (MacMillan); Department of Psychiatry, University of Toronto, Toronto (Nestor); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Frangou)
| | - Sean Nestor
- Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Vila-Rodriguez); Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Todd, Frangou, Vila-Rodriguez); UBC MRI Research Centre, Department of Radiology, University of British Columbia, Vancouver (Barlow, MacMillan); SFU ImageTech Lab, Simon Fraser University, Vancouver (MacMillan); Philips Canada, Mississauga, Ont. (MacMillan); Department of Psychiatry, University of Toronto, Toronto (Nestor); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Frangou)
| | - Sophia Frangou
- Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Vila-Rodriguez); Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Todd, Frangou, Vila-Rodriguez); UBC MRI Research Centre, Department of Radiology, University of British Columbia, Vancouver (Barlow, MacMillan); SFU ImageTech Lab, Simon Fraser University, Vancouver (MacMillan); Philips Canada, Mississauga, Ont. (MacMillan); Department of Psychiatry, University of Toronto, Toronto (Nestor); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Frangou)
| | - Fidel Vila-Rodriguez
- Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Vila-Rodriguez); Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Todd, Frangou, Vila-Rodriguez); UBC MRI Research Centre, Department of Radiology, University of British Columbia, Vancouver (Barlow, MacMillan); SFU ImageTech Lab, Simon Fraser University, Vancouver (MacMillan); Philips Canada, Mississauga, Ont. (MacMillan); Department of Psychiatry, University of Toronto, Toronto (Nestor); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Frangou)
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Zhong X, Jiang H, Jiles DC, Wang Z, Li J, Song B. Investigating the Effects of Anatomical Structures on the Induced Electric Field in the Brain in Transcranial Magnetic Stimulation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:3939-3942. [PMID: 36085730 DOI: 10.1109/embc48229.2022.9871810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Transcranial magnetic stimulation (TMS) is capable of stimulating neurons in the brain non-invasively and provides numerous possibilities for the treatment of various neurological disorders such as major depressive disorder, Parkinson's disease, obsessive compulsive disorder. TMS coils can affect the distribution of induced electric fields significantly, thus the design of TMS coils is always a popular topic in TMS studies. Yet the importance of the role of anatomical structures in the induced electric field has not been thoroughly investigated. Therefore, this work has compared the strength of electric fields induced from fifty realistic head models with twelve commercial or novel TMS coils to explore how anatomical structures affect the electric field. It has been found that the electric field strengths among the fifty head models showed highly correlated patterns. The coils were placed at two positions, where all the twelve coils were placed at the vertex and eight of them were placed at the dorsolateral prefrontal cortex of the head due to the coil geometry. Notably, fifty heterogeneous head models that are derived from MRI data were used in the simulations for examining the difference on the performance of TMS coils caused by different anatomical structures. A total of one thousand simulations have been conducted, providing a large amount of data for analysis. Clinical Relevance- This provides a basis to make treatment protocols or predictions in TMS clinical trials considering the different anatomical structures among subjects.
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Dorsomedial prefrontal rTMS for depression in borderline personality disorder: A pilot randomized crossover trial. J Affect Disord 2022; 301:273-280. [PMID: 34942227 DOI: 10.1016/j.jad.2021.12.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 11/20/2021] [Accepted: 12/18/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Recently, a small literature has emerged suggesting that repetitive transcranial magnetic stimulation (rTMS) may offer benefit for MDD even in BPD patients, perhaps by enhancing cognitive control, and/or disrupting excessive 'non-reward' activity in right orbitofrontal regions. This study aimed primarily to assess the therapeutic effects of dorsomedial prefrontal cortex (DMPFC)-rTMS against MDD symptoms in BPD patients, and secondarily to assess whether the therapeutic effects ensued via mechanisms of reduced impulsivity and core BPD pathology on clinical scales (BIS-11, ZAN-BPD) or of reduced alpha- and theta-band activity on EEG recordings of right orbitofrontal cortex.. METHODS In a crossover-design trial, 20 BPD patients with MDD underwent 2 × 30 session/15 day blocks of either active-then-sham or sham-then-active bilateral 20 Hz DMPFC-rTMS. RESULTS Sixteen out of 20 patients completed treatment. A significant (p = 0.00764) crossover effect was detected, with overall reductions in HamD17 score from 23.1±SD3.1 to 10.75±SD5.8. Nine out of 16 (56.3%) treatment completers achieved response (>50% improvement) and 6/16 (37.5%) achieved remission (HamD≤7), maintained at 1 month followup. BIS-11 scores remained unchanged, and ZAN-BPD scores improved similarly in both groups with no significant crossover effect. Change in low-band power over right orbitofrontal regions correlated with clinical improvement. LIMITATIONS This was a crossover study with a small sample size. A randomized controlled trial with larger sample size will be needed to establish the efficacy more definitively. CONCLUSIONS The results suggest efficacy for DMPFC-rTMS in treating MDD in BPD, and provide a foundation for a larger future trial.
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Relationship of the balloon analog risk task to neurocognitive impairment differs by HIV serostatus and history of major depressive disorder. J Neurovirol 2022; 28:248-264. [PMID: 34981438 PMCID: PMC9187559 DOI: 10.1007/s13365-021-01046-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/11/2021] [Accepted: 12/16/2021] [Indexed: 12/27/2022]
Abstract
HIV and major depressive disorder (MDD) commonly co-occur and are both linked to greater risk-taking behavior, possibly due to neurocognitive impairment (NCI). The present study examined the concordance of the Balloon Analog Risk Task (BART), a gold standard measure of risk-taking propensity, with NCI and real-world sexual risk behaviors in PWH with comorbid MDD. Participants included 259 adults, stratified by HIV serostatus (HIV + /HIV −) and lifetime MDD (MDD + /MDD −), who completed neuropsychological testing, the BART, and sexual risk behavior questionnaires. Logistic regression, stratified by HIV serostatus, examined joint effects of MDD and BART (linear and quadratic) on NCI. Follow-up linear regressions examined sexual risk behavior and neurocognitive domain T-scores as correlates of the BART. NCI prevalence was lowest in HIV − /MDD − , but BART scores did not differ by HIV/MDD status. In the HIV + group, BART performance predicted NCI such that high and low BART scores related to greater odds of NCI, but only in dual-risk HIV + /MDD + individuals. HIV + /MDD + individuals with both low and high BART scores exhibited poorer learning and recall, whereas processing speed and executive function were only poor in low BART risk-taking HIV + /MDD + . Higher BART scores linearly related to higher sexual risk behaviors only in MDD + individuals, independent of HIV serostatus. Low and high risk-taking on the BART may reflect discrete neurocognitive profiles in HIV + /MDD + individuals, with differential implications for real-world sexual risk behavior. HIV and comorbid MDD may disturb corticostriatal circuits responsible for integrating affective and neurocognitive components of decision-making, thereby contributing to risk-averse and risk-taking phenotypes.
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Harita S, Momi D, Mazza F, Griffiths JD. Mapping Inter-individual Functional Connectivity Variability in TMS Targets for Major Depressive Disorder. Front Psychiatry 2022; 13:902089. [PMID: 35815008 PMCID: PMC9260048 DOI: 10.3389/fpsyt.2022.902089] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) is an emerging alternative to existing treatments for major depressive disorder (MDD). The effects of TMS on both brain physiology and therapeutic outcomes are known to be highly variable from subject to subject, however. Proposed reasons for this variability include individual differences in neurophysiology, in cortical geometry, and in brain connectivity. Standard approaches to TMS target site definition tend to focus on coordinates or landmarks within the individual brain regions implicated in MDD, such as the dorsolateral prefrontal cortex (dlPFC) and orbitofrontal cortex (OFC). Additionally considering the network connectivity of these sites (i.e., the wider set of brain regions that may be mono- or poly-synaptically activated by TMS stimulation) has the potential to improve subject-specificity of TMS targeting and, in turn, improve treatment outcomes. In this study, we looked at the functional connectivity (FC) of dlPFC and OFC TMS targets, based on induced electrical field (E-field) maps, estimated using the SimNIBS library. We hypothesized that individual differences in spontaneous functional brain dynamics would contribute more to downstream network engagement than individual differences in cortical geometry (i.e., E-field variability). We generated individualized E-field maps on the cortical surface for 121 subjects (67 female) from the Human Connectome Project database using tetrahedral head models generated from T1- and T2-weighted MR images. F3 and Fp1 electrode positions were used to target the left dlPFC and left OFC, respectively. We analyzed inter-subject variability in the shape and location of these TMS target E-field patterns, their FC, and the major functional networks to which they belong. Our results revealed the key differences in TMS target FC between the dlPFC and OFC, and also how this connectivity varies across subjects. Three major functional networks were targeted across the dlPFC and OFC: the ventral attention, fronto-parietal and default-mode networks in the dlPFC, and the fronto-parietal and default mode networks in the OFC. Inter-subject variability in cortical geometry and in FC was high. Our analyses showed that the use of normative neuroimaging reference data (group-average or representative FC and subject E-field) allows prediction of which networks are targeted, but fails to accurately quantify the relative loading of TMS targeting on each of the principal networks. Our results characterize the FC patterns of canonical therapeutic TMS targets, and the key dimensions of their variability across subjects. The high inter-individual variability in cortical geometry and FC, leading to high variability in distributions of targeted brain networks, may account for the high levels of variability in physiological and therapeutic TMS outcomes. These insights should, we hope, prove useful as part of the broader effort by the psychiatry, neurology, and neuroimaging communities to help improve and refine TMS therapy, through a better understanding of the technology and its neurophysiological effects.
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Affiliation(s)
- Shreyas Harita
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Davide Momi
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Frank Mazza
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.,Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - John D Griffiths
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Marder KG, Barbour T, Ferber S, Idowu O, Itzkoff A. Psychiatric Applications of Repetitive Transcranial Magnetic Stimulation. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:8-18. [PMID: 35746935 PMCID: PMC9063593 DOI: 10.1176/appi.focus.20210021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Transcranial magnetic stimulation (TMS) is an increasingly popular noninvasive brain stimulation modality. In TMS, a pulsed magnetic field is used to noninvasively stimulate a targeted brain region. Repeated stimulation produces lasting changes in brain activity via mechanisms of synaptic plasticity similar to long-term potentiation. Local application of TMS alters activity in distant, functionally connected brain regions, indicating that TMS modulates activity of cortical networks. TMS has been approved by the U.S. Food and Drug Administration for the treatment of major depressive disorder, obsessive-compulsive disorder, and smoking cessation, and a growing evidence base supports its efficacy in the treatment of other neuropsychiatric conditions. TMS is rapidly becoming part of the standard of care for treatment-resistant depression, where it yields response rates of 40%-60%. TMS is generally safe and well tolerated; its most serious risk is seizure, which occurs very rarely. This review aims to familiarize practicing psychiatrists with basic principles of TMS, including target localization, commonly used treatment protocols and their outcomes, and safety and tolerability. Practical considerations, including evaluation and monitoring of patients undergoing TMS, device selection, treatment setting, and insurance reimbursement, are also reviewed.
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Pizzagalli DA, Roberts AC. Prefrontal cortex and depression. Neuropsychopharmacology 2022; 47:225-246. [PMID: 34341498 PMCID: PMC8617037 DOI: 10.1038/s41386-021-01101-7] [Citation(s) in RCA: 188] [Impact Index Per Article: 94.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 01/03/2023]
Abstract
The prefrontal cortex (PFC) has emerged as one of the regions most consistently impaired in major depressive disorder (MDD). Although functional and structural PFC abnormalities have been reported in both individuals with current MDD as well as those at increased vulnerability to MDD, this information has not translated into better treatment and prevention strategies. Here, we argue that dissecting depressive phenotypes into biologically more tractable dimensions - negative processing biases, anhedonia, despair-like behavior (learned helplessness) - affords unique opportunities for integrating clinical findings with mechanistic evidence emerging from preclinical models relevant to depression, and thereby promises to improve our understanding of MDD. To this end, we review and integrate clinical and preclinical literature pertinent to these core phenotypes, while emphasizing a systems-level approach, treatment effects, and whether specific PFC abnormalities are causes or consequences of MDD. In addition, we discuss several key issues linked to cross-species translation, including functional brain homology across species, the importance of dissecting neural pathways underlying specific functional domains that can be fruitfully probed across species, and the experimental approaches that best ensure translatability. Future directions and clinical implications of this burgeoning literature are discussed.
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Affiliation(s)
- Diego A Pizzagalli
- Department of Psychiatry, Harvard Medical School & McLean Hospital, Belmont, MA, USA.
| | - Angela C Roberts
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK.
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36
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Ehrlich TJ, Bhat J, Horwege AM, Mathalon DH, Glover GH, Roach BJ, Badran BW, Forman SD, George MS, Scott JC, Thase ME, Yesavage JA, Yurgelun-Todd DA, Rosen AC. Ruminative reflection is associated with anticorrelations between the orbitofrontal cortex and the default mode network in depression: implications for repetitive transcranial magnetic stimulation. Brain Imaging Behav 2022; 16:1186-1195. [PMID: 34860349 PMCID: PMC9107429 DOI: 10.1007/s11682-021-00596-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 02/01/2023]
Abstract
Patients with depression who ruminate repeatedly focus on depressive thoughts; however, there are two cognitive subtypes of rumination, reflection and brooding, each associated with different prognoses. Reflection involves problem-solving and is associated with positive outcomes, whereas brooding involves passive, negative, comparison with other people and is associated with poor outcomes. Rumination has also been related to atypical functional hyperconnectivity between the default mode network and subgenual prefrontal cortex. Repetitive pulse transcranial magnetic stimulation of the prefrontal cortex has been shown to alter functional connectivity, suggesting that the abnormal connectivity associated with rumination could potentially be altered. This study examined potential repetitive pulse transcranial magnetic stimulation prefrontal cortical targets that could modulate one or both of these rumination subtypes. Forty-three patients who took part in a trial of repetitive pulse transcranial magnetic stimulation completed the Rumination Response Scale questionnaire and resting-state functional magnetic resonance imaging. Seed to voxel functional connectivity analyses identified an anticorrelation between the left lateral orbitofrontal cortex (-44, 26, -8; k = 172) with the default mode network-subgenual region in relation to higher levels of reflection. Parallel analyses were not significant for brooding or the RRS total score. These findings extend previous studies of rumination and identify a potential mechanistic model for symptom-based neuromodulation of rumination.
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Affiliation(s)
- Tobin J Ehrlich
- Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave (151Y), Palo Alto, CA, 94304, USA
- University of Michigan, Ann Arbor, MI, USA
| | - Jyoti Bhat
- Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave (151Y), Palo Alto, CA, 94304, USA
- Palo Alto Veterans Institute for Research, Palo Alto, CA, 94304, USA
| | - Andrea M Horwege
- Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave (151Y), Palo Alto, CA, 94304, USA
| | - Daniel H Mathalon
- Mental Health Service, San Francisco Veterans Affairs Health Care System, University of California, San Francisco, San Francisco, CA, USA
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Gary H Glover
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Brian J Roach
- Mental Health Service, San Francisco Veterans Affairs Health Care System, University of California, San Francisco, San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, San Francisco, CA, USA
| | - Bashar W Badran
- Brain Stimulation Division, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Steven D Forman
- Department of Veterans Affairs, Veterans Affairs Medical Center, Pittsburgh, PA, USA
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, 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
| | - J Cobb Scott
- VISN4 Mental Illness Research, Education, and Clinical Center at the Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael E Thase
- VISN4 Mental Illness Research, Education, and Clinical Center at the Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jerome A Yesavage
- Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave (151Y), Palo Alto, CA, 94304, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Deborah A Yurgelun-Todd
- Rocky Mountain Network Mental Illness Research Education and Clinical Centers (VISN 19), VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Allyson C Rosen
- Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave (151Y), Palo Alto, CA, 94304, USA.
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
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Mikellides G, Michael P, Gregoriou A, Schuhmann T, Sack AT. Bilateral Orbitofrontal Repetitive Transcranial Magnetic Stimulation in Frontal Lobe Epilepsy: A Case Report. Case Rep Neurol 2021; 13:729-737. [PMID: 34950012 PMCID: PMC8647097 DOI: 10.1159/000520257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/01/2021] [Indexed: 11/19/2022] Open
Abstract
Epilepsy is a common and severe neurological disorder affecting millions of people worldwide. Nowadays, antiseizure medications (ASMs) are the main treatment for most epilepsy patients, although many of them do not respond to ASMs and suffer from drug-resistant epilepsy (DRE). Alternative and novel treatment methods have been offered nowadays, showing promising results for the treatment of DRE. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive method that has become increasingly popular in the last decades. This article reports a patient with frontal lobe epilepsy. We aimed to investigate whether bilateral orbitofrontal (OFC) low-frequency rTMS (LF-rTMS) is feasible and tolerable, safe, and potentially clinically effective in treating epileptic seizures. The patient's satisfaction with rTMS therapy was self-reported to be high, as rTMS helped in reducing the frequency of the focal attacks and completely abolished the preceding feeling of fear and panic. Therefore, bilateral OFC rTMS treatment can be well tolerated in patients with frontal epilepsy although the findings of the present case report with regard to clinical efficacy warrant further investigation.
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Affiliation(s)
- Georgios Mikellides
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Cyprus rTMS Centre, Larnaca, Cyprus
| | | | - Angelos Gregoriou
- Consultant Neurologist and Epileptologist, Aretaeio Private Hospital, Nicosia, Cyprus
| | - Teresa Schuhmann
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Alexander T Sack
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Brain+Nerve Centre, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
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Voetterl H, Miron JP, Mansouri F, Fox L, Hyde M, Blumberger DM, Daskalakis ZJ, Vila-Rodriguez F, Sack AT, Downar J. Investigating EEG biomarkers of clinical response to low frequency rTMS in depression. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Using Brain Imaging to Improve Spatial Targeting of Transcranial Magnetic Stimulation for Depression. Biol Psychiatry 2021; 90:689-700. [PMID: 32800379 DOI: 10.1016/j.biopsych.2020.05.033] [Citation(s) in RCA: 134] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/29/2020] [Accepted: 05/29/2020] [Indexed: 01/18/2023]
Abstract
Transcranial magnetic stimulation (TMS) is an effective treatment for depression but is limited in that the optimal therapeutic target remains unknown. Early TMS trials lacked a focal target and thus positioned the TMS coil over the prefrontal cortex using scalp measurements. Over time, it became clear that this method leads to variation in the stimulation site and that this could contribute to heterogeneity in antidepressant response. Newer methods allow for precise positioning of the TMS coil over a specific brain location, but leveraging these precise methods requires a more precise therapeutic target. We review how neuroimaging is being used to identify a more focal therapeutic target for depression. We highlight recent studies showing that more effective TMS targets in the frontal cortex are functionally connected to deep limbic regions such as the subgenual cingulate cortex. We review how connectivity might be used to identify an optimal TMS target for use in all patients and potentially even a personalized target for each individual patient. We address the clinical implications of this emerging field and highlight critical questions for future research.
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Scangos KW, Khambhati AN, Daly PM, Owen LW, Manning JR, Ambrose JB, Austin E, Dawes HE, Krystal AD, Chang EF. Distributed Subnetworks of Depression Defined by Direct Intracranial Neurophysiology. Front Hum Neurosci 2021; 15:746499. [PMID: 34744662 PMCID: PMC8566975 DOI: 10.3389/fnhum.2021.746499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/02/2021] [Indexed: 12/30/2022] Open
Abstract
Major depressive disorder is a common and disabling disorder with high rates of treatment resistance. Evidence suggests it is characterized by distributed network dysfunction that may be variable across patients, challenging the identification of quantitative biological substrates. We carried out this study to determine whether application of a novel computational approach to a large sample of high spatiotemporal resolution direct neural recordings in humans could unlock the functional organization and coordinated activity patterns of depression networks. This group level analysis of depression networks from heterogenous intracranial recordings was possible due to application of a correlational model-based method for inferring whole-brain neural activity. We then applied a network framework to discover brain dynamics across this model that could classify depression. We found a highly distributed pattern of neural activity and connectivity across cortical and subcortical structures that was present in the majority of depressed subjects. Furthermore, we found that this depression signature consisted of two subnetworks across individuals. The first was characterized by left temporal lobe hypoconnectivity and pathological beta activity. The second was characterized by a hypoactive, but hyperconnected left frontal cortex. These findings have applications toward personalization of therapy.
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Affiliation(s)
- Katherine Wilson Scangos
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Ankit N. Khambhati
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Patrick M. Daly
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Lucy W. Owen
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, United States
| | - Jeremy R. Manning
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, United States
| | - Josiah B. Ambrose
- Kaiser Permanente Redwood City Medical Center, Redwood City, CA, United States
| | - Everett Austin
- Kaiser Permanente Redwood City Medical Center, Redwood City, CA, United States
| | - Heather E. Dawes
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Andrew D. Krystal
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Edward F. Chang
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
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Abstract
Emotions can be defined as states elicited by rewards or punishments, and indeed the neurology of emotional disorders can be understood in terms of this foundation. The orbitofrontal cortex in humans and other primates is a critical area in emotion processing, determining the value of stimuli and whether they are rewarding or nonrewarding. The cortical processing that occurs before the orbitofrontal cortex primarily involves defining the identity of stimuli, i.e., "what" is present and not reward value. There is evidence that this holds true for taste, visual, somatosensory, and olfactory stimuli. The human medial orbitofrontal cortex is important in processing many different types of reward, and the lateral orbitofrontal cortex in processing nonreward and punishment. Humans with damage to the orbitofrontal cortex have an impaired ability to identify facial and voice expressions of emotions, and impaired subjective experience of emotion. They can have an altered personality and be impulsive because they are impaired at processing failures to receive expected rewards and at processing punishments. In humans, the role of the amygdala in the processing of emotions is reduced because of the great evolutionary development of the orbitofrontal cortex: amygdala damage has much less effect on emotion than does orbitofrontal cortex damage. The orbitofrontal cortex projects reward value information to the anterior cingulate cortex, which is involved in learning those actions required to obtain rewards and avoid punishments. The cingulate cortex thus provides an output route for emotional behavior. In depression, the medial orbitofrontal cortex has decreased connectivity and sensitivity to reward, and the lateral orbitofrontal cortex has increased connectivity and sensitivity to nonreward. The orbitofrontal cortex has major projections to the anterior cingulate cortex, including its subcommissural region, and the anterior cingulate cortex is also implicated in depression.
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Affiliation(s)
- Edmund T Rolls
- Oxford Centre for Computational Neuroscience, Oxford, United Kingdom; Department of Computer Science, University of Warwick, Coventry, United Kingdom.
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42
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Abstract
China accounts for 17% of the global disease burden attributable to mental, neurological and substance use disorders. As a country undergoing profound societal change, China faces growing challenges to reduce the disease burden caused by psychiatric disorders. In this review, we aim to present an overview of progress in neuroscience research and clinical services for psychiatric disorders in China during the past three decades, analysing contributing factors and potential challenges to the field development. We first review studies in the epidemiological, genetic and neuroimaging fields as examples to illustrate a growing contribution of studies from China to the neuroscience research. Next, we introduce large-scale, open-access imaging genetic cohorts and recently initiated brain banks in China as platforms to study healthy brain functions and brain disorders. Then, we show progress in clinical services, including an integration of hospital and community-based healthcare systems and early intervention schemes. We finally discuss opportunities and existing challenges: achievements in research and clinical services are indispensable to the growing funding investment and continued engagement in international collaborations. The unique aspect of traditional Chinese medicine may provide insights to develop a novel treatment for psychiatric disorders. Yet obstacles still remain to promote research quality and to provide ubiquitous clinical services to vulnerable populations. Taken together, we expect to see a sustained advancement in psychiatric research and healthcare system in China. These achievements will contribute to the global efforts to realize good physical, mental and social well-being for all individuals.
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Rolls ET, Cheng W, Du J, Wei D, Qiu J, Dai D, Zhou Q, Xie P, Feng J. Functional connectivity of the right inferior frontal gyrus and orbitofrontal cortex in depression. Soc Cogn Affect Neurosci 2021; 15:75-86. [PMID: 31993660 PMCID: PMC7171374 DOI: 10.1093/scan/nsaa014] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/30/2019] [Accepted: 01/20/2020] [Indexed: 01/13/2023] Open
Abstract
The orbitofrontal cortex extends into the laterally adjacent inferior frontal gyrus. We analyzed how voxel-level functional connectivity of the inferior frontal gyrus and orbitofrontal cortex is related to depression in 282 people with major depressive disorder (125 were unmedicated) and 254 controls, using FDR correction P < 0.05 for pairs of voxels. In the unmedicated group, higher functional connectivity was found of the right inferior frontal gyrus with voxels in the lateral and medial orbitofrontal cortex, cingulate cortex, temporal lobe, angular gyrus, precuneus, hippocampus and frontal gyri. In medicated patients, these functional connectivities were lower and toward those in controls. Functional connectivities between the lateral orbitofrontal cortex and the precuneus, posterior cingulate cortex, inferior frontal gyrus, ventromedial prefrontal cortex and the angular and middle frontal gyri were higher in unmedicated patients, and closer to controls in medicated patients. Medial orbitofrontal cortex voxels had lower functional connectivity with temporal cortex areas, the parahippocampal gyrus and fusiform gyrus, and medication did not result in these being closer to controls. These findings are consistent with the hypothesis that the orbitofrontal cortex is involved in depression, and can influence mood and behavior via the right inferior frontal gyrus, which projects to premotor cortical areas.
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Affiliation(s)
- Edmund T Rolls
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, 200433, Shanghai, China
- Department of Computer Science, University of Warwick, CV4 7AL, Coventry, UK
- Oxford Centre for Computational Neuroscience, Oxford, UK
| | - Wei Cheng
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, 200433, Shanghai, China
- Correspondence should be addressed to: Wei Cheng. E-mail:
| | - Jingnan Du
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, 200433, Shanghai, China
| | - Dongtao Wei
- Department of Psychology, Southwest University, Chongqing, China
| | - Jiang Qiu
- Department of Psychology, Southwest University, Chongqing, China
- Key Laboratory of Cognition and Personality (SWU), Ministry of Education, Chongqing, China
| | - Dan Dai
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, 200433, Shanghai, China
| | - Qunjie Zhou
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, 200433, Shanghai, China
| | - Peng Xie
- Institute of Neuroscience, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Neurobiology, Chongqing, China
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, 402160, Chongqing, China
| | - Jianfeng Feng
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, 200433, Shanghai, China
- Department of Computer Science, University of Warwick, CV4 7AL, Coventry, UK
- School of Mathematical Sciences, School of Life Science and the Collaborative Innovation Center for Brain Science, Fudan University, 200433, Shanghai, China
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Husain SF, Ong SK, Cuizhen L, Tran B, Ho RC, Ho CS. Functional near-infrared spectroscopy during a decision-making task in patients with major depressive disorder. Aust N Z J Psychiatry 2021; 55:485-493. [PMID: 33300367 DOI: 10.1177/0004867420976856] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Patients with major depressive disorder tend to exhibit poorer decision-making capacity than the general population, but neurobiological evidence is lacking. Functional near-infrared spectroscopy monitors changes in oxy-haemoglobin concentration in the cerebral cortex. It may provide an objective assessment of neurophysiological responses during decision-making processes. Thus, this study investigated the effect of major depressive disorder diagnosis and severity on prefrontal cortex activity during the Iowa gambling task. METHODS Right-handed healthy controls (n = 25) and patients with major depressive disorder (n = 25) were matched for age, gender, ethnicity and years of education in this cross-sectional study. Functional near-infrared spectroscopy signals and the responses made during a computerised Iowa gambling task were recorded. In addition, demographics, clinical history and symptom severity were noted. RESULTS Compared to healthy controls, patients with major depressive disorder had reduced haemodynamic response in several cortical regions of the frontal lobe (Hedge's g range from 0.71 to 1.52; p values range from ⩽0.001 to 0.041). Among patients, mean oxy-haemoglobin declined with major depressive disorder severity in the right orbitofrontal cortex (Pearson's r = -0.423; p = 0.024). CONCLUSION Haemodynamic dysfunction of the prefrontal cortex during decision-making processes is associated with major depressive disorder diagnosis and severity. These neurophysiological alterations may have a role in the decision-making capacity of patients with major depressive disorder.
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Affiliation(s)
- Syeda F Husain
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore.,Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Samantha K Ong
- Department of Psychological Medicine, National University Health System, Singapore
| | - Liu Cuizhen
- Department of Psychology, Faculty of Arts and Social Science, National University of Singapore, Singapore
| | - Bach Tran
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.,Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Roger C Ho
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore.,Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cyrus S Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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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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Xie C, Jia T, Rolls ET, Robbins TW, Sahakian BJ, Zhang J, Liu Z, Cheng W, Luo Q, Zac Lo CY, Wang H, Banaschewski T, Barker GJ, Bokde ALW, Büchel C, Quinlan EB, Desrivières S, Flor H, Grigis A, Garavan H, Gowland P, Heinz A, Hohmann S, Ittermann B, Martinot JL, Paillère Martinot ML, Nees F, Orfanos DP, Paus T, Poustka L, Fröhner JH, Smolka MN, Walter H, Whelan R, Schumann G, Feng J. Reward Versus Nonreward Sensitivity of the Medial Versus Lateral Orbitofrontal Cortex Relates to the Severity of Depressive Symptoms. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 6:259-269. [PMID: 33221327 DOI: 10.1016/j.bpsc.2020.08.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/14/2020] [Accepted: 08/30/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND The orbitofrontal cortex (OFC) is implicated in depression. The hypothesis investigated was whether the OFC sensitivity to reward and nonreward is related to the severity of depressive symptoms. METHODS Activations in the monetary incentive delay task were measured in the IMAGEN cohort at ages 14 years (n = 1877) and 19 years (n = 1140) with a longitudinal design. Clinically relevant subgroups were compared at ages 19 (high-severity group: n = 116; low-severity group: n = 206) and 14. RESULTS The medial OFC exhibited graded activation increases to reward, and the lateral OFC had graded activation increases to nonreward. In this general population, the medial and lateral OFC activations were associated with concurrent depressive symptoms at both ages 14 and 19 years. In a stratified high-severity depressive symptom group versus control group comparison, the lateral OFC showed greater sensitivity for the magnitudes of activations related to nonreward in the high-severity group at age 19 (p = .027), and the medial OFC showed decreased sensitivity to the reward magnitudes in the high-severity group at both ages 14 (p = .002) and 19 (p = .002). In a longitudinal design, there was greater sensitivity to nonreward of the lateral OFC at age 14 for those who exhibited high depressive symptom severity later at age 19 (p = .003). CONCLUSIONS Activations in the lateral OFC relate to sensitivity to not winning, were associated with high depressive symptom scores, and at age 14 predicted the depressive symptoms at ages 16 and 19. Activations in the medial OFC were related to sensitivity to winning, and reduced reward sensitivity was associated with concurrent high depressive symptom scores.
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Affiliation(s)
- Chao Xie
- Institute of Science and Technology for Brain-Inspired Intelligence, Shanghai, China; Ministry of Education Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Shanghai, China
| | - Tianye Jia
- Institute of Science and Technology for Brain-Inspired Intelligence, Shanghai, China; Ministry of Education Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Shanghai, China; Centre for Population Neuroscience and Precision Medicine, London, United Kingdom
| | - Edmund T Rolls
- Institute of Science and Technology for Brain-Inspired Intelligence, Shanghai, China; Ministry of Education Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Shanghai, China; Department of Computer Science, University of Warwick, Coventry, United Kingdom; Oxford Centre for Computational Neuroscience, Oxford, United Kingdom
| | - Trevor W Robbins
- Institute of Science and Technology for Brain-Inspired Intelligence, Shanghai, China; Ministry of Education Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Shanghai, China; Department of the Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom; Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Barbara J Sahakian
- Institute of Science and Technology for Brain-Inspired Intelligence, Shanghai, China; Ministry of Education Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Shanghai, China; Department of the Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom; Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Jie Zhang
- Institute of Science and Technology for Brain-Inspired Intelligence, Shanghai, China; Ministry of Education Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Shanghai, China
| | - Zhaowen Liu
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine & Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Wei Cheng
- Institute of Science and Technology for Brain-Inspired Intelligence, Shanghai, China; Ministry of Education Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Shanghai, China
| | - Qiang Luo
- Institute of Science and Technology for Brain-Inspired Intelligence, Shanghai, China; Ministry of Education Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Shanghai, China; Centre for Population Neuroscience and Precision Medicine, London, United Kingdom
| | - Chun-Yi Zac Lo
- Institute of Science and Technology for Brain-Inspired Intelligence, Shanghai, China; Ministry of Education Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Shanghai, China
| | - He Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Shanghai, China; Ministry of Education Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Shanghai, China
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Gareth J Barker
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Arun L W Bokde
- Discipline of Psychiatry, School of Medicine and Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, United Kingdom
| | | | - Erin Burke Quinlan
- Centre for Population Neuroscience and Precision Medicine, London, United Kingdom
| | - Sylvane Desrivières
- Centre for Population Neuroscience and Precision Medicine, London, United Kingdom
| | - Herta Flor
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany; University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Antoine Grigis
- NeuroSpin, CEA, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Hugh Garavan
- Departments of Psychiatry and Psychology, University of Vermont, Burlington, Vermont
| | - Penny Gowland
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
| | - Andreas Heinz
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Campus Charité Mitte, Berlin, Germany
| | - Sarah Hohmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Bernd Ittermann
- Physikalisch-Technische Bundesanstalt, Braunschweig and Berlin, Germany
| | - Jean-Luc Martinot
- Institut National de la Santé et de la Recherche Médicale, INSERM U A10 "Trajectoires développementales en psychiatrie," Université Paris-Saclay, Ecole Normale supérieure Paris-Saclay, CNRS, Centre Borelli, Gif-sur-Yvette, France
| | - Marie-Laure Paillère Martinot
- Institut National de la Santé et de la Recherche Médicale, INSERM U A10 "Trajectoires développementales en psychiatrie," Université Paris-Saclay, Ecole Normale supérieure Paris-Saclay, CNRS, Centre Borelli, Gif-sur-Yvette, France; AP-HP Sorbonne Université, Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Paris, France
| | - Frauke Nees
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
| | | | - Tomáš Paus
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital and Departments of Psychology and Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Göttingen, Göttingen, Germany
| | - Juliane H Fröhner
- Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
| | - Michael N Smolka
- Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
| | - Henrik Walter
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Campus Charité Mitte, Berlin, Germany
| | - Robert Whelan
- School of Psychology and Global Brain Health Institute, Trinity College Dublin, Dublin, United Kingdom
| | - Gunter Schumann
- PONS Centre, Institute for Science and Technology of Brain-inspired Intelligence, Shanghai, China; Centre for Population Neuroscience and Precision Medicine, London, United Kingdom; PONS-Research Group, Charite Mental Health, Berlin, Germany; Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany; Department of Sports and Health Sciences, University of Potsdam, Potsdam
| | - Jianfeng Feng
- Institute of Science and Technology for Brain-Inspired Intelligence, Shanghai, China; Ministry of Education Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Shanghai, China; Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China; Shanghai Center for Mathematical Sciences, Shanghai, China; Department of Computer Science, University of Warwick, Coventry, United Kingdom.
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47
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Scangos KW, Makhoul GS, Sugrue LP, Chang EF, Krystal AD. State-dependent responses to intracranial brain stimulation in a patient with depression. Nat Med 2021; 27:229-231. [PMID: 33462446 DOI: 10.1038/s41591-020-01175-8] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 11/12/2020] [Indexed: 11/09/2022]
Abstract
Deep brain stimulation is a promising treatment for severe depression, but lack of efficacy in randomized trials raises questions regarding anatomical targeting. We implanted multi-site intracranial electrodes in a severely depressed patient and systematically assessed the acute response to focal electrical neuromodulation. We found an elaborate repertoire of distinctive emotional responses that were rapid in onset, reproducible, and context and state dependent. Results provide proof of concept for personalized, circuit-specific medicine in psychiatry.
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Affiliation(s)
- Katherine W Scangos
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA.
| | - Ghassan S Makhoul
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Leo P Sugrue
- Department of Radiology, University of California, San Francisco, San Francisco, CA, USA
| | - Edward F Chang
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
| | - Andrew D Krystal
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
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48
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Rolls ET, Vatansever D, Li Y, Cheng W, Feng J. Rapid Rule-Based Reward Reversal and the Lateral Orbitofrontal Cortex. Cereb Cortex Commun 2020; 1:tgaa087. [PMID: 34296143 PMCID: PMC8152898 DOI: 10.1093/texcom/tgaa087] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/04/2020] [Accepted: 11/10/2020] [Indexed: 12/14/2022] Open
Abstract
Humans and other primates can reverse their choice of stimuli in one trial when the rewards delivered by the stimuli change or reverse. Rapidly changing our behavior when the rewards change is important for many types of behavior, including emotional and social behavior. It is shown in a one-trial rule-based Go-NoGo deterministic visual discrimination reversal task to obtain points, that the human right lateral orbitofrontal cortex and adjoining inferior frontal gyrus is activated on reversal trials, when an expected reward is not obtained, and the non-reward allows the human to switch choices based on a rule. This reward reversal goes beyond model-free reinforcement learning. This functionality of the right lateral orbitofrontal cortex shown here in very rapid, one-trial, rule-based changes in human behavior when a reward is not received is related to the emotional and social changes that follow orbitofrontal cortex damage, and to depression in which this non-reward system is oversensitive and over-connected.
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Affiliation(s)
- Edmund T Rolls
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, 200433, China.,Oxford Centre for Computational Neuroscience, Oxford, UK.,Department of Computer Science, University of Warwick, Coventry CV4 7AL, UK
| | - Deniz Vatansever
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, 200433, China
| | - Yuzhu Li
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, 200433, China
| | - Wei Cheng
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, 200433, China
| | - Jianfeng Feng
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, 200433, China.,Department of Computer Science, University of Warwick, Coventry CV4 7AL, UK
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49
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Rolls ET, Cheng W, Feng J. The orbitofrontal cortex: reward, emotion and depression. Brain Commun 2020; 2:fcaa196. [PMID: 33364600 PMCID: PMC7749795 DOI: 10.1093/braincomms/fcaa196] [Citation(s) in RCA: 161] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/13/2020] [Accepted: 10/13/2020] [Indexed: 12/11/2022] Open
Abstract
The orbitofrontal cortex in primates including humans is the key brain area in emotion, and in the representation of reward value and in non-reward, that is not obtaining an expected reward. Cortical processing before the orbitofrontal cortex is about the identity of stimuli, i.e. 'what' is present, and not about reward value. There is evidence that this holds for taste, visual, somatosensory and olfactory stimuli. The human medial orbitofrontal cortex represents many different types of reward, and the lateral orbitofrontal cortex represents non-reward and punishment. Not obtaining an expected reward can lead to sadness, and feeling depressed. The concept is advanced that an important brain region in depression is the orbitofrontal cortex, with depression related to over-responsiveness and over-connectedness of the non-reward-related lateral orbitofrontal cortex, and to under-responsiveness and under-connectivity of the reward-related medial orbitofrontal cortex. Evidence from large-scale voxel-level studies and supported by an activation study is described that provides support for this hypothesis. Increased functional connectivity of the lateral orbitofrontal cortex with brain areas that include the precuneus, posterior cingulate cortex and angular gyrus is found in patients with depression and is reduced towards the levels in controls when treated with medication. Decreased functional connectivity of the medial orbitofrontal cortex with medial temporal lobe areas involved in memory is found in patients with depression. Some treatments for depression may act by reducing activity or connectivity of the lateral orbitofrontal cortex. New treatments that increase the activity or connectivity of the medial orbitofrontal cortex may be useful for depression. These concepts, and that of increased activity in non-reward attractor networks, have potential for advancing our understanding and treatment of depression. The focus is on the orbitofrontal cortex in primates including humans, because of differences of operation of the orbitofrontal cortex, and indeed of reward systems, in rodents. Finally, the hypothesis is developed that the orbitofrontal cortex has a special role in emotion and decision-making in part because as a cortical area it can implement attractor networks useful in maintaining reward and emotional states online, and in decision-making.
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Affiliation(s)
- Edmund T Rolls
- Oxford Centre for Computational Neuroscience, Oxford, UK
- Department of Computer Science, University of Warwick, Coventry CV4 7AL, UK
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai 200433, China
| | - Wei Cheng
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai 200433, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai 200433, China
| | - Jianfeng Feng
- Department of Computer Science, University of Warwick, Coventry CV4 7AL, UK
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai 200433, China
- School of Mathematical Sciences, School of Life Science and the Collaborative Innovation Center for Brain Science, Fudan University, Shanghai 200433, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai 200433, China
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50
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Fitzgerald PB. An update on the clinical use of repetitive transcranial magnetic stimulation in the treatment of depression. J Affect Disord 2020; 276:90-103. [PMID: 32697721 DOI: 10.1016/j.jad.2020.06.067] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 06/03/2020] [Accepted: 06/23/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is an increasingly used treatment for patients with depression. The use of rTMS in depression is supported by over 20 years of clinical trials. There has been a significant increase in knowledge around the use of rTMS in recent years. OBJECTIVE The aim of this paper was to review the use of rTMS in depression to provide an update for rTMS practitioners and clinicians interested in the clinical use of this treatment. METHODS A targeted review of the literature around the use of rTMS treatment of depression with a specific focus on studies published in the last 3 years. RESULTS High-frequency rTMS applied to the left dorsolateral prefrontal cortex is an effective treatment for acute episodes of major depressive disorder. There are several additional methods of rTMS delivery that are supported by clinical trials and meta-analyses but no substantive evidence that any one approach is any more effective than any other. rTMS is effective in unipolar depression and most likely bipolar depression. rTMS courses may be repeated in the management of depressive relapse but there is less evidence for the use of rTMS in the maintenance phase. CONCLUSIONS The science around the use of rTMS is rapidly evolving and there is a considerable need for practitioners to remain abreast of the current state of this literature and its implications for clinical practice. rTMS is an effective antidepressant treatment but its optimal use should be continually informed by knowledge of the state of the art.
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Affiliation(s)
- Paul B Fitzgerald
- Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Monash University Central Clinical School, 888 Toorak Rd, Camberwell, Victoria 3004, Australia.
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