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Winninge M, Cernvall M, Persson J, Bodén R. Early symptom improvement and other clinical predictors of response to repetitive transcranial magnetic stimulation for depression. J Affect Disord 2024; 361:383-389. [PMID: 38897300 DOI: 10.1016/j.jad.2024.06.054] [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: 01/22/2024] [Revised: 06/01/2024] [Accepted: 06/15/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is a rapidly emerging treatment for depression, but outcome prediction is still a challenge. This study aimed to identify predictors of response to rTMS among baseline clinical factors and early symptomatic improvements. METHODS This cohort study comprised 136 patients with a unipolar or bipolar depressive episode referred for clinical intermittent theta-burst stimulation or right-sided 1 Hz rTMS at the Uppsala Brain Stimulation Unit. The co-primary outcomes used for logistic regression were response, defined as ≥50 % reduction of Montgomery and Åsberg Depression Rating Scale Self-assessment (MADRS-S) total score, and 1-2 points on the Clinical Global Impression Improvement (CGI-I) scale. Early improvement was defined as ≥20 % reduction in the MADRS-S total score, or ≥ 1 point reduction in each MADRS-S item, after two weeks of treatment. RESULTS The response rates were 21 % for MADRS-S and 45 % for CGI-I. A depressive episode >24 months had lower odds for MADRS-S response compared to ≤12 months. Early improvement of the MADRS-S total score predicted CGI-I response (95 % CI = 1.35-9.47, p = 0.011), Initiative6 predicted MADRS-S response (95 % CI = 1.08-9.05, p = 0.035), and Emotional involvement7 predicted CGI-I response (95 % CI = 1.03-8.66, p = 0.044). LIMITATIONS No adjustment for concurrent medication. CONCLUSIONS A depressive episode ≤12 months and early improvement in overall depressive symptoms, as well as the individual items, Initiative6 and Emotional involvement7, predicted subsequent rTMS response in a naturalistic sample of depressed patients. This could facilitate the early identification of patients who will benefit from further rTMS sessions.
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Affiliation(s)
- Moa Winninge
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Martin Cernvall
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Department of Psychology, Division of Clinical Psychology, Uppsala University, Uppsala, Sweden
| | - Jonas Persson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Robert Bodén
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
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Dalhuisen I, van Oostrom I, Spijker J, Wijnen B, van Exel E, van Mierlo H, de Waardt D, Arns M, Tendolkar I, van Eijndhoven P. rTMS as a Next Step in Antidepressant Nonresponders: A Randomized Comparison With Current Antidepressant Treatment Approaches. Am J Psychiatry 2024; 181:806-814. [PMID: 39108161 DOI: 10.1176/appi.ajp.20230556] [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] [Indexed: 09/02/2024]
Abstract
OBJECTIVE Although repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for depression, little is known about the comparative effectiveness of rTMS and other treatment options, such as antidepressants. In this multicenter randomized controlled trial, rTMS was compared with the next pharmacological treatment step in patients with treatment-resistant depression. METHODS Patients with unipolar nonpsychotic depression (N=89) with an inadequate response to at least two treatment trials were randomized to treatment with rTMS or to a switch of antidepressants, both in combination with psychotherapy. Treatment duration was 8 weeks and consisted of either 25 high-frequency rTMS sessions to the left dorsolateral prefrontal cortex or a switch of antidepressant medication following the Dutch treatment algorithm. The primary outcome was change in depression severity based on the Hamilton Depression Rating Scale (HAM-D). Secondary outcomes were response and remission rates as well as change in symptom dimensions (anhedonia, anxiety, sleep, rumination, and cognitive reactivity). Finally, expectations regarding treatment were assessed. RESULTS rTMS resulted in a significantly larger reduction in depressive symptoms than medication, which was also reflected in higher response (37.5% vs. 14.6%) and remission (27.1% vs. 4.9%) rates. A larger decrease in symptoms of anxiety and anhedonia was observed after rTMS compared with a switch in antidepressants, and no difference from the medication group was seen for symptom reductions in rumination, cognitive reactivity, and sleep disorders. Expectations regarding treatment correlated with changes in HAM-D scores. CONCLUSIONS In a sample of patients with moderately treatment-resistant depression, rTMS was more effective in reducing depressive symptoms than a switch of antidepressant medication. In addition, the findings suggest that the choice of treatment may be guided by specific symptom dimensions.
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Affiliation(s)
- Iris Dalhuisen
- Department of Psychiatry, Radboud University Medical Center, and Donders Institute for Brain, Cognition, and Behavior, Centre for Medical Neuroscience, Nijmegen, the Netherlands (Dalhuisen, Tendolkar, van Eijndhoven); Neurocare Clinics, Nijmegen, the Netherlands (van Oostrom); Depression Expertise Centre, Pro Persona Mental Health Care, and Behavioral Science Institute, Radboud University, Nijmegen, the Netherlands (Spijker); Center for Economic Evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands (Wijnen); GGZ inGeest Specialized Mental Health Care, and Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (van Exel); Department of Psychiatry and Psychology, St. Antonius Hospital, Utrecht/Nieuwegein, the Netherlands (van Mierlo); Department of Psychiatry, Elisabeth-TweeSteden Ziekenhuis Hospital, Tilburg, the Netherlands (de Waardt); Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands (Arns); Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Arns)
| | - Iris van Oostrom
- Department of Psychiatry, Radboud University Medical Center, and Donders Institute for Brain, Cognition, and Behavior, Centre for Medical Neuroscience, Nijmegen, the Netherlands (Dalhuisen, Tendolkar, van Eijndhoven); Neurocare Clinics, Nijmegen, the Netherlands (van Oostrom); Depression Expertise Centre, Pro Persona Mental Health Care, and Behavioral Science Institute, Radboud University, Nijmegen, the Netherlands (Spijker); Center for Economic Evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands (Wijnen); GGZ inGeest Specialized Mental Health Care, and Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (van Exel); Department of Psychiatry and Psychology, St. Antonius Hospital, Utrecht/Nieuwegein, the Netherlands (van Mierlo); Department of Psychiatry, Elisabeth-TweeSteden Ziekenhuis Hospital, Tilburg, the Netherlands (de Waardt); Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands (Arns); Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Arns)
| | - Jan Spijker
- Department of Psychiatry, Radboud University Medical Center, and Donders Institute for Brain, Cognition, and Behavior, Centre for Medical Neuroscience, Nijmegen, the Netherlands (Dalhuisen, Tendolkar, van Eijndhoven); Neurocare Clinics, Nijmegen, the Netherlands (van Oostrom); Depression Expertise Centre, Pro Persona Mental Health Care, and Behavioral Science Institute, Radboud University, Nijmegen, the Netherlands (Spijker); Center for Economic Evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands (Wijnen); GGZ inGeest Specialized Mental Health Care, and Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (van Exel); Department of Psychiatry and Psychology, St. Antonius Hospital, Utrecht/Nieuwegein, the Netherlands (van Mierlo); Department of Psychiatry, Elisabeth-TweeSteden Ziekenhuis Hospital, Tilburg, the Netherlands (de Waardt); Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands (Arns); Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Arns)
| | - Ben Wijnen
- Department of Psychiatry, Radboud University Medical Center, and Donders Institute for Brain, Cognition, and Behavior, Centre for Medical Neuroscience, Nijmegen, the Netherlands (Dalhuisen, Tendolkar, van Eijndhoven); Neurocare Clinics, Nijmegen, the Netherlands (van Oostrom); Depression Expertise Centre, Pro Persona Mental Health Care, and Behavioral Science Institute, Radboud University, Nijmegen, the Netherlands (Spijker); Center for Economic Evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands (Wijnen); GGZ inGeest Specialized Mental Health Care, and Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (van Exel); Department of Psychiatry and Psychology, St. Antonius Hospital, Utrecht/Nieuwegein, the Netherlands (van Mierlo); Department of Psychiatry, Elisabeth-TweeSteden Ziekenhuis Hospital, Tilburg, the Netherlands (de Waardt); Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands (Arns); Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Arns)
| | - Eric van Exel
- Department of Psychiatry, Radboud University Medical Center, and Donders Institute for Brain, Cognition, and Behavior, Centre for Medical Neuroscience, Nijmegen, the Netherlands (Dalhuisen, Tendolkar, van Eijndhoven); Neurocare Clinics, Nijmegen, the Netherlands (van Oostrom); Depression Expertise Centre, Pro Persona Mental Health Care, and Behavioral Science Institute, Radboud University, Nijmegen, the Netherlands (Spijker); Center for Economic Evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands (Wijnen); GGZ inGeest Specialized Mental Health Care, and Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (van Exel); Department of Psychiatry and Psychology, St. Antonius Hospital, Utrecht/Nieuwegein, the Netherlands (van Mierlo); Department of Psychiatry, Elisabeth-TweeSteden Ziekenhuis Hospital, Tilburg, the Netherlands (de Waardt); Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands (Arns); Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Arns)
| | - Hans van Mierlo
- Department of Psychiatry, Radboud University Medical Center, and Donders Institute for Brain, Cognition, and Behavior, Centre for Medical Neuroscience, Nijmegen, the Netherlands (Dalhuisen, Tendolkar, van Eijndhoven); Neurocare Clinics, Nijmegen, the Netherlands (van Oostrom); Depression Expertise Centre, Pro Persona Mental Health Care, and Behavioral Science Institute, Radboud University, Nijmegen, the Netherlands (Spijker); Center for Economic Evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands (Wijnen); GGZ inGeest Specialized Mental Health Care, and Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (van Exel); Department of Psychiatry and Psychology, St. Antonius Hospital, Utrecht/Nieuwegein, the Netherlands (van Mierlo); Department of Psychiatry, Elisabeth-TweeSteden Ziekenhuis Hospital, Tilburg, the Netherlands (de Waardt); Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands (Arns); Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Arns)
| | - Dieuwertje de Waardt
- Department of Psychiatry, Radboud University Medical Center, and Donders Institute for Brain, Cognition, and Behavior, Centre for Medical Neuroscience, Nijmegen, the Netherlands (Dalhuisen, Tendolkar, van Eijndhoven); Neurocare Clinics, Nijmegen, the Netherlands (van Oostrom); Depression Expertise Centre, Pro Persona Mental Health Care, and Behavioral Science Institute, Radboud University, Nijmegen, the Netherlands (Spijker); Center for Economic Evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands (Wijnen); GGZ inGeest Specialized Mental Health Care, and Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (van Exel); Department of Psychiatry and Psychology, St. Antonius Hospital, Utrecht/Nieuwegein, the Netherlands (van Mierlo); Department of Psychiatry, Elisabeth-TweeSteden Ziekenhuis Hospital, Tilburg, the Netherlands (de Waardt); Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands (Arns); Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Arns)
| | - Martijn Arns
- Department of Psychiatry, Radboud University Medical Center, and Donders Institute for Brain, Cognition, and Behavior, Centre for Medical Neuroscience, Nijmegen, the Netherlands (Dalhuisen, Tendolkar, van Eijndhoven); Neurocare Clinics, Nijmegen, the Netherlands (van Oostrom); Depression Expertise Centre, Pro Persona Mental Health Care, and Behavioral Science Institute, Radboud University, Nijmegen, the Netherlands (Spijker); Center for Economic Evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands (Wijnen); GGZ inGeest Specialized Mental Health Care, and Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (van Exel); Department of Psychiatry and Psychology, St. Antonius Hospital, Utrecht/Nieuwegein, the Netherlands (van Mierlo); Department of Psychiatry, Elisabeth-TweeSteden Ziekenhuis Hospital, Tilburg, the Netherlands (de Waardt); Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands (Arns); Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Arns)
| | - Indira Tendolkar
- Department of Psychiatry, Radboud University Medical Center, and Donders Institute for Brain, Cognition, and Behavior, Centre for Medical Neuroscience, Nijmegen, the Netherlands (Dalhuisen, Tendolkar, van Eijndhoven); Neurocare Clinics, Nijmegen, the Netherlands (van Oostrom); Depression Expertise Centre, Pro Persona Mental Health Care, and Behavioral Science Institute, Radboud University, Nijmegen, the Netherlands (Spijker); Center for Economic Evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands (Wijnen); GGZ inGeest Specialized Mental Health Care, and Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (van Exel); Department of Psychiatry and Psychology, St. Antonius Hospital, Utrecht/Nieuwegein, the Netherlands (van Mierlo); Department of Psychiatry, Elisabeth-TweeSteden Ziekenhuis Hospital, Tilburg, the Netherlands (de Waardt); Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands (Arns); Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Arns)
| | - Philip van Eijndhoven
- Department of Psychiatry, Radboud University Medical Center, and Donders Institute for Brain, Cognition, and Behavior, Centre for Medical Neuroscience, Nijmegen, the Netherlands (Dalhuisen, Tendolkar, van Eijndhoven); Neurocare Clinics, Nijmegen, the Netherlands (van Oostrom); Depression Expertise Centre, Pro Persona Mental Health Care, and Behavioral Science Institute, Radboud University, Nijmegen, the Netherlands (Spijker); Center for Economic Evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands (Wijnen); GGZ inGeest Specialized Mental Health Care, and Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (van Exel); Department of Psychiatry and Psychology, St. Antonius Hospital, Utrecht/Nieuwegein, the Netherlands (van Mierlo); Department of Psychiatry, Elisabeth-TweeSteden Ziekenhuis Hospital, Tilburg, the Netherlands (de Waardt); Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands (Arns); Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Arns)
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Trapp NT, Barbour T, Kritzer MD, Pottanat R, Carreon D, Chen L, Brown J, Siddiqi S. Defining a Neurostimulation-Focused Subspecialty: Perspectives Inspired by a Debate at the 2023 Clinical TMS Society Annual Meeting. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2024:10.1007/s40596-024-02025-2. [PMID: 39148002 DOI: 10.1007/s40596-024-02025-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 08/04/2024] [Indexed: 08/17/2024]
Affiliation(s)
| | | | | | | | | | - Leo Chen
- Monash University, Melbourne, Victoria, Australia
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4
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Yang J, Tang T, Gui Q, Zhang K, Zhang A, Wang T, Yang C, Liu X, Sun N. Status and trends of TMS research in depressive disorder: a bibliometric and visual analysis. Front Psychiatry 2024; 15:1432792. [PMID: 39176225 PMCID: PMC11338766 DOI: 10.3389/fpsyt.2024.1432792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 07/22/2024] [Indexed: 08/24/2024] Open
Abstract
Background Depression is a chronic psychiatric condition that places significant burdens on individuals, families, and societies. The rapid evolution of non-invasive brain stimulation techniques has facilitated the extensive clinical use of Transcranial Magnetic Stimulation (TMS) for depression treatment. In light of the substantial recent increase in related research, this study aims to employ bibliometric methods to systematically review the global research status and trends of TMS in depression, providing a reference and guiding future studies in this field. Methods We retrieved literature on TMS and depression published between 1999 and 2023 from the Science Citation Index Expanded (SCIE) and Social Science Citation Index (SSCI) databases within the Web of Science Core Collection (WoSCC). Bibliometric analysis was performed using VOSviewer and CiteSpace software to analyze data on countries, institutions, authors, journals, keywords, citations, and to generate visual maps. Results A total of 5,046 publications were extracted covering the period from 1999 to 2023 in the field of TMS and depression. The publication output exhibited an overall exponential growth trend. These articles were published across 804 different journals, BRAIN STIMULATION is the platform that receives the most articles in this area. The literature involved contributions from over 16,000 authors affiliated with 4,573 institutions across 77 countries. The United States contributed the largest number of publications, with the University of Toronto and Daskalakis ZJ leading as the most prolific institution and author, respectively. Keywords such as "Default Mode Network," "Functional Connectivity," and "Theta Burst" have recently garnered significant attention. Research in this field primarily focuses on TMS stimulation patterns, their therapeutic efficacy and safety, brain region and network mechanisms under combined brain imaging technologies, and the modulation effects of TMS on brain-derived neurotrophic factor (BDNF) and neurotransmitter levels. Conclusion In recent years, TMS therapy has demonstrated extensive potential applications and significant implications for the treatment of depression. Research in the field of TMS for depression has achieved notable progress. Particularly, the development of novel TMS stimulation patterns and the integration of TMS therapy with multimodal techniques and machine learning algorithms for precision treatment and investigation of brain network mechanisms have emerged as current research hotspots.
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Affiliation(s)
- Jun Yang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Tingting Tang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
- Academy of Medical Sciences, Shanxi Medical University, Taiyuan, China
| | - Qianqian Gui
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Kun Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Aixia Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Ting Wang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Chunxia Yang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiaodong Liu
- Department of Neurosurgery, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Ning Sun
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
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5
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Hsu TW, Yeh TC, Kao YC, Thompson T, Brunoni AR, Carvalho AF, Hsu CW, Tu YK, Liang CS. The dose-effect relationship of six stimulation parameters with rTMS over left DLPFC on treatment-resistant depression: A systematic review and meta-analysis. Neurosci Biobehav Rev 2024; 162:105704. [PMID: 38723735 DOI: 10.1016/j.neubiorev.2024.105704] [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] [Received: 01/01/2024] [Revised: 04/17/2024] [Accepted: 05/01/2024] [Indexed: 05/20/2024]
Abstract
This study aimed to evaluate the association of the six parameters, namely stimulation intensity, stimulation frequency, pulses per session, treatment duration, number of sessions, and total number of pulses with the efficacy of conventional transcranial magnetic stimulation (rTMS) over left dorsolateral prefrontal cortex for patients with treatment-resistant depression (TRD). A random-effects dose-response meta-analysis of blinded randomized controlled trials (RCTs) involving 2391 participants were conducted to examine the dose-effect relationship of six stimulation parameters. Any of the six parameters significantly individually predicted proportion of variance in efficacy: pulses per session (R²=52.7%), treatment duration (R²=51.2%), total sessions (R²=50.9%), frequency (R²=49.6%), total pulses (R²=49.5%), and intensity (R²= 40.4%). Besides, we identified frequency as a potential parameter interacting with the other five parameters, resulting in a significant increase in variance(ΔR2) ranging from 5.0% to 16.7%. Finally, we found that RCTs using frequency > 10 Hz compared to those of 10 Hz showed better dose-effect relationships. We conclude that the six stimulation parameters significantly predict the dose-effect relationship of conventional rTMS on TRD. Besides, higher stimulation frequency, higher stimulation intensity, and adequate number of pulses were associated with treatment efficacy.
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Affiliation(s)
- Tien-Wei Hsu
- Department of Psychiatry, E-DA Dachang Hospital, I-Shou University, Kaohsiung, Taiwan; Department of Psychaitry, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ta-Chuan Yeh
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Centre, Taipei, Taiwan; Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, Taipei, Taiwan
| | - Yu-Chen Kao
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Centre, Taipei, Taiwan; Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, Taipei, Taiwan
| | - Trevor Thompson
- Centre for Chronic Illness and Ageing, University of Greenwich, London, UK
| | - Andre R Brunoni
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil; Service of Electroconvulsive Therapy, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Andre F Carvalho
- IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Kang Tu
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan; Institute of Health Data Analytics & Statistics, College of Public Health, National Taiwan University, Taiwan
| | - Chih-Sung Liang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Centre, Taipei, Taiwan; Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, Taipei, Taiwan.
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Xia Z, Yang PY, Chen SL, Zhou HY, Yan C. Uncovering the power of neurofeedback: a meta-analysis of its effectiveness in treating major depressive disorders. Cereb Cortex 2024; 34:bhae252. [PMID: 38889442 DOI: 10.1093/cercor/bhae252] [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: 03/27/2024] [Revised: 05/25/2024] [Accepted: 06/04/2024] [Indexed: 06/20/2024] Open
Abstract
Neurofeedback, a non-invasive intervention, has been increasingly used as a potential treatment for major depressive disorders. However, the effectiveness of neurofeedback in alleviating depressive symptoms remains uncertain. To address this gap, we conducted a comprehensive meta-analysis to evaluate the efficacy of neurofeedback as a treatment for major depressive disorders. We conducted a comprehensive meta-analysis of 22 studies investigating the effects of neurofeedback interventions on depression symptoms, neurophysiological outcomes, and neuropsychological function. Our analysis included the calculation of Hedges' g effect sizes and explored various moderators like intervention settings, study designs, and demographics. Our findings revealed that neurofeedback intervention had a significant impact on depression symptoms (Hedges' g = -0.600) and neurophysiological outcomes (Hedges' g = -0.726). We also observed a moderate effect size for neurofeedback intervention on neuropsychological function (Hedges' g = -0.418). As expected, we observed that longer intervention length was associated with better outcomes for depressive symptoms (β = -4.36, P < 0.001) and neuropsychological function (β = -2.89, P = 0.003). Surprisingly, we found that shorter neurofeedback sessions were associated with improvements in neurophysiological outcomes (β = 3.34, P < 0.001). Our meta-analysis provides compelling evidence that neurofeedback holds promising potential as a non-pharmacological intervention option for effectively improving depressive symptoms, neurophysiological outcomes, and neuropsychological function in individuals with major depressive disorders.
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Affiliation(s)
- Zheng Xia
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, 3663 North Zhongshan Road, Shanghai 200062, China
- Shanghai Changning Mental Health Center, 299 Xiehe Road, Shanghai 200335, China
| | - Peng-Yuan Yang
- Department of Methodology and Statistics, Faculty of Behavioral and Social Sciences, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, The Netherlands
| | - Si-Lu Chen
- Shanghai Changning Mental Health Center, 299 Xiehe Road, Shanghai 200335, China
| | - Han-Yu Zhou
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, 3663 North Zhongshan Road, Shanghai 200062, China
| | - Chao Yan
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, 3663 North Zhongshan Road, Shanghai 200062, China
- Shanghai Changning Mental Health Center, 299 Xiehe Road, Shanghai 200335, China
- Key Laboratory of Philosophy and Social Science of Anhui Province on Adolescent Mental Health and Crisis Intelligence Intervention, Hefei Normal University, 1688 Lianhua Road, Hefei 230601, China
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7
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Meinke C, Lueken U, Walter H, Hilbert K. Predicting treatment outcome based on resting-state functional connectivity in internalizing mental disorders: A systematic review and meta-analysis. Neurosci Biobehav Rev 2024; 160:105640. [PMID: 38548002 DOI: 10.1016/j.neubiorev.2024.105640] [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] [Received: 06/29/2023] [Revised: 02/29/2024] [Accepted: 03/21/2024] [Indexed: 04/07/2024]
Abstract
Predicting treatment outcome in internalizing mental disorders prior to treatment initiation is pivotal for precision mental healthcare. In this regard, resting-state functional connectivity (rs-FC) and machine learning have often shown promising prediction accuracies. This systematic review and meta-analysis evaluates these studies, considering their risk of bias through the Prediction Model Study Risk of Bias Assessment Tool (PROBAST). We examined the predictive performance of features derived from rs-FC, identified features with the highest predictive value, and assessed the employed machine learning pipelines. We searched the electronic databases Scopus, PubMed and PsycINFO on the 12th of December 2022, which resulted in 13 included studies. The mean balanced accuracy for predicting treatment outcome was 77% (95% CI: [72%- 83%]). rs-FC of the dorsolateral prefrontal cortex had high predictive value in most studies. However, a high risk of bias was identified in all studies, compromising interpretability. Methodological recommendations are provided based on a comprehensive exploration of the studies' machine learning pipelines, and potential fruitful developments are discussed.
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Affiliation(s)
- Charlotte Meinke
- Department of Psychology, Humboldt-Universität zu Berlin, Germany.
| | - Ulrike Lueken
- Department of Psychology, Humboldt-Universität zu Berlin, Germany; German Center for Mental Health (DZPG), partner site Berlin/Potsdam, Germany.
| | - Henrik Walter
- Charité Universtätsmedizin Berlin, corporate member of FU Berlin and Humboldt Universität zu Berlin, Department of Psychiatrie and Psychotherapy, CCM, Germany.
| | - Kevin Hilbert
- Department of Psychology, Humboldt-Universität zu Berlin, Germany; Department of Psychology, Health and Medical University Erfurt, Germany.
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Ikawa H, Osawa R, Takeda Y, Sato A, Mizuno H, Noda Y. Real-world retrospective study of repetitive transcranial magnetic stimulation (TMS) treatment for bipolar and unipolar depression using TMS registry data in Tokyo. Heliyon 2024; 10:e27288. [PMID: 38495204 PMCID: PMC10940930 DOI: 10.1016/j.heliyon.2024.e27288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 02/12/2024] [Accepted: 02/27/2024] [Indexed: 03/19/2024] Open
Abstract
Despite the prevalence of empirical practice, evidence supporting the use of repetitive transcranial magnetic stimulation (rTMS) in treating bipolar depression (BD) is sparse compared to that for unipolar depression. Therefore, this study aimed to conduct a retrospective observational analysis using TMS registry data to compare the efficacy of rTMS treatment for BD and unipolar depression. Data from 20 patients diagnosed with unipolar and BD were retrospectively extracted from the TMS registry to ensure age and sex matching. The primary outcomes of this registry study were measured using the 21-item Hamilton Depression Rating Scale (HAM-D21) and Montgomery-Åsberg Depression Rating Scale (MADRS). Analysis did not reveal significant differences between the two groups in terms of depression severity, motor threshold, or stimulus intensity at baseline. Similarly, no significant differences were observed in absolute or relative changes in the total HAM-D21 and MADRS scores. Furthermore, the response and remission rates following rTMS treatment did not differ significantly between groups. The only adverse event reported in this study was scalp pain at the stimulation site; however, the incidence and severity were not significantly different between the groups. In conclusion, this retrospective study, using real-world TMS registry data, suggests that rTMS treatment for BD could be as effective as that for unipolar depression. These findings underscore the need for further validation in prospective randomized controlled trials with larger sample sizes.
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Affiliation(s)
| | | | | | | | | | - Yoshihiro Noda
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
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Conway CR, Aaronson ST, Sackeim HA, Duffy W, Stedman M, Quevedo J, Allen RM, Riva-Posse P, Berger MA, Alva G, Malik MA, Dunner DL, Cichowicz I, Luing H, Zajecka J, Nahas Z, Mickey BJ, Kablinger AS, Kriedt CL, Bunker MT, Lee YCL, Shy O, Majewski S, Olin B, Tran Q, Rush AJ. Clinical characteristics and treatment exposure of patients with marked treatment-resistant unipolar major depressive disorder: A RECOVER trial report. Brain Stimul 2024; 17:448-459. [PMID: 38574853 DOI: 10.1016/j.brs.2024.03.016] [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] [Received: 01/04/2024] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND RECOVER is a randomized sham-controlled trial of vagus nerve stimulation and the largest such trial conducted with a psychiatric neuromodulation intervention. OBJECTIVE To describe pre-implantation baseline clinical characteristics and treatment history of patients with unipolar, major depressive disorder (MDD), overall and as a function of exposure to interventional psychiatric treatments (INTs), including electroconvulsive therapy, transcranial magnetic stimulation, and esketamine. METHODS Medical, psychiatric, and treatment records were reviewed by study investigators and an independent Study Eligibility Committee prior to study qualification. Clinical characteristics and treatment history (using Antidepressant Treatment History [Short] Form) were compared in those qualified (N = 493) versus not qualified (N = 228) for RECOVER, and among the qualified group as a function of exposure to INTs during the current major depressive episode (MDE). RESULTS Unipolar MDD patients who qualified for RECOVER had marked TRD (median of 11.0 lifetime failed antidepressant treatments), severe disability (median WHODAS score of 50.0), and high rate of baseline suicidality (77% suicidal ideation, 40% previous suicide attempts). Overall, 71% had received at least one INT. Compared to the no INT group, INT recipients were younger and more severely depressed (QIDS-C, QIDS-SR), had greater suicidal ideation, earlier diagnosis of MDD, and failed more antidepressant medication trials. CONCLUSIONS RECOVER-qualified unipolar patients had marked TRD and marked treatment resistance with most failing one or more prior INTs. Treatment with ≥1 INTs in the current MDE was associated with earlier age of MDD onset, more severe clinical presentation, and greater treatment resistance relative to patients without a history of INT. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03887715.
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Affiliation(s)
- Charles R Conway
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA.
| | - Scott T Aaronson
- Department of Clinical Research, Sheppard Pratt Health System, Baltimore, MD, USA
| | - Harold A Sackeim
- Departments of Psychiatry and Radiology, Columbia University, New York, NY, USA
| | | | | | - João Quevedo
- Center for Interventional Psychiatry, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX, USA
| | | | - Patricio Riva-Posse
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Gustavo Alva
- ATP Clinical Research, Senior Brain Health, Hoag Hospital, Newport Beach, CA and Department of Psychiatry and Neuroscience, University of California, Riverside, CA, USA
| | | | - David L Dunner
- Center for Anxiety and Depression, Mercer Island, WA, USA
| | | | | | - John Zajecka
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA; Psychiatric Medicine Associates, LLC, Skokie, IL, USA
| | - Ziad Nahas
- Department of Psychiatry & Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Brian J Mickey
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, UT, USA
| | - Anita S Kablinger
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Christopher L Kriedt
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Mark T Bunker
- LivaNova PLC (or a Subsidiary), London, Great Britain, United Kingdom
| | | | - Olivia Shy
- LivaNova PLC (or a Subsidiary), London, Great Britain, United Kingdom
| | - Shannon Majewski
- LivaNova PLC (or a Subsidiary), London, Great Britain, United Kingdom
| | - Bryan Olin
- LivaNova PLC (or a Subsidiary), London, Great Britain, United Kingdom
| | - Quyen Tran
- LivaNova PLC (or a Subsidiary), London, Great Britain, United Kingdom
| | - A John Rush
- Duke-NUS Medical School, Singapore; Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
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Hickson R, Simonsen MW, Miller KJ, Madore MR. Durability of deep transcranial magnetic stimulation for veterans with treatment resistant depression with comorbid suicide risk and PTSD symptoms. Psychiatry Res 2024; 332:115690. [PMID: 38183924 DOI: 10.1016/j.psychres.2023.115690] [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: 08/14/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/08/2024]
Abstract
Evidence supports transcranial magnetic stimulation (TMS) as an effective treatment for symptoms of depression and PTSD; however, there has been limited investigation into the durability of symptoms reduction. The Hampton Veterans Affairs Medical Center's (HVAMC) rTMS clinic used H-coil for dTMS for Veterans with treatment-resistant depression and tracked symptomology at multiple times points up to six months post-treatment. Veterans underwent 30 session of dTMS treatment using the Hesed coil (H1 coil). The PHQ-9, PCL-5, and BSS were administered to Veterans at four time points: pretreatment, post-treatment, three months after treatment, and six months after treatment. In aggregate, there were clinically significant reductions in symptoms of depression (43.47%), PTSD (44.14%) and suicidal ideation (54.02%) at the six month follow-up relative to pretreatment. Results provide evidence of the impact and durability of dTMS on symptoms of MDD, PTSD, and suicidal ideation among Veterans with treatment-resistant depression.
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Affiliation(s)
- Robert Hickson
- Department of Psychology, Palo Alto University, Palo Alto, CA, United States; VA Palo Alto Health Care System Sierra Pacific Mental Illness Research Education Clinical Center, Palo Alto, CA, United States
| | - Max W Simonsen
- Hampton VA Medical Center, Hampton, VA, United States; Department of Psychiatry, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Kenneth J Miller
- Hampton VA Medical Center, Hampton, VA, United States; Department of Psychiatry, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Michelle R Madore
- VA Palo Alto Health Care System Sierra Pacific Mental Illness Research Education Clinical Center, Palo Alto, CA, United States; Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford, CA, United States.
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11
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Breda V, Freire R. Repetitive Transcranial Magnetic Stimulation (rTMS) in Major Depression. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1456:145-159. [PMID: 39261428 DOI: 10.1007/978-981-97-4402-2_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
Major depressive disorder (MDD) is a psychiatric disorder with several effective therapeutic approaches, being antidepressants and psychotherapies the first-line treatments. Nonetheless, due to side effects, limited efficacy, and contraindications for these treatments, alternative treatment options are required. Neurostimulation is a non-pharmacological and non-psychotherapeutic approach that has been under study for diverse neuropsychiatric conditions in the form of electrical or magnetic stimulation of the brain. Repetitive transcranial magnetic stimulation (rTMS) is a neurostimulation method designed to generate magnetic fields and deliver magnetic pulses to stimulate the brain cortex. The magnetic pulses produce electrical currents in the brain which are not intense enough to provoke seizures, differentiating this method from other forms of neurostimulation that produce seizures. Although the exact rTMS mechanisms of action are not completely understood, rTMS seems to cause its beneficial effects through changes in neuroplasticity. Devices and protocols for rTMS are still evolving, becoming more efficient over time. There are still some challenges to be addressed, including further refinement of parameters (coil/device type, location, intensity, frequency, number of sessions, and duration of treatment); treatment cost and burden for patients; and treatment resistance. However, the efficacy, tolerability, and safety of some rTMS protocols have been demonstrated in different double-blind sham-controlled randomized controlled trials and meta-analyses for treatment-resistant depression.
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Affiliation(s)
- Vitor Breda
- Department of Psychiatry, Western University, London, ON, Canada
- Victoria Hospital & Children's Hospital, London Health Sciences Centre, London, ON, Canada
| | - Rafael Freire
- Department of Psychiatry and Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.
- Kingston General Hospital Research Institute, Kingston Health Sciences Centre, Kingston, ON, Canada.
- Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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12
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Yu T, Chen W, Huo L, Luo X, Wang J, Zhang B. Association between daily dose and efficacy of rTMS over the left dorsolateral prefrontal cortex in depression: A meta-analysis. Psychiatry Res 2023; 325:115260. [PMID: 37229909 DOI: 10.1016/j.psychres.2023.115260] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 05/27/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a well-established, safe, and effective brain stimulation technique for depression; however, uniform parameters have not been used in clinical practice. The aim of this study was to identify the parameters that affect rTMS effectiveness and ascertain the range in which that parameter has optimal efficacy. A meta-analysis of sham-controlled trials using rTMS delivered over the left dorsolateral prefrontal cortex (DLPFC) in depression was conducted. In the meta-regression and subgroup analyses, all rTMS stimulation parameters were extracted and their association with efficacy was investigated. Of the 17,800 references, 52 sham-controlled trials were included. Compared to sham controls, our results demonstrated a significant improvement in depressive symptoms at the end of treatment. According to the results of meta-regression, the number of pulses and sessions per day correlated with rTMS efficacy; however, the positioning method, stimulation intensity, frequency, number of treatment days, and total pulses did not. Furthermore, subgroup analysis revealed that the efficacy was correspondingly better in the group with higher daily pulses. In clinical practice, increasing the number of daily pulses and sessions may improve the effectiveness of rTMS.
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Affiliation(s)
- Tong Yu
- Department of Psychiatry, Guangzhou Medical University, Guangzhou, PR. China; The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, PR. China
| | - Wangni Chen
- Department of Psychiatry, Guangzhou Medical University, Guangzhou, PR. China; The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, PR. China
| | - Lijuan Huo
- Department of Psychiatry, Guangzhou Medical University, Guangzhou, PR. China; The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, PR. China
| | - Xin Luo
- Department of Psychiatry, Guangzhou Medical University, Guangzhou, PR. China; The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, PR. China
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR. China
| | - Bin Zhang
- Tianjin Anding Hospital, Tianjin Medical University, Tianjin, PR. China.
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