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Prompiengchai S, Dunlop K. Breakthroughs and challenges for generating brain network-based biomarkers of treatment response in depression. Neuropsychopharmacology 2024:10.1038/s41386-024-01907-1. [PMID: 38951585 DOI: 10.1038/s41386-024-01907-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/17/2024] [Accepted: 06/13/2024] [Indexed: 07/03/2024]
Abstract
Treatment outcomes widely vary for individuals diagnosed with major depressive disorder, implicating a need for deeper understanding of the biological mechanisms conferring a greater likelihood of response to a particular treatment. Our improved understanding of intrinsic brain networks underlying depression psychopathology via magnetic resonance imaging and other neuroimaging modalities has helped reveal novel and potentially clinically meaningful biological markers of response. And while we have made considerable progress in identifying such biomarkers over the last decade, particularly with larger, multisite trials, there are significant methodological and practical obstacles that need to be overcome to translate these markers into the clinic. The aim of this review is to review current literature on brain network structural and functional biomarkers of treatment response or selection in depression, with a specific focus on recent large, multisite trials reporting predictive accuracy of candidate biomarkers. Regarding pharmaco- and psychotherapy, we discuss candidate biomarkers, reporting that while we have identified candidate biomarkers of response to a single intervention, we need more trials that distinguish biomarkers between first-line treatments. Further, we discuss the ways prognostic neuroimaging may help to improve treatment outcomes to neuromodulation-based therapies, such as transcranial magnetic stimulation and deep brain stimulation. Lastly, we highlight obstacles and technical developments that may help to address the knowledge gaps in this area of research. Ultimately, integrating neuroimaging-derived biomarkers into clinical practice holds promise for enhancing treatment outcomes and advancing precision psychiatry strategies for depression management. By elucidating the neural predictors of treatment response and selection, we can move towards more individualized and effective depression interventions, ultimately improving patient outcomes and quality of life.
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Affiliation(s)
| | - Katharine Dunlop
- Centre for Depression and Suicide Studies, Unity Health Toronto, Toronto, ON, Canada.
- Keenan Research Centre for Biomedical Science, Unity Health Toronto, Toronto, ON, Canada.
- Department of Psychiatry and Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
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2
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Jin MX, Qin PP, Xia AWL, Kan RLD, Zhang BBB, Tang AHP, Li ASM, Lin TTZ, Giron CG, Pei JJ, Kranz GS. Neurophysiological and neuroimaging markers of repetitive transcranial magnetic stimulation treatment response in major depressive disorder: A systematic review and meta-analysis of predictive modeling studies. Neurosci Biobehav Rev 2024; 162:105695. [PMID: 38710424 DOI: 10.1016/j.neubiorev.2024.105695] [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: 10/26/2023] [Revised: 04/10/2024] [Accepted: 04/26/2024] [Indexed: 05/08/2024]
Abstract
Predicting repetitive transcranial magnetic stimulation (rTMS) treatment outcomes in major depressive disorder (MDD) could reduce the financial and psychological risks of treatment failure. We systematically reviewed and meta-analyzed studies that leveraged neurophysiological and neuroimaging markers to predict rTMS response in MDD. Five databases were searched from inception to May 25, 2023. The primary meta-analytic outcome was predictive accuracy pooled from classification models. Regression models were summarized qualitatively. A promising marker was identified if it showed a sensitivity and specificity of 80% or higher in at least two independent studies. Searching yielded 36 studies. Twenty-two classification modeling studies produced an estimated area under the summary receiver operating characteristic curve of 0.87 (95% CI = 0.83-0.92), with 86.8% sensitivity (95% CI = 80.6-91.2%) and 81.9% specificity (95% CI = 76.1-86.4%). Frontal theta cordance measured by electroencephalography is closest to proof of concept. Predicting rTMS response using neurophysiological and neuroimaging markers is promising for clinical decision-making. However, replications by different research groups are needed to establish rigorous markers.
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Affiliation(s)
- Min Xia Jin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Special Administrative Region of China; Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Penny Ping Qin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Special Administrative Region of China
| | - Adam Wei Li Xia
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Special Administrative Region of China
| | - Rebecca Lai Di Kan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Special Administrative Region of China
| | - Bella Bing Bing Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Special Administrative Region of China
| | - Alvin Hong Pui Tang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Special Administrative Region of China
| | - Ami Sin Man Li
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Special Administrative Region of China
| | - Tim Tian Ze Lin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Special Administrative Region of China
| | - Cristian G Giron
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Special Administrative Region of China
| | - Jun Jie Pei
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, China
| | - Georg S Kranz
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Special Administrative Region of China; Mental Health Research Center, The Hong Kong Polytechnic University, Hong Kong, Special Administrative Region of China; Department of Psychiatry and Psychotherapy, Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Austria.
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3
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Ge R, Ching CRK, Bassett AS, Kushan L, Antshel KM, van Amelsvoort T, Bakker G, Butcher NJ, Campbell LE, Chow EWC, Craig M, Crossley NA, Cunningham A, Daly E, Doherty JL, Durdle CA, Emanuel BS, Fiksinski A, Forsyth JK, Fremont W, Goodrich‐Hunsaker NJ, Gudbrandsen M, Gur RE, Jalbrzikowski M, Kates WR, Lin A, Linden DEJ, McCabe KL, McDonald‐McGinn D, Moss H, Murphy DG, Murphy KC, Owen MJ, Villalon‐Reina JE, Repetto GM, Roalf DR, Ruparel K, Schmitt JE, Schuite‐Koops S, Angkustsiri K, Sun D, Vajdi A, van den Bree M, Vorstman J, Thompson PM, Vila‐Rodriguez F, Bearden CE. Source-based morphometry reveals structural brain pattern abnormalities in 22q11.2 deletion syndrome. Hum Brain Mapp 2024; 45:e26553. [PMID: 38224541 PMCID: PMC10785196 DOI: 10.1002/hbm.26553] [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: 05/31/2023] [Revised: 11/12/2023] [Accepted: 11/19/2023] [Indexed: 01/17/2024] Open
Abstract
22q11.2 deletion syndrome (22q11DS) is the most frequently occurring microdeletion in humans. It is associated with a significant impact on brain structure, including prominent reductions in gray matter volume (GMV), and neuropsychiatric manifestations, including cognitive impairment and psychosis. It is unclear whether GMV alterations in 22q11DS occur according to distinct structural patterns. Then, 783 participants (470 with 22q11DS: 51% females, mean age [SD] 18.2 [9.2]; and 313 typically developing [TD] controls: 46% females, mean age 18.0 [8.6]) from 13 datasets were included in the present study. We segmented structural T1-weighted brain MRI scans and extracted GMV images, which were then utilized in a novel source-based morphometry (SBM) pipeline (SS-Detect) to generate structural brain patterns (SBPs) that capture co-varying GMV. We investigated the impact of the 22q11.2 deletion, deletion size, intelligence quotient, and psychosis on the SBPs. Seventeen GMV-SBPs were derived, which provided spatial patterns of GMV covariance associated with a quantitative metric (i.e., loading score) for analysis. Patterns of topographically widespread differences in GMV covariance, including the cerebellum, discriminated individuals with 22q11DS from healthy controls. The spatial extents of the SBPs that revealed disparities between individuals with 22q11DS and controls were consistent with the findings of the univariate voxel-based morphometry analysis. Larger deletion size was associated with significantly lower GMV in frontal and occipital SBPs; however, history of psychosis did not show a strong relationship with these covariance patterns. 22q11DS is associated with distinct structural abnormalities captured by topographical GMV covariance patterns that include the cerebellum. Findings indicate that structural anomalies in 22q11DS manifest in a nonrandom manner and in distinct covarying anatomical patterns, rather than a diffuse global process. These SBP abnormalities converge with previously reported cortical surface area abnormalities, suggesting disturbances of early neurodevelopment as the most likely underlying mechanism.
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Affiliation(s)
- Ruiyang Ge
- Department of PsychiatryUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Djavad Mowafaghian Centre for Brain HealthUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | | | - Anne S. Bassett
- Clinical Genetics Research ProgramCentre for Addiction and Mental HealthTorontoOntarioCanada
- The Dalglish Family 22q Clinic, Department of Psychiatry and Division of Cardiology, Department of Medicine, and Toronto General Hospital Research InstituteUniversity Health NetworkTorontoOntarioCanada
- Campbell Family Mental Health Research InstituteCentre for Addiction and Mental HealthTorontoOntarioCanada
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | - Leila Kushan
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human BehaviorUniversity of California, Los AngelesLos AngelesCaliforniaUSA
| | | | | | - Geor Bakker
- Department of Psychiatry and NeuropsychologyMaastricht UniversityMaastrichtNetherlands
| | - Nancy J. Butcher
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
- Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoOntarioCanada
| | | | - Eva W. C. Chow
- Clinical Genetics Research ProgramCentre for Addiction and Mental HealthTorontoOntarioCanada
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | - Michael Craig
- Sackler Institute for Translational Neurodevelopment and Department of Forensic and Neurodevelopmental Sciences, King's College LondonInstitute of Psychiatry, Psychology and NeuroscienceLondonUK
- National Autism UnitBethlem Royal HospitalBeckenhamUK
| | - Nicolas A. Crossley
- Department of PsychiatryPontificia Universidad Catolica de ChileSantiagoChile
| | - Adam Cunningham
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical NeurosciencesCardiff UniversityCardiffUK
| | - Eileen Daly
- Sackler Institute for Translational Neurodevelopment and Department of Forensic and Neurodevelopmental Sciences, King's College LondonInstitute of Psychiatry, Psychology and NeuroscienceLondonUK
| | - Joanne L. Doherty
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical NeurosciencesCardiff UniversityCardiffUK
- Cardiff University Brain Research Imaging Centre, School of PsychologyCardiff UniversityCardiffUK
| | - Courtney A. Durdle
- Department of PediatricsUC Davis MIND InstituteDavisCaliforniaUSA
- Department of Psychological and Brain SciencesUC Santa BarbaraSanta BarbaraCaliforniaUSA
| | - Beverly S. Emanuel
- Division of Human GeneticsThe Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of Pediatrics, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Ania Fiksinski
- Department of Psychology and Department of Pediatrics, Wilhelmina Children's HospitalUniversity Medical Center UtrechtUtrechtNetherlands
- Department of Psychiatry and Neuropsychology, Division of Mental Health, MHeNSMaastricht UniversityMaastrichtNetherlands
| | - Jennifer K. Forsyth
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human BehaviorUniversity of California, Los AngelesLos AngelesCaliforniaUSA
- Department of PsychologyUniversity of WashingtonSeattleWashingtonUSA
| | - Wanda Fremont
- Department of Psychiatry and Behavioral Sciences State University of New YorkUpstate Medical University SyracuseNew YorkUSA
| | - Naomi J. Goodrich‐Hunsaker
- Department of PediatricsUC Davis MIND InstituteDavisCaliforniaUSA
- Department of NeurologyUniversity of UtahSalt Lake CityUtahUSA
| | - Maria Gudbrandsen
- Sackler Institute for Translational Neurodevelopment and Department of Forensic and Neurodevelopmental Sciences, King's College LondonInstitute of Psychiatry, Psychology and NeuroscienceLondonUK
- Centre for Research in Psychological Wellbeing (CREW), School of PsychologyUniversity of RoehamptonLondonUK
| | - Raquel E. Gur
- Department of Psychiatry, Perelman School of MedicineUniversity of Pennsylvania and Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Maria Jalbrzikowski
- Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA
- Department of Psychiatry and Behavioral SciencesBoston Children's HospitalBostonMassachusettsUSA
| | - Wendy R. Kates
- Department of Psychiatry and Behavioral Sciences State University of New YorkUpstate Medical University SyracuseNew YorkUSA
| | - Amy Lin
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human BehaviorUniversity of California, Los AngelesLos AngelesCaliforniaUSA
- Graduate Interdepartmental Program in NeuroscienceUCLA School of MedicineLos AngelesCaliforniaUSA
| | - David E. J. Linden
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical NeurosciencesCardiff UniversityCardiffUK
| | - Kathryn L. McCabe
- School of PsychologyUniversity of NewcastleCallaghanAustralia
- Department of PediatricsUC Davis MIND InstituteDavisCaliforniaUSA
| | - Donna McDonald‐McGinn
- Department of Pediatrics, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- 22q and You Center, Clinical Genetics Center, and Division of Human GeneticsThe Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of Human Biology and Medical GeneticsSapienza UniversityRomeItaly
| | - Hayley Moss
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical NeurosciencesCardiff UniversityCardiffUK
| | - Declan G. Murphy
- Sackler Institute for Translational Neurodevelopment and Department of Forensic and Neurodevelopmental Sciences, King's College LondonInstitute of Psychiatry, Psychology and NeuroscienceLondonUK
- Behavioural Genetics Clinic, Adult Autism Service, Behavioural and Developmental Psychiatry Clinical Academic GroupSouth London and Maudsley Foundation NHS TrustLondonUK
| | - Kieran C. Murphy
- Department of PsychiatryRoyal College of Surgeons in IrelandDublinIreland
| | - Michael J. Owen
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical NeurosciencesCardiff UniversityCardiffUK
| | | | - Gabriela M. Repetto
- Centro de Genetica y Genomica, Facultad de MedicinaClinica Alemana Universidad del DesarrolloSantiagoChile
| | - David R. Roalf
- Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Kosha Ruparel
- Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - J. Eric Schmitt
- Department of Radiology and PsychiatryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Sanne Schuite‐Koops
- Department of PsychiatryUniversity Medical Center Groningen, Rijksuniversiteit GroningenGroningenNetherlands
| | | | - Daqiang Sun
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human BehaviorUniversity of California, Los AngelesLos AngelesCaliforniaUSA
| | - Ariana Vajdi
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human BehaviorUniversity of California, Los AngelesLos AngelesCaliforniaUSA
- Kaiser Permanente Bernard J. Tyson School of Medicine PasadenaCaliforniaUSA
| | - Marianne van den Bree
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical NeurosciencesCardiff UniversityCardiffUK
| | - Jacob Vorstman
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
- Program in Genetics and Genome Biology, Research Institute, and Department of PsychiatryThe Hospital for Sick ChildrenTorontoOntarioCanada
| | - Paul M. Thompson
- Departments of Neurology, Psychiatry, Radiology, Engineering, Pediatrics and OphthalmologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Fidel Vila‐Rodriguez
- Department of PsychiatryUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Djavad Mowafaghian Centre for Brain HealthUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- School of Biomedical Engineering University of British Columbia VancouverBritish ColumbiaCanada
| | - Carrie E. Bearden
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human BehaviorUniversity of California, Los AngelesLos AngelesCaliforniaUSA
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4
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Schiller CE, Walsh E, Eisenlohr-Moul TA, Prim J, Dichter GS, Schiff L, Bizzell J, Slightom SL, Richardson EC, Belger A, Schmidt P, Rubinow DR. Effects of gonadal steroids on reward circuitry function and anhedonia in women with a history of postpartum depression. J Affect Disord 2022; 314:176-184. [PMID: 35777494 PMCID: PMC9605402 DOI: 10.1016/j.jad.2022.06.078] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/25/2022] [Accepted: 06/23/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Reward system dysfunction is evident across neuropsychiatric conditions. Here we present data from a double-blinded pharmaco-fMRI study investigating the triggering of anhedonia and reward circuit activity in women. METHODS The hormonal states of pregnancy and parturition were simulated in euthymic women with a history of postpartum depression (PPD+; n = 15) and those without such a history (PPD-; n = 15) by inducing hypogonadism, adding back estradiol and progesterone for 8 weeks ("addback"), and then withdrawing both steroids ("withdrawal"). Anhedonia was assessed using the Inventory of Depression and Anxiety Symptoms (IDAS) during each hormone phase. Those who reported a 30 % or greater increase in IDAS anhedonia, dysphoria, or ill temper during addback or withdrawal, compared with pre-treatment, were identified as hormone sensitive (HS+) and all others were identified as non-hormone sensitive (HS-). The monetary incentive delay (MID) task was administered during fMRI sessions at pre-treatment and during hormone withdrawal to assess brain activation during reward anticipation and feedback. RESULTS On average, anhedonia increased during addback and withdrawal in PPD+ but not PPD-. During reward feedback, both HS+ (n = 10) and HS- (n = 18) showed decreased activation in clusters in the right putamen (p < .031, FWE-corrected) and left postcentral and supramarginal gyri (p < .014, FWE-corrected) at the withdrawal scans, relative to pre-treatment scans. LIMITATIONS A modest sample size, stringent exclusion criteria, and relative lack of diversity in study participants limit the generalizability of results. CONCLUSION Although results do not explain differential hormone sensitivity in depression, they demonstrate significant effects of reproductive hormones on reward-related brain function in women.
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Affiliation(s)
- C E Schiller
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, United States of America.
| | - E Walsh
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, United States of America
| | - T A Eisenlohr-Moul
- Department of Psychiatry, University of Illinois at Chicago, United States of America
| | - J Prim
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, United States of America
| | - G S Dichter
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, United States of America
| | - L Schiff
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, United States of America
| | - J Bizzell
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, United States of America
| | - S L Slightom
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, United States of America
| | | | - A Belger
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, United States of America
| | - P Schmidt
- National Institute of Mental Health, Behavioral Endocrinology Branch, United States of America
| | - D R Rubinow
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, United States of America
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Wei L, Zhang Y, Wang J, Xu L, Yang K, Lv X, Zhu Z, Gong Q, Hu W, Li X, Qian M, Shen Y, Chen W. Parietal-hippocampal rTMS improves cognitive function in Alzheimer's disease and increases dynamic functional connectivity of default mode network. Psychiatry Res 2022; 315:114721. [PMID: 35839637 DOI: 10.1016/j.psychres.2022.114721] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 11/26/2022]
Abstract
Parietal-hippocampal repetitive transcranial magnetic stimulation (rTMS) improves cognitive function in Alzheimer's disease (AD), however, the underlying therapeutic mechanism has not been elucidated. A double-blind, randomized, sham-controlled parietal-hippocampal rTMS trial (five sessions/week for a total of 10 sessions) of mild-to-moderate AD patients was conducted in the study. High-frequency rTMS was applied to a subject-specific left lateral parietal region with the highest functional connectivity with the hippocampus based on resting-state fMRI. A multimodal MRI scan and a complete neuropsychological battery of tests were conducted at baseline, immediately after the intervention and 12-week follow-up after the rTMS treatment. Compared to sham treatment (n = 27), patients undergoing active rTMS treatment (n = 29) showed higher Mini Mental State Examination (MMSE) score and dynamic functional connectivity (dFC) magnitude of the default mode network (DMN) after two weeks of rTMS treatment, but not at 12-week follow-up. A significant positive correlation was observed between changes in MMSE and changes in the dFC magnitude of DMN in patients who underwent active-rTMS treatment, but not in those who received sham-rTMS treatment. The findings of the current study indicate that fMRI-guided rTMS treatment improves cognitive function of AD patients in the short term, and DMN functional connectivity contributes to therapeutic effectiveness of rTMS.
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Affiliation(s)
- Lili Wei
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, East Qingchun Road 3#, Hangzhou, Zhejiang 310016, China
| | - Yingchun Zhang
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, East Qingchun Road 3#, Hangzhou, Zhejiang 310016, China
| | - Jintao Wang
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, East Qingchun Road 3#, Hangzhou, Zhejiang 310016, China
| | - Luoyi Xu
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, East Qingchun Road 3#, Hangzhou, Zhejiang 310016, China
| | - Kehua Yang
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, East Qingchun Road 3#, Hangzhou, Zhejiang 310016, China
| | - Xinghui Lv
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, East Qingchun Road 3#, Hangzhou, Zhejiang 310016, China
| | - Zhenwei Zhu
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, East Qingchun Road 3#, Hangzhou, Zhejiang 310016, China
| | - Qian Gong
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, East Qingchun Road 3#, Hangzhou, Zhejiang 310016, China
| | - Weiming Hu
- Third People's Hospital of Quzhou, Quzhou, Zhejiang 324003, China
| | - Xia Li
- Shanghai Mental Health Center, Shanghai 200030, China
| | - Mincai Qian
- Third People's Hospital of Huzhou, Huzhou, Zhejiang 313002, China.
| | - Yuedi Shen
- Hangzhou Normal University School of Medicine, Hangzhou, Zhejiang 311121, China.
| | - Wei Chen
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, East Qingchun Road 3#, Hangzhou, Zhejiang 310016, China; Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou 310007, China; Key Laboratory of Medical Neurobiology of Zhejiang Province, Hangzhou 310016, China.
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6
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Gregory EC, Torres IJ, Blumberger DM, Downar J, Daskalakis ZJ, Vila-Rodriguez F. Repetitive Transcranial Magnetic Stimulation Shows Longitudinal Improvements in Memory in Patients With Treatment-Resistant Depression. Neuromodulation 2022; 25:596-605. [DOI: 10.1016/j.neurom.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/27/2021] [Accepted: 09/13/2021] [Indexed: 10/19/2022]
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Large-scale structural network change correlates with clinical response to rTMS in depression. Neuropsychopharmacology 2022; 47:1096-1105. [PMID: 35110687 PMCID: PMC8938539 DOI: 10.1038/s41386-021-01256-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/06/2021] [Accepted: 12/13/2021] [Indexed: 12/12/2022]
Abstract
Response to repetitive transcranial magnetic stimulation (rTMS) among individuals with major depressive disorder (MDD) varies widely. The neural mechanisms underlying rTMS are thought to involve changes in large-scale networks. Whether structural network integrity and plasticity are associated with response to rTMS therapy is unclear. Structural MRIs were acquired from a series of 70 adult healthy controls and 268 persons with MDD who participated in two arms of a large randomized, non-inferiority trial, THREE-D, comparing intermittent theta-burst stimulation to high-frequency rTMS of the left dorsolateral prefrontal cortex (DLPFC). Patients were grouped according to percentage improvement on the 17-item Hamilton Depression Rating Score at treatment completion. For the entire sample and then for each treatment arm, multivariate analyses were used to characterize structural covariance networks (SCN) from cortical gray matter thickness, volume, and surface area maps from T1-weighted MRI. The association between SCNs and clinical improvement was assessed. For both study arms, cortical thickness and volume SCNs distinguished healthy controls from MDD (p = 0.005); however, post-hoc analyses did not reveal a significant association between pre-treatment SCN expression and clinical improvement. We also isolated an anticorrelated SCN between the left DLPFC rTMS target site and the subgenual anterior cingulate cortex across cortical measures (p = 0.0004). Post-treatment change in cortical thickness SCN architecture was associated with clinical improvement in treatment responders (p = 0.001), but not in non-responders. Structural network changes may underpin clinical response to rTMS, and SCNs are useful for understanding the pathophysiology of depression and neural mechanisms of plasticity and response to circuit-based treatments.
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8
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Godfrey KEM, Muthukumaraswamy SD, Stinear CM, Hoeh N. Decreased salience network fMRI functional connectivity following a course of rTMS for treatment-resistant depression. J Affect Disord 2022; 300:235-242. [PMID: 34986371 DOI: 10.1016/j.jad.2021.12.129] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/08/2021] [Accepted: 12/30/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is a treatment shown to be effective in treating major depressive disorder (MDD). However, the effect of rTMS therapy on functional connectivity within the brains of patients being treated for MDD remains poorly understood. Few studies have investigated the effects of a course of rTMS on resting-state network activity. METHODS In an open-label naturalistic study, resting-state fMRI was collected prior to and following a four-week course of rTMS in 24 participants with MDD and 2 with bipolar disorder. Montgomery-Asberg depression rating scale scores showed a response rate of 42%. RESULTS Clinical response to rTMS was correlated with reduced functional connectivity from baseline to post-rTMS within the salience network (SN). This indicates SN connectivity may be functionally relevant to how rTMS produces antidepressant effects. In an exploratory inter-network analysis, connectivity between the SN and posterior default mode network (pDMN) was higher following treatment. However this difference was not correlated with the antidepressant response. Local BOLD activity within these networks was also assessed using the fractional amplitude of low-frequency fluctuations (fALFF) technique. Local activity increased in both the SN and pDMN following rTMS. However this increase was also not correlated with antidepressant response. LIMITATIONS The sample population was heterogeneous, continuing current use of medications, and the study lacked a healthy control or sham stimulation comparison group. CONCLUSIONS Together, these results provide evidence for the involvement of the SN in the antidepressant response to rTMS treatment.
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Affiliation(s)
- Kate E M Godfrey
- School of Pharmacy, The University of Auckland, University of Auckland Grafton Campus, 85 Park Road, Auckland 1023, New Zealand.
| | - Suresh D Muthukumaraswamy
- School of Pharmacy, The University of Auckland, University of Auckland Grafton Campus, 85 Park Road, Auckland 1023, New Zealand
| | - Cathy M Stinear
- School of Medicine, The University of Auckland, Auckland, New Zealand
| | - Nicholas Hoeh
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand; Auckland District Health Board, Auckland, New Zealand
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9
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Decreased gray matter volume is associated with theory of mind deficit in adolescents with schizophrenia. Brain Imaging Behav 2022; 16:1441-1450. [PMID: 35060009 DOI: 10.1007/s11682-021-00591-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 11/02/2022]
Abstract
Schizophrenia patients often suffer from deficit in theory of mind (TOM). Prior neuroimaging studies revealed neuroimaging correlates of TOM deficit in adults with schizophrenia, neuroimaging correlates of TOM in adolescents is less well established. This study aimed to investigate gray matter volume (GMV) abnormalities and TOM deficits in schizophrenic adolescents, and examine the relationship between them. Twenty adolescent schizophrenic patients and 25 age, sex-matched healthy controls underwent T1-weighted magnetic resonance imaging (MRI) scans, and were examined for TOM based on the Reading the Mind in the Eyes test (RMET). Univariate voxel-based morphometry (VBM) and multivariate source-based morphometry (SBM) were employed to examine alterations of two GMV phenotypes in schizophrenic adolescents: voxel-wise GMV and covarying structural brain patterns (SBPs). Compared with controls, our results revealed a significant deficit in RMET performance of the patients, Voxel-wise VBM analysis revealed that patients exhibited decreased GMV in bilateral insula, orbitofrontal cortex, and right rolandic operculum, and GMV of these brain regions were positively correlated with RMET performance. Multivariate SBM analysis identified a significantly different between-group SBP comprising of bilateral insula and inferior frontal cortex, bilateral superior temporal cortex, and bilateral lateral parietal cortex and right rolandic operculum. The loading scores of this SBP was positively correlated with RMET performance. This study revealed impairment of TOM ability in schizophrenic adolescents and revealed an association between TOM deficit and decreased GMV in regions which are crucial for social cognition, thereby provided insight and possible target regions for understanding the neural pathology and normalizing TOM deficit in adolescent schizophrenia patients.
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Harika-Germaneau G, Wassouf I, Le Tutour T, Guillevin R, Doolub D, Rostami R, Delbreil A, Langbour N, Jaafari N. Baseline Clinical and Neuroimaging Biomarkers of Treatment Response to High-Frequency rTMS Over the Left DLPFC for Resistant Depression. Front Psychiatry 2022; 13:894473. [PMID: 35669263 PMCID: PMC9163359 DOI: 10.3389/fpsyt.2022.894473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/05/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) has proven to be an efficient treatment option for patients with treatment-resistant depression (TRD). However, the success rate of this method is still low, and the treatment outcome is unpredictable. The objective of this study was to explore clinical and structural neuroimaging factors as potential biomarkers of the efficacy of high-frequency (HF) rTMS (20 Hz) over the left dorso-lateral pre-frontal cortex (DLPFC). METHODS We analyzed the records of 131 patients with mood disorders who were treated with rTMS and were assessed at baseline at the end of the stimulation and at 1 month after the end of the treatment. The response is defined as a 50% decrease in the MADRS score between the first and the last assessment. Each of these patients underwent a T1 MRI scan of the brain, which was subsequently segmented with FreeSurfer. Whole-brain analyses [Query, Design, Estimate, Contrast (QDEC)] were conducted and corrected for multiple comparisons. Additionally, the responder status was also analyzed using binomial multivariate regression models. The explored variables were clinical and anatomical features of the rTMS target obtained from T1 MRI: target-scalp distance, DLPFC gray matter thickness, and various cortical measures of interest previously studied. RESULTS The results of a binomial multivariate regression model indicated that depression type (p = 0.025), gender (p = 0.010), and the severity of depression (p = 0.027) were found to be associated with response to rTMS. Additionally, the resistance stage showed a significant trend (p = 0.055). Whole-brain analyses on volume revealed that the average volume of the left part of the superior frontal and the caudal middle frontal regions is associated with the response status. Other MRI-based measures are not significantly associated with response to rTMS in our population. CONCLUSION In this study, we investigated the clinical and neuroimaging biomarkers associated with responsiveness to high-frequency rTMS over the left DLPFC in a large sample of patients with TRD. Women, patients with bipolar depressive disorder (BDD), and patients who are less resistant to HF rTMS respond better. Responders present a lower volume of the left part of the superior frontal gyrus and the caudal middle frontal gyrus. These findings support further investigation into the use of clinical variables and structural MRI as possible biomarkers of rTMS treatment response.
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Affiliation(s)
- Ghina Harika-Germaneau
- Centre Hospitalier Henri Laborit, Unité de Recherche Clinique Pierre Deniker, Poitiers, France.,Centre de Recherches sur la Cognition et l'Apprentissage, Centre National de la Recherche Scientifique (CNRS 7295), Université de Poitiers, Poitiers, France
| | - Issa Wassouf
- Centre Hospitalier Henri Laborit, Unité de Recherche Clinique Pierre Deniker, Poitiers, France.,Centre de Recherches sur la Cognition et l'Apprentissage, Centre National de la Recherche Scientifique (CNRS 7295), Université de Poitiers, Poitiers, France.,Centre Hospitalier Nord Deux-Sèvres, Service de Psychiatrie Adulte, Thouars, France
| | - Tom Le Tutour
- Centre Hospitalier Henri Laborit, Unité de Recherche Clinique Pierre Deniker, Poitiers, France
| | - Remy Guillevin
- CHU de Poitiers, Service de Radiologie, Poitiers, France.,Laboratoire Dactim Mis, LMA, UMR CNRS 7348, Poitiers, France
| | - Damien Doolub
- Centre Hospitalier Henri Laborit, Unité de Recherche Clinique Pierre Deniker, Poitiers, France.,Centre de Recherches sur la Cognition et l'Apprentissage, Centre National de la Recherche Scientifique (CNRS 7295), Université de Poitiers, Poitiers, France
| | - Reza Rostami
- Department of Psychology, University of Tehran, Tehran, Iran.,Atieh Clinical Neuroscience Centre, Tehran, Iran
| | - Alexia Delbreil
- Centre Hospitalier Henri Laborit, Unité de Recherche Clinique Pierre Deniker, Poitiers, France.,Centre de Recherches sur la Cognition et l'Apprentissage, Centre National de la Recherche Scientifique (CNRS 7295), Université de Poitiers, Poitiers, France.,CHU Poitiers, Service de Médecine Légale, Poitiers, France
| | - Nicolas Langbour
- Centre Hospitalier Henri Laborit, Unité de Recherche Clinique Pierre Deniker, Poitiers, France.,Centre de Recherches sur la Cognition et l'Apprentissage, Centre National de la Recherche Scientifique (CNRS 7295), Université de Poitiers, Poitiers, France
| | - Nematollah Jaafari
- Centre Hospitalier Henri Laborit, Unité de Recherche Clinique Pierre Deniker, Poitiers, France.,Centre de Recherches sur la Cognition et l'Apprentissage, Centre National de la Recherche Scientifique (CNRS 7295), Université de Poitiers, Poitiers, France
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11
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Ge R, Hassel S, Arnott SR, Davis AD, Harris JK, Zamyadi M, Milev R, Frey BN, Strother SC, Müller DJ, Rotzinger S, MacQueen GM, Kennedy SH, Lam RW, Vila-Rodriguez F. Structural covariance pattern abnormalities of insula in major depressive disorder: A CAN-BIND study report. Prog Neuropsychopharmacol Biol Psychiatry 2021; 111:110194. [PMID: 33296696 DOI: 10.1016/j.pnpbp.2020.110194] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/25/2020] [Accepted: 11/30/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND METHODS Investigation of the insula may inform understanding of the etiopathogenesis of major depressive disorder (MDD). In the present study, we introduced a novel gray matter volume (GMV) based structural covariance technique, and applied it to a multi-centre study of insular subregions of 157 patients with MDD and 93 healthy controls from the Canadian Biomarker Integration Network in Depression (CAN-BIND, https://www.canbind.ca/). Specifically, we divided the unilateral insula into three subregions, and investigated their coupling with whole-brain GMV-based structural brain networks (SBNs). We compared between-group difference of the structural coupling patterns between the insular subregions and SBNs. RESULTS The insula was divided into three subregions, including an anterior one, a superior-posterior one and an inferior-posterior one. In the comparison between MDD patients and controls we found that patients' right anterior insula showed increased inter-network coupling with the default mode network, and it showed decreased inter-network coupling with the central executive network; whereas patients' right ventral-posterior insula showed decreased inter-network coupling with the default mode network, and it showed increased inter-network coupling with the central executive network. We also demonstrated that patients' loading parameters of the right ventral-posterior insular structural covariance negatively correlated with their suicidal ideation scores; and controls' loading parameters of the right ventral-posterior insular structural covariance positively correlated with their motor and psychomotor speed scores, whereas these phenomena were not found in patients. Additionally, we did not find significant inter-network coupling between the whole-brain SBNs, including salience network, default mode network, and central executive network. CONCLUSIONS Our work proposed a novel technique to investigate the structural covariance coupling between large-scale structural covariance networks, and provided further evidence that MDD is a system-level disorder that shows disrupted structural coupling between brain networks.
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Affiliation(s)
- Ruiyang Ge
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Stefanie Hassel
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB, Canada
| | | | - Andrew D Davis
- Department of Psychology, Neuroscience & Behaviour, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | | | - Mojdeh Zamyadi
- Rotman Research Institute, Baycrest, Toronto, ON, Canada
| | - Roumen Milev
- Department of Psychiatry, Queen's University and Providence Care Hospital, Kingston, ON, Canada; Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton, ON, Canada
| | | | - Daniel J Müller
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Susan Rotzinger
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Krembil Research Centre, University Health Network, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Glenda M MacQueen
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Krembil Research Centre, University Health Network, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Fidel Vila-Rodriguez
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
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12
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Steele VR, Maxwell AM. Treating cocaine and opioid use disorder with transcranial magnetic stimulation: A path forward. Pharmacol Biochem Behav 2021; 209:173240. [PMID: 34298030 PMCID: PMC8445657 DOI: 10.1016/j.pbb.2021.173240] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 06/19/2021] [Accepted: 07/16/2021] [Indexed: 12/15/2022]
Abstract
Developing new, effective treatments for substance use disorders (SUDs), especially cocaine and opioid use disorders (CUD and OUD), are of immense importance. These are chronic, relapsing brain diseases characterized by dysregulated circuits manifesting from neuroplastic change brought on by repeated exposure to substances of abuse. A potential treatment is therapeutically inducing neuroplastic change in targeted dysregulated circuits. One such intervention, repetitive transcranial magnetic stimulation (rTMS) has gained traction over the past two decades as a method of noninvasively stimulating cortical structures in order to induce subcortical neuroplastic change. By doing so, rTMS ameliorates symptoms that are consequent of dysregulations in disease-related circuits, such as craving, and reduces drug use. Although rTMS has been successfully applied as a treatment for other clinical disorders, progress toward treatment applications for SUDs has been stymied by what we dub "known unknowns". These are fundamental lines of research within the rTMS-SUD field that have yet to be systematically understood which could help to optimize TMS as an intervention for SUDs. Because progress in treatment for CUD and OUD is imperative given the widespread severity of OUD and the lack of treatment for CUD, it is necessary to critically reflect on the ways in which rTMS research for these disorders can most effectively move forward to help patients. We articulate six "known unknowns" and outline a direction of research to address each. Briefly, the "known unknowns" in the field are: 1) Cortical target selection, 2) subcortical circuit engagement, 3) optimizing rTMS sequences, 4) rTMS as an adjuvant to existing interventions, 5) manipulating brain state, and 6) selecting outcome measures. We also outline research design approaches to address these "known unknowns" in the rTMS-SUDs field. Unification of efforts across research laboratories is necessary to develop empirically validated treatments that will benefit patients in a timely fashion.
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Affiliation(s)
- Vaughn R Steele
- Yale University, School of Medicine, Department of Psychiatry, New Haven CT, USA.
| | - Andrea M Maxwell
- Medical Scientist Training Program, University of Minnesota, Minneapolis MN, USA
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13
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Lai CH. Fronto-limbic neuroimaging biomarkers for diagnosis and prediction of treatment responses in major depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2021; 107:110234. [PMID: 33370569 DOI: 10.1016/j.pnpbp.2020.110234] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 12/02/2020] [Accepted: 12/21/2020] [Indexed: 12/23/2022]
Abstract
The neuroimaging is an important tool for understanding the biomarkers and predicting treatment responses in major depressive disorder (MDD). The potential biomarkers and prediction of treatment response in MDD will be addressed in the review article. The brain regions of cognitive control and emotion regulation, such as the frontal and limbic regions, might represent the potential targets for MDD biomarkers. The potential targets of frontal lobes might include anterior cingulate cortex (ACC), dorsolateral prefrontal cortex (DLPFC) and orbitofrontal cortex (OFC). For the limbic system, hippocampus and amygdala might be the potentially promising targets for MDD. The potential targets of fronto-limbic regions have been found in the studies of several major neuroimaging modalities, such as the magnetic resonance imaging, near-infrared spectroscopy, electroencephalography, positron emission tomography, and single-photon emission computed tomography. Additional regions, such as brainstem and midbrain, might also play a part in the MDD biomarkers. For the prediction of treatment response, the gray matter volumes, white matter tracts, functional representations and receptor bindings of ACC, DLPFC, OFC, amygdala, and hippocampus might play a role in the prediction of antidepressant responses in MDD. For the response prediction of psychotherapies, the fronto-limbic, reward regions, and insula will be the potential targets. For the repetitive transcranial magnetic stimulation, the DLPFC, ACC, limbic, and visuospatial regions might represent the predictive targets for treatment. The neuroimaging targets of MDD might be focused in the fronto-limbic regions. However, the neuroimaging targets for the prediction of treatment responses might be inconclusive and beyond the fronto-limbic regions.
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Affiliation(s)
- Chien-Han Lai
- Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan; PhD Psychiatry & Neuroscience Clinic, Taoyuan, Taiwan.
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14
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Ge R, Liu X, Long D, Frangou S, Vila-Rodriguez F. Sex effects on cortical morphological networks in healthy young adults. Neuroimage 2021; 233:117945. [PMID: 33711482 DOI: 10.1016/j.neuroimage.2021.117945] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/17/2021] [Accepted: 03/03/2021] [Indexed: 12/30/2022] Open
Abstract
Understanding sex-related differences across the human cerebral cortex is an important step in elucidating the basis of psychological, behavioural and clinical differences between the sexes. Prior structural neuroimaging studies primarily focused on regional sex differences using univariate analyses. Here we focus on sex differences in cortical morphological networks (CMNs) derived using multivariate modelling of regional cortical measures of volume and surface from high-quality structural MRI scans from healthy participants in the Human Connectome Project (HCP) (n = 1,063) and the Southwest University Longitudinal Imaging Multimodal (SLIM) study (n = 549). The functional relevance of the CMNs was inferred using the NeuroSynth decoding function. Sex differences were widespread but not uniform. In general, females had higher volume, thickness and cortical folding in networks that involve prefrontal (both ventral and dorsal regions including the anterior cingulate) and parietal regions while males had higher volume, thickness and cortical folding in networks that primarily include temporal and posterior cortical regions. CMN loading coefficients were used as input features to linear discriminant analyses that were performed separately in the HCP and SLIM; sex was predicted with a high degree of accuracy (81%-85%) across datasets. The availability of behavioral data in the HCP enabled us to show that male-biased surface-based CMNs were associated with externalizing behaviors. These results extend previous literature on regional sex-differences by identifying CMNs that can reliably predict sex, are relevant to the expression of psychopathology and provide the foundation for the future investigation of their functional significance in clinical populations.
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Affiliation(s)
- Ruiyang Ge
- Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, BC, Canada
| | - Xiang Liu
- Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, BC, Canada
| | - David Long
- Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, BC, Canada
| | - Sophia Frangou
- Department of Psychiatry, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, BC, Canada; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Fidel Vila-Rodriguez
- Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, BC, Canada.
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15
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Homan S, Muscat W, Joanlanne A, Marousis N, Cecere G, Hofmann L, Ji E, Neumeier M, Vetter S, Seifritz E, Dierks T, Homan P. Treatment effect variability in brain stimulation across psychiatric disorders: A meta-analysis of variance. Neurosci Biobehav Rev 2021; 124:54-62. [PMID: 33482243 DOI: 10.1016/j.neubiorev.2020.11.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/26/2020] [Accepted: 11/29/2020] [Indexed: 02/07/2023]
Abstract
Noninvasive brain stimulation methods such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) are promising add-on treatments for a number of psychiatric conditions. Yet, some of the initial excitement is wearing off. Randomized controlled trials (RCT) have found inconsistent results. This inconsistency is suspected to be the consequence of variation in treatment effects and solvable by identifying responders in RCTs and individualizing treatment. However, is there enough evidence from RCTs that patients respond differently to treatment? This question can be addressed by comparing the variability in the active stimulation group with the variability in the sham group. We searched MEDLINE/PubMed and included all double-blinded, sham-controlled RCTs and crossover trials that used TMS or tDCS in adults with a unipolar or bipolar depression, bipolar disorder, schizophrenia spectrum disorder, or obsessive compulsive disorder. In accordance with the PRISMA guidelines to ensure data quality and validity, we extracted a measure of variability of the primary outcome. A total of 130 studies with 5748 patients were considered in the analysis. We calculated variance-weighted variability ratios for each comparison of active stimulation vs sham and entered them into a random-effects model. We hypothesized that treatment effect variability in TMS or tDCS would be reflected by increased variability after active compared with sham stimulation, or in other words, a variability ratio greater than one. Across diagnoses, we found only a minimal increase in variability after active stimulation compared with sham that did not reach statistical significance (variability ratio = 1.03; 95% CI, 0.97, 1.08, P = 0.358). In conclusion, this study found little evidence for treatment effect variability in brain stimulation, suggesting that the need for personalized or stratified medicine is still an open question.
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Affiliation(s)
- Stephanie Homan
- University Hospital of Psychiatry Zurich, Zurich, Switzerland; University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
| | - Whitney Muscat
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA; Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, New York, NY, USA; Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA
| | - Andrea Joanlanne
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA; Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, New York, NY, USA; Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA
| | | | - Giacomo Cecere
- University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Lena Hofmann
- University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Ellen Ji
- University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Maria Neumeier
- University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Stefan Vetter
- University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Erich Seifritz
- University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Thomas Dierks
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Philipp Homan
- University Hospital of Psychiatry Zurich, Zurich, Switzerland; Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA; Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, New York, NY, USA; Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA.
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16
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Yuan LQ, Zeng Q, Wang D, Wen XY, Shi Y, Zhu F, Chen SJ, Huang GZ. Neuroimaging mechanisms of high-frequency repetitive transcranial magnetic stimulation for treatment of amnestic mild cognitive impairment: a double-blind randomized sham-controlled trial. Neural Regen Res 2021; 16:707-713. [PMID: 33063732 PMCID: PMC8067941 DOI: 10.4103/1673-5374.295345] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Individuals with amnestic mild cognitive impairment (aMCI) have a high risk of developing Alzheimer’s disease. Although repetitive transcranial magnetic stimulation (rTMS) is considered a potentially effective treatment for cognitive impairment in patients with aMCI, the neuroimaging mechanisms are poorly understood. Therefore, we performed a double-blind randomized sham-controlled trial in which rTMS was applied to the left dorsolateral prefrontal cortex of aMCI patients recruited from a community near the Third Hospital Affiliated to Sun Yat-sen University, China. Twenty-four patients with aMCI were randomly assigned to receive true rTMS (treatment group, n = 12, 6 men and 6 women; age 65.08 ± 4.89 years) or sham stimulation (sham group, n = 12, 5 men and 7 women; age 64.67 ± 4.77 years). rTMS parameters included a stimulation frequency of 10 Hz, stimulation duration of 2 seconds, stimulation interval of 8 seconds, 20 repetitions at 80% of the motor threshold, and 400 pulses per session. rTMS/sham stimulation was performed five times per week over a period of 4 consecutive weeks. Our results showed that compared with baseline, Montreal Cognitive Assessment scores were significantly increased and the value of the amplitude of low-frequency fluctuation (ALFF) was significantly increased at the end of treatment and 1 month after treatment. Compared with the sham group, the ALFF values in the right inferior frontal gyrus, triangular part of the inferior frontal gyrus, right precuneus, left angular gyrus, and right supramarginal gyrus were significantly increased, and the ALFF values in the right superior frontal gyrus were significantly decreased in the treatment group. These findings suggest that high-frequency rTMS can effectively improve cognitive function in aMCI patients and alter spontaneous brain activity in cognitive-related brain areas. This study was approved by the Ethics Committee of Shenzhen Baoan Hospital of Southern Medical University, China (approval No. BYL20190901) on September 3, 2019, and registered in the Chinese Clinical Trials Registry (registration No. ChiCTR1900028180) on December 14, 2019.
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Affiliation(s)
- Li-Qiong Yuan
- Department of Rehabilitation Medicine and Physiotherapy, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, China
| | - Qing Zeng
- Department of Rehabilitation Medicine and Physiotherapy, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, China
| | - Dan Wang
- Department of Rehabilitation Medicine and Physiotherapy, Shenzhen Baoan Hospital of Southern Medical University, Shenzhen, Guangdong Province, China
| | - Xiu-Yun Wen
- Department of Rehabilitation Medicine and Physiotherapy, Shenzhen Baoan Hospital of Southern Medical University, Shenzhen, Guangdong Province, China
| | - Yu Shi
- Department of Rehabilitation Medicine and Physiotherapy, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, China
| | - Fen Zhu
- Department of Rehabilitation Medicine and Physiotherapy, Shenzhen Baoan Hospital of Southern Medical University, Shenzhen, Guangdong Province, China
| | - Shang-Jie Chen
- Department of Rehabilitation Medicine and Physiotherapy, Shenzhen Baoan Hospital of Southern Medical University, Shenzhen, Guangdong Province, China
| | - Guo-Zhi Huang
- Department of Rehabilitation Medicine and Physiotherapy, Zhujiang Hospital of Southern Medical University; Rehabilitation School of Southern Medical University, Guangzhou, Guangdong Province, China
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Yun JY, Kim YK. Phenotype Network and Brain Structural Covariance Network of Major Depression. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1305:3-18. [PMID: 33834391 DOI: 10.1007/978-981-33-6044-0_1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Phenotype networks enable clinicians to elucidate the patterns of coexistence and interactions among the clinical symptoms, negative cognitive styles , neurocognitive performance, and environmental factors in major depressive disorder (MDD). Results of phenotype network approach could be used in finding the target symptoms as these are tightly connected or associated with many other phenomena within the phenotype network of MDD specifically when comorbid psychiatric disorder(s) is/are present. Further, by comparing the differential patterns of phenotype networks before and after the treatment, changing or enduring patterns of associations among the clinical phenomena in MDD have been deciphered.Brain structural covariance networks describe the inter-regional co-varying patterns of brain morphologies, and overlapping findings have been reported between the brain structural covariance network and coordinated trajectories of brain development and maturation. Intra-individual brain structural covariance illustrates the degrees of similarities among the different brain regions for how much the values of brain morphological features are deviated from those of healthy controls. Inter-individual brain structural covariance reflects the degrees of concordance among the different brain regions for the inter-individual distribution of brain morphologic values. Estimation of the graph metrics for these brain structural covariance networks uncovers the organizational profile of brain morphological variations in the whole brain and the regional distribution of brain hubs.
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Affiliation(s)
- Je-Yeon Yun
- Seoul National University Hospital, Seoul, Republic of Korea. .,Yeongeon Student Support Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Yong-Ku Kim
- Department of Psychiatry, Korea University Ansan Hospital, College of Medicine, Ansan, Republic of Korea
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18
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Ge R, Ding S, Keeling T, Honer WG, Frangou S, Vila-Rodriguez F. SS-Detect: Development and Validation of a New Strategy for Source-Based Morphometry in Multiscanner Studies. J Neuroimaging 2020; 31:261-271. [PMID: 33270962 DOI: 10.1111/jon.12814] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/01/2020] [Accepted: 11/12/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Source-based morphometry(SBM) has been used in multicenter studies pooling magnetic resonance imaging data across different scanners to advance the reproducibility of neuroscience research. In the present study, we developed an analysis strategy for Scanner-Specific Detection (SS-Detect) of SBPs in multiscanner studies, and evaluated its performance relative to a conventional strategy. METHODS In the first experiment, the SimTB toolbox was used to generate simulated datasets mimicking 20 different scanners with common and scanner-specific SBPs. In the second experiment, we generated one simulated SBP from empirical gray matter volume (GMV) datasets from two different scanners. Moreover, we applied two strategies to compare SBPs between schizophrenia patients' and healthy controls' GMV from two scanners. RESULTS The outputs of the conventional strategy were limited to whole-sample-level results across all scanners; the outputs of SS-Detect included whole-sample-level and scanner-specific results. In the first simulation experiment, SS-Detect successfully estimated all simulated SBPs, including the common and scanner-specific SBPs, whereas the conventional strategy detected only some of the whole-sample SBPs. The second simulation experiment showed that both strategies could detect the simulated SBP. Quantitative evaluations of both experiments demonstrated greater accuracy of the SS-Detect in estimating spatial SBPs and subject-specific loading parameters. In the third experiment, SS-Detect detected more significant between-group SBPs, and these SBPs corresponded with the results from voxel-based morphometry analysis, suggesting that SS-Detect has higher sensitivity in detecting between-group differences. CONCLUSIONS SS-Detect outperformed the conventional strategy and can be considered advantageous when SBM is applied to a multiscanner study.
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Affiliation(s)
- Ruiyang Ge
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shiqing Ding
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tyler Keeling
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sophia Frangou
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, New York, US
| | - Fidel Vila-Rodriguez
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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19
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Fitzgerald PB. An update on the clinical use of repetitive transcranial magnetic stimulation in the treatment of depression. J Affect Disord 2020; 276:90-103. [PMID: 32697721 DOI: 10.1016/j.jad.2020.06.067] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 06/03/2020] [Accepted: 06/23/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is an increasingly used treatment for patients with depression. The use of rTMS in depression is supported by over 20 years of clinical trials. There has been a significant increase in knowledge around the use of rTMS in recent years. OBJECTIVE The aim of this paper was to review the use of rTMS in depression to provide an update for rTMS practitioners and clinicians interested in the clinical use of this treatment. METHODS A targeted review of the literature around the use of rTMS treatment of depression with a specific focus on studies published in the last 3 years. RESULTS High-frequency rTMS applied to the left dorsolateral prefrontal cortex is an effective treatment for acute episodes of major depressive disorder. There are several additional methods of rTMS delivery that are supported by clinical trials and meta-analyses but no substantive evidence that any one approach is any more effective than any other. rTMS is effective in unipolar depression and most likely bipolar depression. rTMS courses may be repeated in the management of depressive relapse but there is less evidence for the use of rTMS in the maintenance phase. CONCLUSIONS The science around the use of rTMS is rapidly evolving and there is a considerable need for practitioners to remain abreast of the current state of this literature and its implications for clinical practice. rTMS is an effective antidepressant treatment but its optimal use should be continually informed by knowledge of the state of the art.
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Affiliation(s)
- Paul B Fitzgerald
- Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Monash University Central Clinical School, 888 Toorak Rd, Camberwell, Victoria 3004, Australia.
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20
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Zheng A, Yu R, Du W, Liu H, Zhang Z, Xu Z, Xiang Y, Du L. Two-week rTMS-induced neuroimaging changes measured with fMRI in depression. J Affect Disord 2020; 270:15-21. [PMID: 32275215 DOI: 10.1016/j.jad.2020.03.038] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/30/2019] [Accepted: 03/20/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To study the neuroimaging mechanisms of repetitive transcranial magnetic stimulation (rTMS) in treating major depressive disorder (MDD). METHODS Twenty-seven treatment-naive patients with major depressive disorder (MDD) and 27 controls were enrolled. All of them were scanned with resting-state functional magnetic resonance imaging (fMRI) at baseline, and 15 patients were rescanned after two-week rTMS. The amplitude of low frequency fluctuation (ALFF) and functional connection degree (FCD), based on voxels and 3 brain networks (default mode network [DMN], central executive network [CEN], salience network[SN]),were used as imaging indicators to analyze. The correlations of brain imaging changes after rTMS with clinical efficacy were calculated. RESULTS At baseline, patients groups showed increased ALFF in the right orbital frontal cortex (OFC) and decreased ALFF in the left striatal cortex and medial prefrontal cortex (PFC), while increased FCD in the right dorsal anterior cingulate cortex and OFC and decreased FCD in the right inferior parietal lobe and in the CEN. After rTMS, patients showed increased ALFF in the left dorsolateral prefrontal cortex (DLPFC)and superior frontal gyrus, FCD in the right dorsal anterior cingulate cortex, superior temporal gyrus and CEN, as well as decreased FCD in the bilateral lingual gyrus than pre-rTMS . These rTMS induced neuroimaging changes did not significantly correlated with clinical effecacy. CONCLUSIONS This study indicated that rTMS resulted in changes of ALFF and FCD in some brain regions and CEN. But we could not conclude this is the neuroimaging mechanism of rTMS according to the correlation analysis.
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Affiliation(s)
- Anhai Zheng
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, PR China
| | - Renqiang Yu
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, PR China
| | - Wanyi Du
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, PR China
| | - Huan Liu
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, PR China
| | - Zhiwei Zhang
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, PR China
| | - Zhen Xu
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, PR China
| | - Yisijia Xiang
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, PR China
| | - Lian Du
- Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, PR China.
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21
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Nestor SM, Blumberger DM. Mapping Symptom Clusters to Circuits: Toward Personalizing TMS Targets to Improve Treatment Outcomes in Depression. Am J Psychiatry 2020; 177:373-375. [PMID: 32354264 DOI: 10.1176/appi.ajp.2020.20030271] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sean M Nestor
- Department of Psychiatry, Faculty of Medicine, University of Toronto, and Temerty Centre for Therapeutic Brain Intervention and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto
| | - Daniel M Blumberger
- Department of Psychiatry, Faculty of Medicine, University of Toronto, and Temerty Centre for Therapeutic Brain Intervention and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto
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22
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Hung YY, Yang LH, Stubbs B, Li DJ, Tseng PT, Yeh TC, Chen TY, Liang CS, Chu CS. Efficacy and tolerability of deep transcranial magnetic stimulation for treatment-resistant depression: A systematic review and meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2020; 99:109850. [PMID: 31863873 DOI: 10.1016/j.pnpbp.2019.109850] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 11/24/2019] [Accepted: 12/17/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES This study aimed to investigate the efficacy of deep transcranial magnetic stimulation (dTMS) for treatment-resistant depression (TRD). METHODS This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Medline, PsycINFO, Embase, and Cochrane Library were systematically searched from the time of their inception until July 17, 2019. Data were pooled using a random-effects model. Primary outcomes were mean change of depression and anxiety severity. Secondary outcomes were response and remission rate of depression. RESULTS Fifteen studies including three randomized controlled trials (RCTs) (n = 417, mean age: 50.6 years) and twelve uncontrolled clinical trials (n = 284, mean age: 46.4 years) were included. dTMS significantly improved the depressive (Hedges' g = -1.323, 95% CI = -1.651 to -0.995, p < .001) and anxiety symptoms (Hedges' g = -1.282, 95% CI = -1.514 to -1.051, p < .001) in patients with TRD. Subgroup analysis showed that non-RCTs had a larger effect size than RCTs (-1.461 vs -0.756) on depression severity. Although the response and remission rates of the dTMS group were high, only studies using both dTMS and antidepressant medications achieved significance. The anxiolytic effect of dTMS was more heterogeneous, and the results were obtained mainly from non-RCTs. Importantly, the dTMS group showed favorable tolerability without major adverse events. CONCLUSIONS dTMS is a safe and effective intervention in patients with TRD. Studies combining dTMS and antidepressant medications seemed to show greater therapeutic effects. Future studies are needed to address the interaction effect of dTMS with different classes of antidepressant medications.
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Affiliation(s)
- Yu-Yung Hung
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Li-Heng Yang
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Bredon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK; Positive Ageing Research Institute (PARI), Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
| | - Dian-Jeng Li
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan
| | - Ping-Tao Tseng
- WinShine Clinics in Specialty of Psychiatry, Kaohsiung City, Taiwan
| | - Ta-Chuan Yeh
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Tien-Yu Chen
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan; Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.
| | - Che-Sheng Chu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan; Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.
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23
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Zhou ZW, Lan XQ, Fang YT, Gong Y, Zang YF, Luo H, Zhang H. The Inter-Regional Connectivity Within the Default Mode Network During the Attentional Processes of Internal Focus and External Focus: An fMRI Study of Continuous Finger Force Feedback. Front Psychol 2019; 10:2198. [PMID: 31616356 PMCID: PMC6775218 DOI: 10.3389/fpsyg.2019.02198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/12/2019] [Indexed: 11/16/2022] Open
Abstract
Sustained attention involves two distinct processes, i.e., external focus and internal focus. Some recent neuroimaging studies employed the instruction of experimenters or the self-report from participants to generate the two attentional processes, and observed that the default mode network (DMN) was also responding to the external focus. These observations challenged the general view that the DMN accounts for the internally directed cognition, e.g., unfocused mind wandering, task independent-thoughts and internally focused events. Notably, the instruction or self-report may not effectively ensure the participants engage in the external focus/internal focus, and thus, the functional significance of the DMN for the externally focused process remains to be verified. In the present study, a new task paradigm, i.e., real/sham continuous feedback of finger force, was employed to generate the attentional process of external focus/internal focus, and the functional connectivity among the node regions of the DMN was further investigated in the two processes respectively. We found that two regions of the DMN, posterior cingulate cortex and left inferior parietal cortex/angular gyrus showed stronger inter-regional connectivity in the externally focused process than it in the internally focused process. Intriguingly, this functional connectivity was closely related to the behavioral performance in the process of external focus. These findings implicated that the functional significance of the DMN in sustained attention was more than responding to the internally directed cognition, and the task paradigm of continuous finger force feedback could benefit for the future studies on the externally focused/internally focused process of sustained attention.
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Affiliation(s)
- Zhi-Wei Zhou
- Institute of Psychological Sciences, College of Education, Hangzhou Normal University, Hangzhou, China.,Center for Cognition and Brain Disorders and the Affiliated Hospital, Hangzhou Normal University, Hangzhou, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China
| | - Xia-Qing Lan
- Institute of Psychological Sciences, College of Education, Hangzhou Normal University, Hangzhou, China.,Center for Cognition and Brain Disorders and the Affiliated Hospital, Hangzhou Normal University, Hangzhou, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China
| | - Yan-Tong Fang
- Center for Cognition and Brain Disorders and the Affiliated Hospital, Hangzhou Normal University, Hangzhou, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China
| | - Yun Gong
- Center for Cognition and Brain Disorders and the Affiliated Hospital, Hangzhou Normal University, Hangzhou, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China
| | - Yu-Feng Zang
- Institute of Psychological Sciences, College of Education, Hangzhou Normal University, Hangzhou, China.,Center for Cognition and Brain Disorders and the Affiliated Hospital, Hangzhou Normal University, Hangzhou, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China
| | - Hong Luo
- Center for Cognition and Brain Disorders and the Affiliated Hospital, Hangzhou Normal University, Hangzhou, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China
| | - Hang Zhang
- Institute of Psychological Sciences, College of Education, Hangzhou Normal University, Hangzhou, China.,Center for Cognition and Brain Disorders and the Affiliated Hospital, Hangzhou Normal University, Hangzhou, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China
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24
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Functional disconnectivity of the hippocampal network and neural correlates of memory impairment in treatment-resistant depression. J Affect Disord 2019; 253:248-256. [PMID: 31060011 DOI: 10.1016/j.jad.2019.04.096] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/29/2019] [Accepted: 04/27/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is a disabling neuropsychiatric condition associated with cognitive impairment. Neuroimaging studies have consistently linked memory deficits with hippocampal atrophy in MDD patients. However, there has been a paucity of research examining how the hippocampus functionally contributes to memory impairments in MDD. The present study examined whether hippocampal networks distinguish treatment-resistant depression (TRD) patients from healthy controls (HCs), and whether these networks underlie declarative memory deficits in TRD. We hypothesized that functional connectivity (FC) of the posterior hippocampus would correlate preferentially with memory in patients, whereas FC pattern of the anterior and intermediate hippocampus would correlate with emotion-mediated regions and show a significant correlation with memory. METHODS Resting-state functional magnetic resonance imaging (fMRI) scans were acquired in 56 patients and 42 age- and sex-matched HCs. We parcellated the hippocampus into three subregions based on a sparse representation-based method recently developed by our group. FC networks of hippocampal subregions were compared between patients and HCs and correlated with clinical measures and cognitive performance. RESULTS Decreased connectivity of the right intermediate hippocampus (RIH) with the limbic regions was a distinguishing feature between TRD and HCs. These functional abnormalities were present in the absence of structural volumetric differences. Furthermore, lower right amygdalar connectivity to the RIH related to a longer current depressive episode. Declarative memory deficits in TRD were significantly associated with left posterior and right intermediate hippocampal FC patterns. LIMITATIONS Our patient samples were treatment-resistant, the conclusions from this study cannot be generalized to all MDD patients directly. Task-based imaging studies are needed to demonstrate hippocampal engagement in the memory deficits of patients. Finally, our findings are strongly in need of replication in independent validation samples. CONCLUSIONS These findings demonstrate a transitional property of the intermediate hippocampal subregion between its anterior and posterior counterparts in TRD patients, and provide new insights into the neural network-level dysfunction of the hippocampus in TRD.
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