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Bouaziz N, Laidi C, Bulteau S, Berjamin C, Thomas F, Moulier V, Benadhira R, Szekely D, Poulet E, Galvao F, Guillin O, Castillo MC, Sauvaget A, Plaze M, Januel D, Brunelin J, Rotharmel M. Real world transcranial magnetic stimulation for major depression: A multisite, naturalistic, retrospective study. J Affect Disord 2023; 326:26-35. [PMID: 36708953 DOI: 10.1016/j.jad.2023.01.070] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/01/2023] [Accepted: 01/16/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND In 2008, the U.S. FDA approved rTMS as a treatment against medication-resistant depression. However, real-world rTMS outcomes remain understudied. This study investigates how rTMS for depression is delivered in routine clinical practice in France, and measures its effectiveness as well as its moderators. METHODS Five centers provided retrospective data on patients who were treated with rTMS for treatment-resistant depression from January 2015 to December 2020. Patients were assessed twice using a hetero-questionnaire, with baseline and immediate post-treatment assessments. We conducted univariate analyses to study which factors were significantly associated with rTMS effectiveness. We then included age, gender, and significant factors in a multivariate model. RESULTS We collected data from 435 patients with a mean age of 51.27 (14.91): 66 % were female, and 26 % suffered from bipolar depression. Stimulation was delivered using four different stimulation parameters: 1 Hz (7 % of the individuals), 10 Hz (43 %), 20 Hz (12 %), and 50 Hz (intermittent Theta Burst Stimulation, iTBS) (38 %). The mean improvement of depressive symptoms was 33 % (p < 0.001, effect-size: 0.79). Response and remission rates were of 31 % and 22.8 %, respectively. In the multivariate analysis, improvement in depressive symptoms was associated with higher baseline symptoms. CONCLUSION This is one of the largest studies that investigates, with careful clinician-rated scales by trained psychiatrists, the effect of rTMS in naturalistic settings. Repetitive TMS appears to be effective in routine clinical practice, although its efficacy could be improved by analyzing predictors of response, as well as personalized targeting of specific brain areas.
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Affiliation(s)
- Noomane Bouaziz
- EPS Ville Evrard, Pôle 93G03, Centre de Recherche Clinique, Neuilly-sur-Marne, France.; La Fondation FondaMental, F-94010 Créteil, France.
| | - Charles Laidi
- La Fondation FondaMental, F-94010 Créteil, France; Pôle de Psychiatrie, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine de Créteil, DMU IMPACT, Hôpitaux Universitaires Mondor, Créteil, France
| | - Samuel Bulteau
- CHU Nantes, Department of Addictology and Psychiatry, Nantes, France
| | - Caroline Berjamin
- University Department of Psychiatry, Centre d'Excellence Thérapeutique-Institut de Psychiatrie-Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
| | - Fanny Thomas
- EPS Ville Evrard, Pôle 93G03, Centre de Recherche Clinique, Neuilly-sur-Marne, France
| | - Virginie Moulier
- EPS Ville Evrard, Pôle 93G03, Centre de Recherche Clinique, Neuilly-sur-Marne, France.; University Department of Psychiatry, Centre d'Excellence Thérapeutique-Institut de Psychiatrie-Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
| | - René Benadhira
- EPS Ville Evrard, Pôle 93G03, Centre de Recherche Clinique, Neuilly-sur-Marne, France
| | | | - Emmanuel Poulet
- Psychiatric emergency service, Hospices Civils de Lyon, F-69005 Lyon, France; Centre Hospitalier Le Vinatier, PSYR2 team, CRNL, INSERM U1028, CNRS UMR5292, Université Lyon 1, F-69500 Bron cedex, France
| | - Filipe Galvao
- Centre Hospitalier Le Vinatier, PSYR2 team, CRNL, INSERM U1028, CNRS UMR5292, Université Lyon 1, F-69500 Bron cedex, France
| | - Olivier Guillin
- University Department of Psychiatry, Centre d'Excellence Thérapeutique-Institut de Psychiatrie-Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
| | | | - Anne Sauvaget
- CHU Nantes, Department of Addictology and Psychiatry, Nantes, France
| | - Marion Plaze
- GHU Paris Psychiatrie & Neurosciences, Hôpital Sainte-Anne, Paris, France
| | - Dominique Januel
- EPS Ville Evrard, Pôle 93G03, Centre de Recherche Clinique, Neuilly-sur-Marne, France.; La Fondation FondaMental, F-94010 Créteil, France; Université Sorbonne Paris Nord. France
| | - Jérôme Brunelin
- Psychiatric emergency service, Hospices Civils de Lyon, F-69005 Lyon, France; Centre Hospitalier Le Vinatier, PSYR2 team, CRNL, INSERM U1028, CNRS UMR5292, Université Lyon 1, F-69500 Bron cedex, France
| | - Maud Rotharmel
- University Department of Psychiatry, Centre d'Excellence Thérapeutique-Institut de Psychiatrie-Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
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2
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Zhao YJ, Bai W, Cai H, Sha S, Zhang Q, Lei SM, Lok KI, Chow IHI, Cheung T, Su Z, Balbuena L, Xiang YT. The backbone symptoms of depression: a network analysis after the initial wave of the COVID-19 pandemic in Macao. PeerJ 2022; 10:e13840. [PMID: 36128195 PMCID: PMC9482773 DOI: 10.7717/peerj.13840] [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: 12/21/2021] [Accepted: 07/14/2022] [Indexed: 01/21/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic disrupted the working lives of Macau residents, possibly leading to mental health issues such as depression. The pandemic served as the context for this investigation of the network structure of depressive symptoms in a community sample. This study aimed to identify the backbone symptoms of depression and to propose an intervention target. Methods This study recruited a convenience sample of 975 Macao residents between 20th August and 9th November 2020. In an electronic survey, depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9). Symptom relationships and centrality indices were identified using directed and undirected network estimation methods. The undirected network was constructed using the extended Bayesian information criterion (EBIC) model, and the directed network was constructed using the Triangulated Maximally Filtered Graph (TMFG) method. The stability of the centrality indices was evaluated by a case-dropping bootstrap procedure. Wilcoxon signed rank tests of the centrality indices were used to assess whether the network structure was invariant between age and gender groups. Results Loss of energy, psychomotor problems, and guilt feelings were the symptoms with the highest centrality indices, indicating that these three symptoms were backbone symptoms of depression. The directed graph showed that loss of energy had the highest number of outward projections to other symptoms. The network structure remained stable after randomly dropping 50% of the study sample, and the network structure was invariant by age and gender groups. Conclusion Loss of energy, psychomotor problems and guilt feelings constituted the three backbone symptoms during the pandemic. Based on centrality and relative influence, loss of energy could be targeted by increasing opportunities for physical activity.
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Affiliation(s)
- Yan-Jie Zhao
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China,Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
| | - Wei Bai
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China,Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
| | - Hong Cai
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China,Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
| | - Sha Sha
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing An Ding Hospital, Beijing, China
| | - Qinge Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing An Ding Hospital, Beijing, China
| | - Si Man Lei
- Faculty of Education, University of Macau, Macau SAR, China
| | - Ka-In Lok
- Kiang Wu Nursing College of Macau, Macau SAR, China
| | - Ines Hang Iao Chow
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China,Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Zhaohui Su
- Center on Smart and Connected Health Technologies, Mays Cancer Center, School of Nursing, UT Health San Antonio, San Antonio, Texas, US
| | - Lloyd Balbuena
- Department of Psychiatry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China,Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
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3
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Hennessy LA, Seewoo BJ, Jaeschke LA, Mackie LA, Figliomeni A, Arena-Foster Y, Etherington SJ, Dunlop SA, Croarkin PE, Rodger J. Accelerated low-intensity rTMS does not rescue anxiety behaviour or abnormal connectivity in young adult rats following chronic restraint stress. NEUROIMAGE. REPORTS 2022; 2:100104. [PMID: 36277329 PMCID: PMC9583935 DOI: 10.1016/j.ynirp.2022.100104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Currently approved repetitive transcranial magnetic stimulation (rTMS) protocols for the treatment of major depressive disorder (MDD) involve once-daily (weekday) stimulation sessions, with 10 Hz or intermittent theta burst stimulation (iTBS) frequencies, over 4-6 weeks. Recently, accelerated treatment protocols (multiple daily stimulation sessions for 1-2 weeks) have been increasingly studied to optimize rTMS treatments. Accelerated protocols might confer unique advantages for adolescents and young adults but there are many knowledge gaps related to dosing in this age group. Off-label, clinical practice frequently outpaces solid evidence as rigorous clinical trials require substantial time and resources. Murine models present an opportunity for high throughput dose finding studies to focus subsequent clinical trials in humans. This project investigated the brain and behavioural effects of an accelerated low-intensity rTMS (LI-rTMS) protocol in a young adult rodent model of chronic restraint stress (CRS). Depression and anxiety-related behaviours were induced in young adult male Sprague Dawley rats using the CRS model, followed by the 3-times-daily delivery of 10 Hz LI-rTMS, for two weeks. Behaviour was assessed using the Elevated Plus Maze and Forced Swim Test, and functional, chemical, and structural brain changes measured using magnetic resonance imaging techniques. CRS induced an agitated depression-like phenotype but therapeutic effects from the accelerated protocol were not detected. Our findings suggest that the age of rodents may impact response to CRS and LI-rTMS. Future studies should also examine higher intensities of rTMS and accelerated theta burst protocols.
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Affiliation(s)
- Lauren A. Hennessy
- Experimental and Regenerative Neurosciences, School of Biological Sciences, The University of Western Australia, Perth, WA, Australia
- Brain Plasticity Group, Perron Institute for Neurological and Translational Science, Perth, WA, Australia
| | - Bhedita J. Seewoo
- Experimental and Regenerative Neurosciences, School of Biological Sciences, The University of Western Australia, Perth, WA, Australia
- Brain Plasticity Group, Perron Institute for Neurological and Translational Science, Perth, WA, Australia
- Centre for Microscopy, Characterisation & Analysis, Research Infrastructure Centres, The University of Western Australia, Perth, WA, Australia
| | - Liz A. Jaeschke
- Experimental and Regenerative Neurosciences, School of Biological Sciences, The University of Western Australia, Perth, WA, Australia
| | - Leah A. Mackie
- Experimental and Regenerative Neurosciences, School of Biological Sciences, The University of Western Australia, Perth, WA, Australia
| | - Abbey Figliomeni
- Brain Plasticity Group, Perron Institute for Neurological and Translational Science, Perth, WA, Australia
- School of Veterinary and Life Sciences, Murdoch University, Perth, WA, Australia
| | - Yasmin Arena-Foster
- Brain Plasticity Group, Perron Institute for Neurological and Translational Science, Perth, WA, Australia
- School of Human Sciences, The University of Western Australia, Perth, WA, Australia
| | - Sarah J. Etherington
- Medical, Molecular and Forensic Sciences, Murdoch University, Perth, WA, Australia
| | - Sarah A. Dunlop
- Experimental and Regenerative Neurosciences, School of Biological Sciences, The University of Western Australia, Perth, WA, Australia
- Minderoo Foundation, Perth, WA, Australia
| | - Paul E. Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Jennifer Rodger
- Experimental and Regenerative Neurosciences, School of Biological Sciences, The University of Western Australia, Perth, WA, Australia
- Brain Plasticity Group, Perron Institute for Neurological and Translational Science, Perth, WA, Australia
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4
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Nikolin S, Tan YY, Martin D, Moffa A, Loo CK, Boonstra TW. Behavioural and neurophysiological differences in working memory function of depressed patients and healthy controls. J Affect Disord 2021; 295:559-568. [PMID: 34509071 DOI: 10.1016/j.jad.2021.08.083] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Major depressive disorder (MDD) is associated with deficits in working memory. Several cognitive subprocesses interact to produce working memory, including attention, encoding, maintenance and manipulation. We sought to clarify the contribution of functional deficits in these subprocesses in MDD by varying cognitive load during a working memory task. METHODS 41 depressed participants and 41 age and gender-matched healthy controls performed the n-back working memory task at three levels of difficulty (0-, 1-, and 2-back) in a pregistered study. We assessed response times, accuracy, and event-related electroencephalography (EEG), including P2 and P3 amplitudes, and frontal theta power (4-8 Hz). RESULTS MDD participants had prolonged response times and more positive frontal P3 amplitudes (i.e., Fz) relative to controls, mainly in the most difficult 2-back condition. Working memory accuracy, P2 amplitudes and frontal theta event-related synchronisation did not differ between groups at any level of task difficulty. CONCLUSIONS Depression is associated with generalized psychomotor slowing of working memory processes, and may involve compensatory hyperactivity in frontal and parietal regions. SIGNIFICANCE These findings provide insights into MDD working memory deficits, indicating that depressed individuals dedicate greater levels of cortical processing and cognitive resources to achieve comparable working memory performance to controls.
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Affiliation(s)
- Stevan Nikolin
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Hospital Road, Sydney, Randwick NSW 2031, Australia.
| | - Yi Yin Tan
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Donel Martin
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Hospital Road, Sydney, Randwick NSW 2031, Australia
| | - Adriano Moffa
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Colleen K Loo
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Hospital Road, Sydney, Randwick NSW 2031, Australia; St. George Hospital, Sydney, Australia
| | - Tjeerd W Boonstra
- School of Psychiatry, University of New South Wales, Sydney, Australia; Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
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5
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Circadian depression: A mood disorder phenotype. Neurosci Biobehav Rev 2021; 126:79-101. [PMID: 33689801 DOI: 10.1016/j.neubiorev.2021.02.045] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 02/18/2021] [Accepted: 02/28/2021] [Indexed: 12/15/2022]
Abstract
Major mood syndromes are among the most common and disabling mental disorders. However, a lack of clear delineation of their underlying pathophysiological mechanisms is a major barrier to prevention and optimised treatments. Dysfunction of the 24-h circadian system is a candidate mechanism that has genetic, behavioural, and neurobiological links to mood syndromes. Here, we outline evidence for a new clinical phenotype, which we have called 'circadian depression'. We propose that key clinical characteristics of circadian depression include disrupted 24-h sleep-wake cycles, reduced motor activity, low subjective energy, and weight gain. The illness course includes early age-of-onset, phenomena suggestive of bipolarity (defined by bidirectional associations between objective motor and subjective energy/mood states), poor response to conventional antidepressant medications, and concurrent cardiometabolic and inflammatory disturbances. Identifying this phenotype could be clinically valuable, as circadian-targeted strategies show promise for reducing depressive symptoms and stabilising illness course. Further investigation of underlying circadian disturbances in mood syndromes is needed to evaluate the clinical utility of this phenotype and guide the optimal use of circadian-targeted interventions.
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6
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Walther S, Alexaki D, Schoretsanitis G, Weiss F, Vladimirova I, Stegmayer K, Strik W, Schäppi L. Inhibitory Repetitive Transcranial Magnetic Stimulation to Treat Psychomotor Slowing: A Transdiagnostic, Mechanism-Based Randomized Double-Blind Controlled Trial. ACTA ACUST UNITED AC 2020. [DOI: 10.1093/schizbullopen/sgaa020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Abstract
Psychomotor slowing is frequently distressing patients with depression and schizophrenia. Increased neural activity within premotor cortices is linked to psychomotor slowing. This transdiagnostic study tested whether add-on inhibitory repetitive transcranial magnetic stimulation (rTMS) of the supplementary motor area (SMA) may alleviate psychomotor slowing. Forty-five patients with severe psychomotor slowing (26 psychosis, 19 major depression) were randomized in this transdiagnostic, double-blind, parallel-group, sham-controlled trial of 15 daily sessions of add-on rTMS over 3 weeks. Treatment arms included inhibitory 1 Hz stimulation of the SMA, facilitatory intermittent theta burst stimulation (iTBS) of the SMA, facilitatory 15 Hz stimulation of the left dorsolateral prefrontal cortex (DLPFC), and sham stimulation of the occipital cortex. The primary outcome was response (>30% reduction from baseline) according to the Salpêtrière Retardation Rating Scale (SRRS). Secondary outcomes were course of SRRS and further symptom rating scales. Last-observation carried forward method was applied to all subjects with baseline data. Response rates differed between protocols: 82% with inhibitory 1 Hz rTMS of the SMA, 0% with facilitatory iTBS of the SMA, 30% with sham, and 33% with 15 Hz DLPFC rTMS (χ 2 = 16.6, P < .001). Dropouts were similarly distributed across protocols. Response rates were similar in the completer analysis. This transdiagnostic trial of rTMS demonstrates that inhibitory SMA stimulation may ameliorate psychomotor slowing in severely ill patients. It further provides proof-of-concept that motor inhibition is linked to increased neural activity in the SMA because the inhibitory protocol performed best in reducing symptoms.
Trial registration: NCT03275766 (www.clinicaltrials.gov).
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Affiliation(s)
- Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Danai Alexaki
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Georgios Schoretsanitis
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
- The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY
| | - Florian Weiss
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Irena Vladimirova
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Katharina Stegmayer
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Werner Strik
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Lea Schäppi
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
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7
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Robin A, Sauvaget A, Deschamps T, Bulteau S, Thomas-Ollivier V. Combined Measures of Psychomotor and Cognitive Alterations as a Potential Hallmark for Bipolar Depression. Psychiatry Investig 2019; 16:954-957. [PMID: 31870090 PMCID: PMC6933132 DOI: 10.30773/pi.2019.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 10/03/2019] [Accepted: 11/07/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The current study aimed to examine whether specific features of psychomotor retardation (PMR) and cognitive functioning established different profiles in unipolar (UD) and bipolar depression (BD). METHODS Two groups of age-matched patients with UD (n=54) and BD (n=20) completed the Montgomery-Asberg Depression Rating Scale (MADRS/60), the Montreal Cognitive Assessment (MoCA/30), and the Salpêtrière Retardation Rating Scale (SRRS/60). We analyzed the group effect and then performed intra-group analyses. RESULTS The BD patients have higher SRRS score, and lower MoCA score than UD despite no difference on the level of depression between UD and BD. Our results show that PMR can be predicted by the level of depression in UD and by the cognitive alteration and onset of disease in BD. CONCLUSION PMR is a relevant marker of depression. Our results highlight the importance of concomitant evaluation of psychomotor and cognitive functions in the distinction of UD and BD symptoms.
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Affiliation(s)
- Alison Robin
- Laboratory “Movement, Interactions, Performance” (E.A. 4334), Faculty of Sport Sciences, University of Nantes, Nantes, France
- Addictology and Liaison Psychiatry Department, University Hospital Nantes, Nantes, France
| | - Anne Sauvaget
- Laboratory “Movement, Interactions, Performance” (E.A. 4334), Faculty of Sport Sciences, University of Nantes, Nantes, France
- Addictology and Liaison Psychiatry Department, University Hospital Nantes, Nantes, France
| | - Thibault Deschamps
- Laboratory “Movement, Interactions, Performance” (E.A. 4334), Faculty of Sport Sciences, University of Nantes, Nantes, France
| | - Samuel Bulteau
- Addictology and Liaison Psychiatry Department, University Hospital Nantes, Nantes, France
| | - Véronique Thomas-Ollivier
- Laboratory “Movement, Interactions, Performance” (E.A. 4334), Faculty of Sport Sciences, University of Nantes, Nantes, France
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8
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Klooster DCW, Franklin SL, Besseling RMH, Jansen JFA, Caeyenberghs K, Duprat R, Aldenkamp AP, de Louw AJA, Boon PAJM, Baeken C. Focal application of accelerated iTBS results in global changes in graph measures. Hum Brain Mapp 2018; 40:432-450. [PMID: 30273448 PMCID: PMC6585849 DOI: 10.1002/hbm.24384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 08/07/2018] [Accepted: 08/26/2018] [Indexed: 12/21/2022] Open
Abstract
Graph analysis was used to study the effects of accelerated intermittent theta burst stimulation (aiTBS) on the brain's network topology in medication‐resistant depressed patients. Anatomical and resting‐state functional MRI (rs‐fMRI) was recorded at baseline and after sham and verum stimulation. Depression severity was assessed using the Hamilton Depression Rating Scale (HDRS). Using various graph measures, the different effects of sham and verum aiTBS were calculated. It was also investigated whether changes in graph measures were correlated to clinical responses. Furthermore, by correlating baseline graph measures with the changes in HDRS in terms of percentage, the potential of graph measures as biomarker was studied. Although no differences were observed between the effects of verum and sham stimulation on whole‐brain graph measures and changes in graph measures did not correlate with clinical response, the baseline values of clustering coefficient and global efficiency showed to be predictive of the clinical response to verum aiTBS. Nodal effects were found throughout the whole brain. The distribution of these effects could not be linked to the strength of the functional connectivity between the stimulation site and the node. This study showed that the effects of aiTBS on graph measures distribute beyond the actual stimulation site. However, additional research into the complex interactions between different areas in the brain is necessary to understand the effects of aiTBS in more detail.
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Affiliation(s)
- Deborah C W Klooster
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Kempenhaeghe Academic Center for Epileptology, Heeze, the Netherlands.,Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Suzanne L Franklin
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - René M H Besseling
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Kempenhaeghe Academic Center for Epileptology, Heeze, the Netherlands.,Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Jaap F A Jansen
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Romain Duprat
- Department of Neurology, Ghent University Hospital, Ghent, Belgium.,University of Pennsylvania, Pennsylvania, Philadelphia
| | - Albert P Aldenkamp
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Kempenhaeghe Academic Center for Epileptology, Heeze, the Netherlands.,Department of Neurology, Ghent University Hospital, Ghent, Belgium.,Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Anton J A de Louw
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Kempenhaeghe Academic Center for Epileptology, Heeze, the Netherlands.,Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Paul A J M Boon
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Kempenhaeghe Academic Center for Epileptology, Heeze, the Netherlands.,Department of Neurology, Ghent University Hospital, Ghent, Belgium.,Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Chris Baeken
- University Hospital Brussels, Jette, Belgium.,Ghent University, Ghent Experimental Psychiatry GHEP Lab, Ghent, Belgium
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9
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Thomas-Ollivier V, Foyer E, Bulteau S, Pichot A, Valriviere P, Sauvaget A, Deschamps T. Cognitive component of psychomotor retardation in unipolar and bipolar depression: Is verbal fluency a relevant marker? Impact of repetitive transcranial stimulation. Psychiatry Clin Neurosci 2017; 71:612-623. [PMID: 28419623 DOI: 10.1111/pcn.12529] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 03/14/2017] [Accepted: 04/10/2017] [Indexed: 12/26/2022]
Abstract
AIMS In the literature, psychomotor retardation (PMR) is increasingly highlighted as a relevant marker for depression. Currently, we chose to focus on the fluency capacities as an evaluation of the frontal lobes functioning to reach a better understanding of cognitive and neurobiological mechanisms involved in PMR in depression. The aims of this study were: (i) to explore the cognitive component of PMR through the analysis of verbal fluency (VF) performance in unipolar and bipolar depression; and (ii) to examine whether a repetitive transcranial magnetic stimulation treatment could improve concomitantly the PMR and VF capacities, as a relevant marker characteristic of the cognitive component of PMR. METHODS Fifteen unipolar and 15 bipolar patients were compared to 15 healthy adults. Before treatment, the results showed VF deficits, particularly marked in the bipolar group. The investigation of the interplay between PMR, VF performance, Montgomery-Åsberg Depression Rating Scale scores, and Montreal Cognitive Assessment scores showed that the deficits in these various dimensions were not homogeneous. RESULTS The absence of correlation between the psychomotor retardation scale (the French Retardation Rating Scale for Depression) and VF, and the correlation with MoCA raise the hypothesis of a more global cognitive impairment associated with PMR in the BD group. The repetitive transcranial magnetic stimulation treatment had a positive impact on depression, PMR, and fluency scores. CONCLUSION Correlations between the Retardation Rating Scale for Depression and VF performances appeared after treatment, showing the cognitive role of psychomotor functioning in depression. Further analyses, including other cognitive measures in an objective evaluation of PMR, are required for a better understanding of these complex relationships.
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Affiliation(s)
- Véronique Thomas-Ollivier
- Laboratory 'Movement, Interactions, Performance' (EA 4334), Faculty of Sport Sciences, University of Nantes, Nantes, France
| | - Emmanuelle Foyer
- Laboratory 'Movement, Interactions, Performance' (EA 4334), Faculty of Sport Sciences, University of Nantes, Nantes, France.,Addictology and Liaison Psychiatry Department, University Hospital of Nantes, Nantes, France
| | - Samuel Bulteau
- Addictology and Liaison Psychiatry Department, University Hospital of Nantes, Nantes, France.,EA SPHERE 4275 MethodS for Patients-centered outcomes and Health Research, University of Nantes, Nantes, France
| | - Anne Pichot
- Addictology and Liaison Psychiatry Department, University Hospital of Nantes, Nantes, France
| | - Pierre Valriviere
- Addictology and Liaison Psychiatry Department, University Hospital of Nantes, Nantes, France
| | - Anne Sauvaget
- Addictology and Liaison Psychiatry Department, University Hospital of Nantes, Nantes, France.,EA SPHERE 4275 MethodS for Patients-centered outcomes and Health Research, University of Nantes, Nantes, France
| | - Thibault Deschamps
- Laboratory 'Movement, Interactions, Performance' (EA 4334), Faculty of Sport Sciences, University of Nantes, Nantes, France
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The effects of high-frequency rTMS over the left DLPFC on cognitive control in young healthy participants. PLoS One 2017; 12:e0179430. [PMID: 28614399 PMCID: PMC5470713 DOI: 10.1371/journal.pone.0179430] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 05/29/2017] [Indexed: 01/10/2023] Open
Abstract
A large body of evidence suggests that repetitive transcranial magnetic stimulation (rTMS) is clinically effective in treating neuropsychiatric disorders and multiple sessions are commonly used. However, it is unknown whether multiple sessions of rTMS improve cognitive control, which is a function of the neural circuitry of the left dorsolateral prefrontal cortex (DLPFC)-cingulate cortex in healthy individuals. In addition, it is still unclear which stages of neural processing are altered by rTMS. In this study, we investigated the effects of high-frequency rTMS on cognitive control and explored the time course changes of cognitive processing after rTMS using event-related potentials (ERPs). For seven consecutive days, 25 young healthy participants underwent one 10-Hz rTMS session per day in which stimulation was applied over the left DLPFC, and a homogeneous participant group of 25 individuals received a sham rTMS treatment. A Stroop task was performed, and an electroencephalogram (EEG) was recorded. The results revealed that multiple sessions of rTMS can decrease reaction time (RTs) under both congruent and incongruent conditions and also increased the amplitudes of both N2 and N450 compared with sham rTMS. The negative correlations between the mean amplitudes of both N2 and N450 and the RTs were found, however, the latter correlation were restricted to incongruent trials and the correlation was enhanced significantly by rTMS. This observation supports the view that high-frequency rTMS over the left DLPFC can not only recruit more neural resources from the prefrontal cortex by inducing an electrophysiologically excitatory effect but also enhance efficiency of resources to deploy for conflict resolution during multiple stages of cognitive control processing in healthy young people.
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11
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El Arfani A, Parthoens J, Demuyser T, Servaes S, De Coninck M, De Deyn PP, Van Dam D, Wyckhuys T, Baeken C, Smolders I, Staelens S. Accelerated high-frequency repetitive transcranial magnetic stimulation enhances motor activity in rats. Neuroscience 2017; 347:103-110. [DOI: 10.1016/j.neuroscience.2017.01.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 01/23/2017] [Accepted: 01/27/2017] [Indexed: 01/21/2023]
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12
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Deschamps T, Sauvaget A, Pichot A, Valrivière P, Maroulidès M, Bois A, Bulteau S, Thomas-Ollivier V. Posture-cognitive dual-tasking: A relevant marker of depression-related psychomotor retardation. An illustration of the positive impact of repetitive transcranial magnetic stimulation in patients with major depressive disorder. J Psychiatr Res 2016; 83:86-93. [PMID: 27580486 DOI: 10.1016/j.jpsychires.2016.08.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/14/2016] [Accepted: 08/18/2016] [Indexed: 12/28/2022]
Abstract
This study examined whether postural control variables, particularly the center-of-pressure (COP) velocity-based parameters, could be a relevant hallmark of depression-related psychomotor retardation (PMR). We first aimed at investigating the interplay between the PMR scores and the COP performance in patients with major depressive disorder (MDD), as compared to age-matched healthy controls; secondly, we focused on the impact of a repetitive transcranial magnetic stimulation (rTMS) treatment on depression, PMR scores and postural performance. 16 MDD patients, and a control group of 16 healthy adults, were asked to maintain quiet standing balance during two trials with or without vision, and while backward counting (dual task). All the position and velocity-based COP variables were computed. Before and after the rTMS session (n eligible MDD = 10), we assessed the depression level with the Montgomery-Asberg Depression Rating Scale (MADRS), the PMR scores with the French Retardation Rating Scale for Depression (ERD), and postural performance. Before the treatment, significant positive partial correlations were found between the pre-ERD scores and the velocity-based COP variables, especially in the dual-task conditions (p < 0.05). In contrast, there was no significant correlation between the post-ERD scores and any postural parameter after the treatment. The MADRS and ERD scores showed a significant decrease between before and after the rTMS intervention. For the first time, the findings clearly validated the view that the assessment of postural performance - easy to envisage in clinical settings-constitutes a reliable and objective marker of PMR in MDD patients.
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Affiliation(s)
- Thibault Deschamps
- Laboratory "Movement, Interactions, Performance" (E.A. 4334), University of Nantes, France.
| | - Anne Sauvaget
- CHU de Nantes, Service d'Addictologie et Psychiatrie de liaison, France; EA SPHERE 4275 Methods for Patients-centered outcomes and Health Research, University of Nantes, Nantes, France
| | - Anne Pichot
- CHU de Nantes, Service d'Addictologie et Psychiatrie de liaison, France
| | - Pierre Valrivière
- CHU de Nantes, Service d'Addictologie et Psychiatrie de liaison, France
| | - Maxime Maroulidès
- Laboratory "Movement, Interactions, Performance" (E.A. 4334), University of Nantes, France
| | - Aurore Bois
- Laboratory "Movement, Interactions, Performance" (E.A. 4334), University of Nantes, France
| | - Samuel Bulteau
- CHU de Nantes, Service d'Addictologie et Psychiatrie de liaison, France
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13
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Malhi GS, Bassett D, Boyce P, Bryant R, Fitzgerald PB, Fritz K, Hopwood M, Lyndon B, Mulder R, Murray G, Porter R, Singh AB. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry 2015; 49:1087-206. [PMID: 26643054 DOI: 10.1177/0004867415617657] [Citation(s) in RCA: 511] [Impact Index Per Article: 56.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To provide guidance for the management of mood disorders, based on scientific evidence supplemented by expert clinical consensus and formulate recommendations to maximise clinical salience and utility. METHODS Articles and information sourced from search engines including PubMed and EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (MDC) (e.g., books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Information was reviewed and discussed by members of the MDC and findings were then formulated into consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous successive consultation and external review involving: expert and clinical advisors, the public, key stakeholders, professional bodies and specialist groups with interest in mood disorders. RESULTS The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (Mood Disorders CPG) provide up-to-date guidance and advice regarding the management of mood disorders that is informed by evidence and clinical experience. The Mood Disorders CPG is intended for clinical use by psychiatrists, psychologists, physicians and others with an interest in mental health care. CONCLUSIONS The Mood Disorder CPG is the first Clinical Practice Guideline to address both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. MOOD DISORDERS COMMITTEE Professor Gin Malhi (Chair), Professor Darryl Bassett, Professor Philip Boyce, Professor Richard Bryant, Professor Paul Fitzgerald, Dr Kristina Fritz, Professor Malcolm Hopwood, Dr Bill Lyndon, Professor Roger Mulder, Professor Greg Murray, Professor Richard Porter and Associate Professor Ajeet Singh. INTERNATIONAL EXPERT ADVISORS Professor Carlo Altamura, Dr Francesco Colom, Professor Mark George, Professor Guy Goodwin, Professor Roger McIntyre, Dr Roger Ng, Professor John O'Brien, Professor Harold Sackeim, Professor Jan Scott, Dr Nobuhiro Sugiyama, Professor Eduard Vieta, Professor Lakshmi Yatham. AUSTRALIAN AND NEW ZEALAND EXPERT ADVISORS Professor Marie-Paule Austin, Professor Michael Berk, Dr Yulisha Byrow, Professor Helen Christensen, Dr Nick De Felice, A/Professor Seetal Dodd, A/Professor Megan Galbally, Dr Josh Geffen, Professor Philip Hazell, A/Professor David Horgan, A/Professor Felice Jacka, Professor Gordon Johnson, Professor Anthony Jorm, Dr Jon-Paul Khoo, Professor Jayashri Kulkarni, Dr Cameron Lacey, Dr Noeline Latt, Professor Florence Levy, A/Professor Andrew Lewis, Professor Colleen Loo, Dr Thomas Mayze, Dr Linton Meagher, Professor Philip Mitchell, Professor Daniel O'Connor, Dr Nick O'Connor, Dr Tim Outhred, Dr Mark Rowe, Dr Narelle Shadbolt, Dr Martien Snellen, Professor John Tiller, Dr Bill Watkins, Dr Raymond Wu.
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Affiliation(s)
- Gin S Malhi
- Discipline of Psychiatry, Kolling Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Darryl Bassett
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA, Australia School of Medicine, University of Notre Dame, Perth, WA, Australia
| | - Philip Boyce
- Discipline of Psychiatry, Sydney Medical School, Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre (MAPrc), Monash University Central Clinical School and The Alfred, Melbourne, VIC, Australia
| | - Kristina Fritz
- CADE Clinic, Discipline of Psychiatry, Sydney Medical School - Northern, University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Bill Lyndon
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia Mood Disorders Unit, Northside Clinic, Greenwich, NSW, Australia ECT Services Northside Group Hospitals, Greenwich, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - Greg Murray
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Richard Porter
- Department of Psychological Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - Ajeet B Singh
- School of Medicine, Deakin University, Geelong, VIC, Australia
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14
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Sabesan P, Lankappa S, Khalifa N, Krishnan V, Gandhi R, Palaniyappan L. Transcranial magnetic stimulation for geriatric depression: Promises and pitfalls. World J Psychiatry 2015; 5:170-181. [PMID: 26110119 PMCID: PMC4473489 DOI: 10.5498/wjp.v5.i2.170] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 03/04/2015] [Accepted: 04/14/2015] [Indexed: 02/05/2023] Open
Abstract
As the global population gets older, depression in the elderly is emerging as an important health issue. A major challenge in treating geriatric depression is the lack of robust efficacy for many treatments that are of significant benefit to depressed working age adults. Repetitive transcranial magnetic stimulation (rTMS) is a novel physical treatment approach used mostly in working age adults with depression. Many TMS trials and clinics continue to exclude the elderly from treatment citing lack of evidence in this age group. In this review, we appraise the evidence regarding the safety and efficacy of rTMS in the elderly. A consistent observation supporting a high degree of tolerability and safety among the elderly patients emerged across the Randomised Controlled Trials and the uncontrolled trials. Further, there is no reliable evidence negating the utility of rTMS in the elderly with depression. We also identified several factors other than age that moderate the observed variations in the efficacy of rTMS in the elderly. These factors include but not limited to: (1) brain atrophy; (2) intensity and number of pulses (dose-response relationship); and (3) clinical profile of patients. On the basis of the current evidence, the practice of excluding elderly patients from TMS clinics and trials cannot be supported.
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15
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Baeken C, Desmyter S, Duprat R, De Raedt R, Van Denabbeele D, Tandt H, Lemmens GMD, Vervaet M, van Heeringen K. Self-directedness: an indicator for clinical response to the HF-rTMS treatment in refractory melancholic depression. Psychiatry Res 2014; 220:269-74. [PMID: 25175912 DOI: 10.1016/j.psychres.2014.07.084] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 07/27/2014] [Accepted: 07/31/2014] [Indexed: 12/26/2022]
Abstract
Although well-defined predictors of response are still unclear, clinicians refer a variety of depressed patients for a repetitive Transcranial Magnetic Stimulation (rTMS) treatment. It has been suggested that personality features such as Harm Avoidance (HA) and self-directedness (SD) might provide some guidance for a classical antidepressant treatment outcome. However, to date no such research has been performed in rTMS treatment paradigms. In this open study, we wanted to examine whether these temperament and character scores in particular would predict clinical outcome in refractory unipolar depressed patients when a typical high-frequency (HF)-rTMS treatment protocol is applied. Thirty six unipolar right-handed antidepressant-free treatment resistant depressed (TRD) patients, all of the melancholic subtype, received 10 HF-rTMS sessions applied to the left dorsolateral prefrontal cortex (DLPFC). All patients were classified as at least stage III TRD and were assessed with the Temperament and Character Inventory (TCI) before a HF-rTMS treatment. Only the individual scores on SD predicted clinical outcome. No other personality scales were found to be a predictor of this kind of application. Our results suggest that refractory MDD patients who score higher on the character scale SD may be more responsive to the HF-rTMS treatment.
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Affiliation(s)
- Chris Baeken
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Department of Psychiatry University Hospital (UZBrussel), Brussels, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium.
| | - Stefanie Desmyter
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium
| | - Romain Duprat
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium
| | - Rudi De Raedt
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Dirk Van Denabbeele
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Hannelore Tandt
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Gilbert M D Lemmens
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Myriam Vervaet
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Kees van Heeringen
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium
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16
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Qualité de vie liée à la santé dans la dépression après stimulation magnétique transcrânienne basse fréquence. Encephale 2014; 40:74-80. [DOI: 10.1016/j.encep.2013.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 04/04/2013] [Indexed: 12/22/2022]
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17
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Psychomotor retardation in depression: a systematic review of diagnostic, pathophysiologic, and therapeutic implications. BIOMED RESEARCH INTERNATIONAL 2013. [PMID: 24286073 DOI: 10.1155/2013/158746.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Psychomotor retardation is a central feature of depression which includes motor and cognitive impairments. Effective management may be useful to improve the classification of depressive subtypes and treatment selection, as well as prediction of outcome in patients with depression. The aim of this paper was to review the current status of knowledge regarding psychomotor retardation in depression, in order to clarify its role in the diagnostic management of mood disorders. Retardation modifies all the actions of the individual, including motility, mental activity, and speech. Objective assessments can highlight the diagnostic importance of psychomotor retardation, especially in melancholic and bipolar depression. Psychomotor retardation is also related to depression severity and therapeutic change and could be considered a good criterion for the prediction of therapeutic effect. The neurobiological process underlying the inhibition of activity includes functional deficits in the prefrontal cortex and abnormalities in dopamine neurotransmission. Future investigations of psychomotor retardation should help improve the understanding of the pathophysiological mechanisms underlying mood disorders and contribute to improving their therapeutic management.
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18
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Psychomotor retardation in depression: a systematic review of diagnostic, pathophysiologic, and therapeutic implications. BIOMED RESEARCH INTERNATIONAL 2013; 2013:158746. [PMID: 24286073 PMCID: PMC3830759 DOI: 10.1155/2013/158746] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 07/26/2013] [Accepted: 08/26/2013] [Indexed: 11/23/2022]
Abstract
Psychomotor retardation is a central feature of depression which includes motor and cognitive impairments. Effective management may be useful to improve the classification of depressive subtypes and treatment selection, as well as prediction of outcome in patients with depression. The aim of this paper was to review the current status of knowledge regarding psychomotor retardation in depression, in order to clarify its role in the diagnostic management of mood disorders. Retardation modifies all the actions of the individual, including motility, mental activity, and speech. Objective assessments can highlight the diagnostic importance of psychomotor retardation, especially in melancholic and bipolar depression. Psychomotor retardation is also related to depression severity and therapeutic change and could be considered a good criterion for the prediction of therapeutic effect. The neurobiological process underlying the inhibition of activity includes functional deficits in the prefrontal cortex and abnormalities in dopamine neurotransmission. Future investigations of psychomotor retardation should help improve the understanding of the pathophysiological mechanisms underlying mood disorders and contribute to improving their therapeutic management.
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19
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Schrijvers DL, Baeken C, De Raedt R, Sabbe BGC. The impact of high-frequency repetitive transcranial magnetic stimulation on fine motor functions in medication-resistant major depression. Neuropsychobiology 2013; 66:252-8. [PMID: 23095489 DOI: 10.1159/000341881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 07/16/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Although high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) over the left dorsolateral prefrontal cortex (DLPFC) has been reported to improve mood symptoms in major depressive disorder (MDD), research on its impact on psychomotor symptoms is scarce. This study assessed the psychomotor effects of 1 and 10 sessions, respectively, of HF-rTMS over the left DLPFC. METHODS Ten HF-rTMS sessions were applied in 21 medication-free MDD patients over a 2-week period. At the beginning, one placebo (sham)-controlled rTMS session was also applied in a cross-over, single-blind design. Psychomotor variables were digitally recorded during completion of a Fitts' task, at baseline, after the first and second real/sham session and at the end point. RESULTS The total 10-session treatment period resulted in a decrease of depression severity. One HF-rTMS session resulted in improvements on the Fitts' task, without a difference between active and sham stimulation, however. No further improvements occurred from session 2 to session 10. CONCLUSIONS No evidence was provided to link the observed psychomotor improvements to HF-rTMS stimulation, as a practice effect could have impacted the significant psychomotor outcomes.
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Affiliation(s)
- Didier L Schrijvers
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Faculty of Medicine and Health Sciences, Antwerp, Belgium.
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20
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Ullrich H, Kranaster L, Sigges E, Andrich J, Sartorius A. Ultra-high-frequency left prefrontal transcranial magnetic stimulation as augmentation in severely ill patients with depression: a naturalistic sham-controlled, double-blind, randomized trial. Neuropsychobiology 2013; 66:141-8. [PMID: 22948250 DOI: 10.1159/000339561] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 05/21/2012] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND AIM Repetitive transcranial magnetic stimulation (rTMS) is supposed to be not as effective in severe depression as it is in medium depression. We evaluated the treatment response to an ultra-high-frequency (UHF; 30 Hz) approach, which was used to maximize the rTMS efficacy in severely ill patients. METHODS 43 severely depressed patients were included in the randomized, double-blind study and received either rTMS with 30 Hz over the left dorsolateral prefrontal cortex or sham condition for 3 weeks as an add-on therapy to stable antidepressant medication. Hamilton Depression Rating Scale (HDRS) and cognitive performance were evaluated before and after the intervention. RESULTS In the active UHF group, the HRDS score was reduced by about 7.2, whereas the sham condition showed a smaller reduction of the HDRS score with 3.9. However, lithium as a covariant was responsible for the outcome difference, not the group of stimulation. No adverse events were reported. Comparing the differences of both groups in the pre- and post-study performance in a trail-making test, a group effect for the UHF group that was not influenced by the lithium intake was observed. CONCLUSION A 30-Hz left prefrontal rTMS in severely depressed patients was safe and no adverse events occurred. Due to a strong effect of lithium as a covariate, we could not demonstrate favorable antidepressant effects of the UHF stimulation compared to sham. However, we found an improvement of processing speed performance in the UHF group, which covaried with improvement of psychomotor retardation.
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Affiliation(s)
- Heiko Ullrich
- Department of Psychiatry and Psychotherapy, Kreisklinikum Siegen GmbH, Siegen, Germany
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21
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Baeken C, Schrijvers DL, Sabbe BGC, Vanderhasselt MA, De Raedt R. Impact of one HF-rTMS session on fine motor function in right-handed healthy female subjects: a comparison of stimulation over the left versus the right dorsolateral prefrontal cortex. Neuropsychobiology 2012; 65:96-102. [PMID: 22261613 DOI: 10.1159/000329699] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 05/30/2011] [Indexed: 12/20/2022]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive tool to investigate neural conduction in motor processes. Most rTMS research has been conducted by targeting the primary motor cortex. Several studies have also found increased psychomotor speed after rTMS of the dorsolateral prefrontal cortex (DLPFC). However, these studies were mainly performed in psychiatric patients, only targeting the left DLPFC, and often without sham control. Moreover, psychomotor speed is mostly measured based on tasks that also require higher executive functions. METHODS Here, we examined the lateralized effect of one sham-controlled high-frequency rTMS session applied to the left or right DLPFC on fine motor function in 36 healthy right-handed females, using the Fitts' paradigm. RESULTS We found a significant improvement in psychomotor speed only after actively stimulating the right DLPFC. CONCLUSION Our results support the assumption of a right prefrontal neural network implicated in visuomotor behavior and performance processes, and that the improvement in psychomotor speed is not a secondary effect of decreased mood.
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Affiliation(s)
- C Baeken
- Department of Psychiatry, University Hospital (UZ Brussel), Vrije Universiteit Brussel, Brussels, Belgium.
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Minichino A, Bersani FS, Capra E, Pannese R, Bonanno C, Salviati M, Delle Chiaie R, Biondi M. ECT, rTMS, and deepTMS in pharmacoresistant drug-free patients with unipolar depression: a comparative review. Neuropsychiatr Dis Treat 2012; 8:55-64. [PMID: 22347797 PMCID: PMC3280107 DOI: 10.2147/ndt.s27025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Biological treatments are considered as additional options for the treatment of resistant unipolar depression. Controversial data exist about the efficacy and tolerability of three of the most used somatic treatments: electroconvulsive therapy (ECT), transcranial magnetic stimulation (rTMS), and deep transcranial magnetic stimulation (deepTMS). The aim of this review is to investigate and compare the efficacy and tolerability of these three techniques in drug-free patients with pharmacoresistant unipolar depression. METHODS Three independent reviewers extracted data and assessed the quality of methodological reporting of selected studies. The first outcome was the clinical response to the three different techniques defined as a percentage improvement of Hamilton Depression Rating Scale (HDRS). The second outcome was the evaluation of their neuropsychological effects. The third outcome was the evaluation of the number of remitted patients; remission was defined as an absolute HDRS-24 score of ≤11 or as an absolute HDRS-17 score of ≤8. Tolerability was the fourth outcome; it was evaluated by examining the number of dropped-out patients. RESULTS The comparative evaluation of HDRS percentage variations shows ECT as the most effective method after 4 weeks of therapy; on the other hand, a better efficacy is obtainable by deepTMS after 2 weeks of therapy. DeepTMS is the technique that gives the best improvement of cognitive performances. The percentage of remitted patients obtained with ECT treatment is the same obtained in the deepTMS group. Both techniques have a remitted patients percentage two times larger than the rTMS. DeepTMS shows a tolerability, measured by the number of dropped-out patients, worse than ECT. CONCLUSION Our investigation confirms the great therapeutic power of ECT. DeepTMS seems to be the only therapy that provides a substantial improvement of both depressive symptoms and cognitive performances; nevertheless it is characterized by a poor tolerability. rTMS seems to provide a better tolerability for patients, but its therapeutic efficacy is lower. Considering the small therapeutic efficacy of deepTMS in the last 2 weeks of treatment, it could be reasonable to shorten the standard period of deepTMS treatment from 4 to 2 weeks, expecting a reduction of dropped-out patients and thus optimizing the treatment outcome.
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Affiliation(s)
- Amedeo Minichino
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
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Abstract
PURPOSE OF REVIEW The key question for melancholia is whether it should have status as a separate disorder and the literature of the last 12-24 months is surveyed largely from that perspective. RECENT FINDINGS A number of interesting findings have appeared across a broad range of issues, but, with the possible exception of some large clinical trials, remain largely unreplicated. SUMMARY Supporters of melancholia as a distinct entity will find little comfort in the recent literature.
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Rizvi SJ, Kennedy SH. The keys to improving depression outcomes. Eur Neuropsychopharmacol 2011; 21 Suppl 4:S694-702. [PMID: 21924209 DOI: 10.1016/j.euroneuro.2011.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 06/27/2011] [Accepted: 07/04/2011] [Indexed: 01/28/2023]
Abstract
The heterogeneity of symptoms within major depressive disorder poses significant challenges for treatment and it is likely that current pharmacotherapies do not target all symptoms equally, although they have similar efficacy rates. While there is still continuing interest in understanding monoamine interactions and consequent downstream effects, the limited efficacy and tolerability achieved with classical antidepressants provides a compelling argument to move beyond the monoamines. Several lines of biological research in depression exploring immune function, neurotrophins, amino acid and neuropeptide neurotransmitters, neuroanatomical function and circadian rhythms, may lead to novel therapeutic targets and enhance depression outcomes. This review will evaluate the evidence for emerging treatments as well as recommendations from current international guidelines regarding antidepressant management.
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Affiliation(s)
- Sakina J Rizvi
- Department of Pharmaceutical Sciences and Neuroscience, University of Toronto, Toronto, Ontario Canada
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Baeken C, De Raedt R. Neurobiological mechanisms of repetitive transcranial magnetic stimulation on the underlying neurocircuitry in unipolar depression. DIALOGUES IN CLINICAL NEUROSCIENCE 2011. [PMID: 21485753 PMCID: PMC3181968 DOI: 10.31887/dcns.2011.13.1/cbaeken] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
For nearly two decades now, transcranial magnetic stimulation (TMS) has been available as a noninvasive clinical tool to treat patients suffering from major depression. In this period, a bulk of animal and human studies examined TMS parameters to improve clinical outcome. However, the neurobiological mechanisms underlying mood changes remain an important focus of research. In addition to having an effect on neuroendocrinological processes, neurotransmitter systems, and neurotrophic factors, TMS may not only affect the stimulated cortical regions, but also those connected to them. Therefore, we will review current human data on possible neurobiological mechanisms of repetitive (r) TMS implicated in the deregulated neurocircuitry present in unipolar depression. Furthermore, as the rTMS application can be considered as a “top-down” neuronal intervention, we will focus on the neuronal pathways linked with the stimulated area and we will present an integrative model of action.
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Affiliation(s)
- Chris Baeken
- Department of Psychiatry and Center for Neurosciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
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Buyukdura JS, McClintock SM, Croarkin PE. Psychomotor retardation in depression: biological underpinnings, measurement, and treatment. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:395-409. [PMID: 21044654 PMCID: PMC3646325 DOI: 10.1016/j.pnpbp.2010.10.019] [Citation(s) in RCA: 217] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 10/05/2010] [Accepted: 10/25/2010] [Indexed: 01/09/2023]
Abstract
Psychomotor retardation is a long established component of depression that can have significant clinical and therapeutic implications for treatment. Due to its negative impact on overall function in depressed patients, we review its biological correlates, optimal methods of measurement, and relevance in the context of therapeutic interventions. The aim of the paper is to provide a synthesis of the literature on psychomotor retardation in depression with the goal of enhanced awareness for clinicians and researchers. Increased knowledge and understanding of psychomotor retardation in major depressive disorder may lead to further research and better informed diagnosis in regards to psychomotor retardation. Manifestations of psychomotor retardation include slowed speech, decreased movement, and impaired cognitive function. It is common in patients with melancholic depression and those with psychotic features. Biological correlates may include abnormalities in the basal ganglia and dopaminergic pathways. Neurophysiologic tools such as neuroimaging and transcranial magnetic stimulation may play a role in the study of this symptom in the future. At present, there are three objective scales to evaluate psychomotor retardation severity. Studies examining the impact of psychomotor retardation on clinical outcome have found differential results. However, available evidence suggests that depressed patients with psychomotor retardation may respond well to electroconvulsive therapy (ECT). Current literature regarding antidepressants is inconclusive, though tricyclic antidepressants may be considered for treatment of patients with psychomotor retardation. Future work examining this objective aspect of major depressive disorder (MDD) is essential. This could further elucidate the biological underpinnings of depression and optimize its treatment.
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Affiliation(s)
- Jeylan S. Buyukdura
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shawn M. McClintock
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Division of Brain Stimulation and Therapeutic Modulation, Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York, USA
| | - Paul E. Croarkin
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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