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Strafella R, Momi D, Zomorrodi R, Lissemore J, Noda Y, Chen R, Rajji TK, Griffiths JD, Vila-Rodriguez F, Downar J, Daskalakis ZJ, Blumberger DM, Voineskos D. Identifying Neurophysiological Markers of Intermittent Theta Burst Stimulation in Treatment-Resistant Depression Using Transcranial Magnetic Stimulation-Electroencephalography. Biol Psychiatry 2023; 94:454-465. [PMID: 37084864 DOI: 10.1016/j.biopsych.2023.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 03/12/2023] [Accepted: 04/03/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Intermittent theta burst stimulation (iTBS) targeting the left dorsolateral prefrontal cortex is effective for treatment-resistant depression, but the effects of iTBS on neurophysiological markers remain unclear. Here, we indexed transcranial magnetic stimulation-electroencephalography (TMS-EEG) markers, specifically, the N45 and N100 amplitudes, at baseline and post-iTBS, comparing separated and contiguous iTBS schedules. TMS-EEG markers were also compared between iTBS responders and nonresponders. METHODS TMS-EEG was analyzed from a triple-blind 1:1 randomized trial for treatment-resistant depression, comparing a separated (54-minute interval) and contiguous (0-minute interval) schedule of 2 × 600-pulse iTBS for 30 treatments. Participants underwent TMS-EEG over the left dorsolateral prefrontal cortex at baseline and posttreatment. One hundred fourteen participants had usable TMS-EEG at baseline, and 98 at posttreatment. TMS-evoked potential components (N45, N100) were examined via global mean field analysis. RESULTS The N100 amplitude decreased from baseline to posttreatment, regardless of the treatment group (F1,106 = 5.20, p = .02). There were no changes in N45 amplitude in either treatment group. In responders, the N100 amplitude decreased after iTBS (F1,102 = 11.30, p = .001, pcorrected = .0004). Responders showed higher posttreatment N45 amplitude than nonresponders (F1,94 = 4.11, p = .045, pcorrected = .016). Higher baseline N100 amplitude predicted lower post-iTBS depression scores (F4,106 = 6.28, p = .00014). CONCLUSIONS These results provide further evidence for an association between the neurophysiological effects of iTBS and treatment efficacy in treatment-resistant depression. Future studies are needed to test the predictive potential for clinical applications of TMS-EEG markers.
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Affiliation(s)
- Rebecca Strafella
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Davide Momi
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Krembil Centre for Neuroinformatics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Reza Zomorrodi
- Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jennifer Lissemore
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California
| | - Yoshihiro Noda
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Robert Chen
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tarek K Rajji
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto Dementia Research Alliance, University of Toronto, Toronto, Ontario, Canada
| | - John D Griffiths
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Krembil Centre for Neuroinformatics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Fidel Vila-Rodriguez
- Non-Invasive Neurostimulation Therapies Laboratory, Vancouver, British Columbia, Canada; Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathan Downar
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of California San Diego, La Jolla, California
| | - Daniel M Blumberger
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Daphne Voineskos
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
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2
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Boosting psychological change: Combining non-invasive brain stimulation with psychotherapy. Neurosci Biobehav Rev 2022; 142:104867. [PMID: 36122739 DOI: 10.1016/j.neubiorev.2022.104867] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 11/21/2022]
Abstract
Mental health disorders and substance use disorders are a leading cause of morbidity and mortality worldwide, and one of the most important challenges for public health systems. While evidence-based psychotherapy is generally pursued to address mental health challenges, psychological change is often hampered by non-adherence to treatments, relapses, and practical barriers (e.g., time, cost). In recent decades, Non-invasive brain stimulation (NIBS) techniques have emerged as promising tools to directly target dysfunctional neural circuitry and promote long-lasting plastic changes. While the therapeutic efficacy of NIBS protocols for mental illnesses has been established, neuromodulatory interventions might also be employed to support the processes activated by psychotherapy. Indeed, combining psychotherapy with NIBS might help tailor the treatment to the patient's unique characteristics and therapeutic goal, and would allow more direct control of the neuronal changes induced by therapy. Herein, we overview emerging evidence on the use of NIBS to enhance the psychotherapeutic effect, while highlighting the next steps in advancing clinical and research methods toward personalized intervention approaches.
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Hebel T, Grözinger M, Landgrebe M, Padberg F, Schecklmann M, Schlaepfer T, Schönfeldt-Lecuona C, Ullrich H, Zwanzger P, Langguth B, Bajbouj M, Bewernick B, Brinkmann K, Cordes J, Di Pauli J, Eichhammer P, Freundlieb N, Hajak G, Höppner-Buchmann J, Hurlemann R, Kamp D, Kayser S, Kis B, Kreuzer PM, Kuhn J, Lammers M, Lugmayer B, Mielacher C, Nickl-Jockschat T, Nunhofer C, Palm U, Poeppl TB, Polak T, Sakreida K, Sartorius A, Silberbauer C, Zilles-Wegner D. Evidence and expert consensus based German guidelines for the use of repetitive transcranial magnetic stimulation in depression. World J Biol Psychiatry 2022; 23:327-348. [PMID: 34668449 DOI: 10.1080/15622975.2021.1995810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Non-invasive brain stimulation techniques such as repetitive transcranial magnetic stimulation (rTMS) offer a promising alternative to psychotherapeutic and pharmacological treatments for depression. This paper aims to present a practical guide for its clinical implementation based on evidence from the literature as well as on the experience of a group of leading German experts in the field. METHODS The current evidence base for the use of rTMS in depression was examined via review of the literature. From the evidence and from clinical experience, recommendations for the use of rTMS in clinical practice were derived. All members of the of the German Society for Brain Stimulation in Psychiatry and all members of the sections Clinical Brain Stimulation and Experimental Brain Stimulation of the German Society for Psychiatry, Psychotherapy, Psychosomatics and Mental Health were invited to participate in a poll on whether they consent with the recommendations. FINDINGS Among rTMS experts, a high consensus rate could be identified for clinical practice concerning the setting and the technical parameters of rTMS treatment in depression, indications and contra-indications, the relation of rTMS to other antidepressive treatment modalities and the frequency and management of side effects.
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Affiliation(s)
- Tobias Hebel
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
| | - Michael Grözinger
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH University, Aachen, Germany
| | - Michael Landgrebe
- Department of Psychiatry, Kbo-Lech-Mangfall Clinic, Agatharied, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, LMU University Munich, Munich, Germany
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
| | - Thomas Schlaepfer
- Department of Psychiatry and Psychotherapy, Interventional Biological Psychiatry, University Freiburg, Freiburg, Germany
| | | | - Heiko Ullrich
- Department of Psychiatry, Psychotherapy and Psychosomatics, Siegen Hospital, Siegen, Germany
| | - Peter Zwanzger
- Department of Psychiatry and Psychotherapy, LMU University Munich, Munich, Germany.,Clinical Center for Psychiatry, Psychotherapy, Psychosomatic Medicine, Geriatrics and Neurology, Kbo-Inn-Salzach-Klinikum, Wasserburg/Inn, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
| | | | | | - Bettina Bewernick
- Departments of Geriatric Psychiatry, Psychiatry, and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Klaus Brinkmann
- Center for Psychosocial Medicine, Agaplesion Diakonieklinikum Hospital Rotenburg, Rotenburg, Germany
| | - Joachim Cordes
- Department of Psychiatry and Psychotherapy, Kaiserswerther Diakonie, Düsseldorf, Germany
| | - Jan Di Pauli
- Department of Adult Psychiatry, Rankweil Hospital, Vocklabruck, Austria
| | - Peter Eichhammer
- Clinic for Mental Health, Goldener Steig Hospital, Freyung, Germany
| | - Nils Freundlieb
- Department of Psychiatry and Psychotherapy, Center for Psychosocial Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Göran Hajak
- Department of Psychiatry and Psychotherapy, Sozialstiftung, Bamberg, Germany
| | - Jacqueline Höppner-Buchmann
- Department of Geriatric Psychiatry and Psychotherapy, Helios Hospital Schwerin, Carl-Friedrich-Flemming Hospital, Schwerin, Germany
| | - Rene Hurlemann
- Department of Psychiatry and Psychotherapy, Karl-Jaspers Hospital, University Oldenburg, Bad Zwischenahn, Germany
| | - Daniel Kamp
- Department of Psychiatry and Psychotherapy, LVR Hospital, Heinrich-Heine University, Düsseldorf, Germany
| | - Sarah Kayser
- Department of General Psychiatry, Psychotherapy and Psychosomatics 3/Geriatric Psychiatry, Rheinhessen Hospital Alzey, Alzey, Germany
| | - Bernhard Kis
- Department of Psychiatry, Psychotherapy and Psychosomatics, Catholic Hospitals Ruhrhalbinsel, Hattingen, Germany
| | - Peter M Kreuzer
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
| | - Jens Kuhn
- Department of Psychiatry, Psychotherapy and Psychosomatics, Johanniter Hospital Oberhausen, Oberhausen, Germany
| | - Melisande Lammers
- Hospital for Psychosomatics and Psychotherapy, MediClin Reichshof Hospital, Reichshof-Eckenhagen, Germany
| | - Beatrix Lugmayer
- Department of Psychiatry, Salzkammergut Hospital Vöcklabruck, Vocklabruck, Austria
| | - Clemens Mielacher
- Department of Psychiatry and Psychotherapy, Section Clinical Psychology, University Hospital Bonn, Bonn, Germany
| | - Thomas Nickl-Jockschat
- Departments of Psychiatry, Neuroscience and Pharmacology, Iowa Neuroscience Institute Carver College of Medicine University of Iowa, Iowa City, IA, USA
| | - Christian Nunhofer
- Private Practice in Neurology, Psychiatry and Psychotherapy, Neumarkt, Germany
| | - Ulrich Palm
- Medical Park Chiemseeblick, Bernau-Felden, Germany
| | - Timm B Poeppl
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH University, Aachen, Germany
| | - Thomas Polak
- Department and Clinic of Psychiatry, Psychosomatics and Psychotherapy, Neurovascular Functional Diagnostics, Center for Mental Health, Würzburg University Hospital, Wuerzburg, Germany
| | - Katrin Sakreida
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH University, Aachen, Germany
| | - Alexander Sartorius
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
| | | | - David Zilles-Wegner
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Georg-August University, Göttingen, Germany
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Huang J, Zhang J, Zhang T, Wang P, Zheng Z. Increased Prefrontal Activation During Verbal Fluency Task After Repetitive Transcranial Magnetic Stimulation Treatment in Depression: A Functional Near-Infrared Spectroscopy Study. Front Psychiatry 2022; 13:876136. [PMID: 35444573 PMCID: PMC9013767 DOI: 10.3389/fpsyt.2022.876136] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/09/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Previous studies have shown the clinical effect of 2 Hz repetitive transcranial magnetic stimulation (rTMS) for depression; however, its underlying neural mechanisms are poorly understood. The aim of this study was to examine the effects of rTMS on the activity of the prefrontal cortex in patients with depression, using functional near-infrared spectroscopy (fNIRS). METHODS Forty patients with major depressive disorder (MDD) and 40 healthy controls were enrolled in this study. Patients underwent 4 weeks of 2 Hz TMS delivered to the right dorsolateral prefrontal cortex (DLPFC). fNIRS was used to measure the changes in the concentration of oxygenated hemoglobin ([oxy-Hb]) in the prefrontal cortex during a verbal fluency task (VFT) in depressed patients before and after rTMS treatment. The severity of depression was assessed using the Hamilton Rating Scale for Depression-24 item (HAMD-24). RESULTS Prior to rTMS, depressed patients exhibited significantly smaller [oxy-Hb] values in the bilateral prefrontal cortex during the VFT compared with the healthy controls. After 4 weeks of 2 Hz right DLPFC rTMS treatment, increased [oxy-Hb] values in the bilateral frontopolar prefrontal cortex (FPPFC), ventrolateral prefrontal cortex (VLPFC) and left DLPFC during the VFT were observed in depressed patients. The increased [oxy-Hb] values from baseline to post-treatment in the right VLPFC in depressed patients were positively related to the reduction of HAMD score following rTMS. CONCLUSION These findings suggest that the function of the prefrontal cortex in depressed patients was impaired and could be recovered by 2 Hz rTMS. The fNIRS-measured prefrontal activation during a cognitive task is a potential biomarker for monitoring depressed patients' treatment response to rTMS.
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Affiliation(s)
- Jiaxi Huang
- Mental Health Center, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Jiaqi Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Tingyu Zhang
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Pu Wang
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.,Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, Guangzhou, China
| | - Zhong Zheng
- Mental Health Center, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
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5
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Lin J, Ling F, Huang P, Chen M, Song M, Lu K, Wang W. The Development of GABAergic Network in Depression in Recent 17 Years: A Visual Analysis Based on CiteSpace and VOSviewer. Front Psychiatry 2022; 13:874137. [PMID: 35664493 PMCID: PMC9157549 DOI: 10.3389/fpsyt.2022.874137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/27/2022] [Indexed: 11/21/2022] Open
Abstract
In this study, we analyzed the status and research trends of the GABAergic system in depression from 2004 to 2020 to provide a reference for further research. The Web of Science database was used as the data source and 1,658 publishments were included. Using two visualization analysis software, CiteSpace and VOSviewer, we analyzed the publishing years, countries, institutions, authors, journals, categories, keywords, and research frontiers in depression. The publishments revealed an upward trend from 2004 to 2020; the most prolific country and institutions were the United States and INSERM, respectively. The journal of Neuroscience was the most published and cited journal. The most relevant category was neurosciences. The hot topics in this field were GABAergic research in Gaba(a) receptor; the research frontier was depressive model. These analysis results provide a new perspective for researchers to conduct studies on related topics in the future and guidance for scientists to identify potential collaborators and research cooperation institutions.
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Affiliation(s)
- Jieping Lin
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fa Ling
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ping Huang
- Laboratory Animal Management Center, Southern Medical University, Guangzhou, China
| | - Min Chen
- College of Medical Examination and Biotechnology, Southern Medical University, Guangzhou, China
| | - Min Song
- Southern Medical University Library, Guangzhou, China
| | - Kangrong Lu
- NMPA Key Laboratory for Safety Evaluation of Cosmetics, Southern Medical University, Guangzhou, China
| | - Wanshan Wang
- Laboratory Animal Management Center, Southern Medical University, Guangzhou, China.,Guangzhou Southern Medical Laboratory Animal Sci. and Tech. Co., Ltd., Guangzhou, China
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Illes J, Lipsman N, McDonald PJ, Hrincu V, Chandler J, Fasano A, Giacobbe P, Hamani C, Ibrahim GM, Kiss Z, Meng Y, Sankar T, Weise L. From vision to action: Canadian leadership in ethics and neurotechnology. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2021; 159:241-273. [PMID: 34446249 DOI: 10.1016/bs.irn.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This chapter explores the complex neuroethical aspects of neurosurgery and neuromodulation in the context of Canadian healthcare and innovation, as seen through the lens of the Pan Canadian Neurotechnology Ethics Consortium (PCNEC). Highlighted are key areas of ethical focus, each with its own unique challenges: technical advances, readiness and risk, vulnerable populations, medico-legal issues, training, and research. Through an exploration of Canadian neurotechnological practice from these various clusters, we provide a critical review of progress, describe opportunities to address areas of debate, and seek to foster ethical innovation. Underpinning this comprehensive review are the fundamental principles of solution-oriented, practical neuroethics, with beneficence and justice at the core. In our view, it is a moral imperative that neurotechnological advancements include a delineation of ethical priorities for future guidelines, oversight, and interactions.
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Affiliation(s)
- Judy Illes
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Nir Lipsman
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Patrick J McDonald
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Division of Neurosurgery, Department of Surgery, BC Children's Hospital, Vancouver, BC, Canada
| | - Viorica Hrincu
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Chandler
- University of Ottawa, Centre for Health Law, Policy and Ethics, Ottawa, ON, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada; Division of Neurology, University of Toronto, Toronto, ON, Canada; Krembil Brain Institute, Toronto, ON, Canada; Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada
| | - Peter Giacobbe
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Clement Hamani
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - George M Ibrahim
- Division of Neurosurgery, Hospital for Sick Children and Toronto Western Hospital, Toronto, ON, Canada
| | - Zelma Kiss
- Hotchkiss Brain Institute, Departments of Psychiatry and Clinical Neuroscience, University of Calgary, Calgary, AB, Canada
| | - Ying Meng
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Tejas Sankar
- Division of Neurosurgery, University of Alberta, Edmonton, AB, Canada
| | - Lutz Weise
- Department of Neurosurgery, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
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Miller SM. Fluctuations of consciousness, mood, and science: The interhemispheric switch and sticky switch models two decades on. J Comp Neurol 2020; 528:3171-3197. [DOI: 10.1002/cne.24943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Steven M. Miller
- Perceptual and Clinical Neuroscience Laboratory, Department of Physiology Monash Biomedicine Discovery Institute, School of Biomedical Sciences, Monash University Melbourne Victoria Australia
- Monash Alfred Psychiatry Research Centre Central Clinical School, Monash University and Alfred Health Melbourne Victoria Australia
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Konstantinou GN, Vigod SN, Mehta S, Daskalakis ZJ, Blumberger DM. "A systematic review of non-invasive neurostimulation for the treatment of depression during pregnancy". J Affect Disord 2020; 272:259-268. [PMID: 32553366 DOI: 10.1016/j.jad.2020.03.151] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/20/2020] [Accepted: 03/29/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Antidepressant use in pregnancy is associated with high levels of decision-making difficulty for patients, and psychotherapy may not be effective for severe symptoms. Alternative treatment options are needed. We conducted a systematic review of the clinical effects and tolerability of non-invasive neurostimulation: repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), trigeminal nerve stimulation (TNS), and transcutaneous vagus nerve stimulation (tVNS) for the treatment of antenatal depression. METHODS We searched PubMed, Google Scholar and Scopus for published articles in English (1990 to June 2019). Two reviewers reviewed full-text articles, assessed quality, and extracted data on maternal psychiatric, pregnancy and neonatal outcomes. RESULTS Of 565 articles, 21 met inclusion criteria: two RCTs (1 rTMS; 1 tDCS), four open-label studies (3 rTMS; 1 tDCS), three case series (3 rTMS), and twelve case reports (9 rTMS; 1 tDCS; 1 tACS; 1 TNS). In all but one published study (1 rTMS), non-invasive neurostimulation resulted in either response or remission of antenatal depression. Minor maternal side effects were reported in rTMS and tDCS studies, but not in other modalities. Fetal adverse effects were not reported in any intervention. A small proportion of participants dropped out of treatment (rTMS, tDCS). LIMITATIONS Very few randomized trials have been conducted and there is significant heterogeneity in the parameters of the modalities that have been studied. CONCLUSIONS Non-invasive neurostimulation holds promise as a potentially effective and feasible alternative treatment for antenatal depression. Strategies to enhance recruitment of pregnant women into non-invasive neurostimulation trials that have longitudinal follow-up are needed.
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Affiliation(s)
- Gerasimos N Konstantinou
- Department of Psychiatry, University of Toronto; Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Simone N Vigod
- Department of Psychiatry, University of Toronto; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Shobha Mehta
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of Toronto; Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Daniel M Blumberger
- Department of Psychiatry, University of Toronto; Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
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9
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Nestor SM, Blumberger DM. Mapping Symptom Clusters to Circuits: Toward Personalizing TMS Targets to Improve Treatment Outcomes in Depression. Am J Psychiatry 2020; 177:373-375. [PMID: 32354264 DOI: 10.1176/appi.ajp.2020.20030271] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sean M Nestor
- Department of Psychiatry, Faculty of Medicine, University of Toronto, and Temerty Centre for Therapeutic Brain Intervention and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto
| | - Daniel M Blumberger
- Department of Psychiatry, Faculty of Medicine, University of Toronto, and Temerty Centre for Therapeutic Brain Intervention and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto
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10
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Weiler M, Stieger KC, Long JM, Rapp PR. Transcranial Magnetic Stimulation in Alzheimer's Disease: Are We Ready? eNeuro 2020; 7:ENEURO.0235-19.2019. [PMID: 31848209 PMCID: PMC6948923 DOI: 10.1523/eneuro.0235-19.2019] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 02/08/2023] Open
Abstract
Transcranial magnetic stimulation (TMS) is among a growing family of noninvasive brain stimulation techniques being developed to treat multiple neurocognitive disorders, including Alzheimer's disease (AD). Although small clinical trials in AD have reported positive effects on cognitive outcome measures, significant knowledge gaps remain, and little attention has been directed at examining the potential influence of TMS on AD pathogenesis. Our review briefly outlines some of the proposed neurobiological mechanisms of TMS benefits in AD, with particular emphasis on the modulatory effects on excitatory/inhibitory balance. On the basis of converging evidence from multiple fields, we caution that TMS therapeutic protocols established in young adults may have unexpected detrimental effects in older individuals or in the brain compromised by AD pathology. Our review surveys clinical studies of TMS in AD alongside basic research as a guide for moving this important area of work forward toward effective treatment development.
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Affiliation(s)
- Marina Weiler
- Neurocognitive Aging Section, Laboratory of Behavioral Neuroscience, National Institute on Aging, Intramural Research Program, Baltimore, Maryland 21224
| | - Kevin C Stieger
- Neurocognitive Aging Section, Laboratory of Behavioral Neuroscience, National Institute on Aging, Intramural Research Program, Baltimore, Maryland 21224
| | - Jeffrey M Long
- Neurocognitive Aging Section, Laboratory of Behavioral Neuroscience, National Institute on Aging, Intramural Research Program, Baltimore, Maryland 21224
| | - Peter R Rapp
- Neurocognitive Aging Section, Laboratory of Behavioral Neuroscience, National Institute on Aging, Intramural Research Program, Baltimore, Maryland 21224
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