1
|
Guo ZP, Liao D, Chen L, Wang C, Qu M, Lv XY, Fang JL, Liu CH. Transcutaneous Auricular Vagus Nerve Stimulation Modulating the Brain Topological Architecture of Functional Network in Major Depressive Disorder: An fMRI Study. Brain Sci 2024; 14:945. [PMID: 39335439 PMCID: PMC11430561 DOI: 10.3390/brainsci14090945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 09/20/2024] [Accepted: 09/20/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Transcutaneous auricular vagus nerve stimulation (taVNS) is effective in regulating mood and high-level cognition in patients with major depressive disorder (MDD). This study aimed to investigate the efficacy of taVNS treatment in patients with MDD and an altered brain topological organization of functional networks. METHODS Nineteen patients with MDD were enrolled in this study. Patients with MDD underwent 4 weeks of taVNS treatments; resting-state functional magnetic resonance imaging (rs-fMRI) data of the patients were collected before and after taVNS treatment. The graph theory method and network-based statistics (NBS) analysis were used to detect abnormal topological organizations of functional networks in patients with MDD before and after taVNS treatment. A correlation analysis was performed to characterize the relationship between altered network properties and neuropsychological scores. RESULTS After 4 weeks of taVNS treatment, patients with MDD had increased global efficiency and decreased characteristic path length (Lp). Additionally, patients with MDD exhibited increased nodal efficiency (NE) and degree centrality (DC) in the left angular gyrus. NBS results showed that patients with MDD exhibited reduced connectivity between default mode network (DMN)-frontoparietal network (FPN), DMN-cingulo-opercular network (CON), and FPN-CON. Furthermore, changes in Lp and DC were correlated with changes in Hamilton depression scores. CONCLUSIONS These findings demonstrated that taVNS may be an effective method for reducing the severity of depressive symptoms in patients with MDD, mainly through modulating the brain's topological organization. Our study may offer insights into the underlying neural mechanism of taVNS treatment in patients with MDD.
Collapse
Affiliation(s)
- Zhi-Peng Guo
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| | - Dan Liao
- Department of Radiology, Guizhou Provincial People's Hospital, Guiyang 550002, China
| | - Lei Chen
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| | - Cong Wang
- Kerfun Medical (Suzhou) Co., Ltd., Suzhou 215000, China
| | - Miao Qu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Xue-Yu Lv
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Ji-Liang Fang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Chun-Hong Liu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| |
Collapse
|
2
|
Hassanzadeh E, Moradi G, Arasteh M, Moradi Y. The effect of repetitive transcranial magnetic stimulation on the Hamilton Depression Rating Scale-17 criterion in patients with major depressive disorder without psychotic features: a systematic review and meta-analysis of intervention studies. BMC Psychol 2024; 12:480. [PMID: 39256851 PMCID: PMC11389065 DOI: 10.1186/s40359-024-01981-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/03/2024] [Indexed: 09/12/2024] Open
Abstract
AIM In line with the publication of clinical information related to the therapeutic process of repetitive transcranial magnetic stimulation (rTMS) and the updating of relevant treatment guidelines, the present meta-analysis study was designed and conducted to determine the effect of repetitive transcranial magnetic stimulation (rTMS) on the Hamilton Depression Rating Scale-17 (HDRS-17) criterion in patients with major depressive disorder (MDD) without psychotic features. METHODS In this study, a systematic search was conducted in electronic databases such as PubMed [Medline], Scopus, Web of Science, Embase, Ovid, Cochrane Library, and ClinicalTrials. gov using relevant keywords. The search period in this study was from January 2000 to January 2022, which was updated until May 2023. Randomized controlled trials (RCTs) that determined the effect of repetitive transcranial magnetic stimulation (rTMS) on the Hamilton Depression Rating Scale-17 (HDRS-17) criterion in patients with major depressive disorder (MDD) without psychotic features were included in the analysis. The quality of the included RCTs was assessed using the Cochrane Risk of Bias checklist. Statistical analyses were performed using STATA (Version 16) and RevMan (Version 5). RESULTS Following the combination of results from 16 clinical trial studies in the present meta-analysis, it was found that the mean Hamilton Depression Rating Scale-17 (HDRS-17) in patients with major depressive disorder (MDD) decreases by an average of 1.46 units (SMD: -1.46; % 95 CI: -1.65, -1.27, I square: 45.74%; P heterogeneity: 0.56). Subgroup analysis results indicated that the standardized mean difference of Hamilton Depression Rating Scale-17 (HDRS-17) varied based on the number of treatment sessions: patients receiving 10 or fewer repetitive transcranial magnetic stimulation (rTMS) sessions showed a mean Hamilton Depression Rating Scale-17 (HDRS-17) reduction of 2.60 units (SMD: -2.60; % 95 CI: -2.86, -2.33, I square: 55.12%; P heterogeneity: 0.55), while those receiving 11 to 20 sessions showed a mean Hamilton Depression Rating Scale-17 (HDRS-17) reduction of 0.28 units (SMD: -0.28; % 95 CI: -0.65, -0.09, I square: 39.91%; P heterogeneity: 0.89). CONCLUSION In conclusion, our meta-analysis demonstrates the efficacy of repetitive transcranial magnetic stimulation (rTMS) in reducing depressive symptoms in major depressive disorder (MDD) patients. The complex results of subgroup analysis revealed insight on the possible benefits of a more focused strategy with fewer sessions, as well as the impact of treatment session frequency. These findings add to our understanding of repetitive transcranial magnetic stimulation (rTMS) as a therapeutic intervention for the treatment of major depressive illnesses.
Collapse
Affiliation(s)
- Elham Hassanzadeh
- Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ghobad Moradi
- Social Determinants of the Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Modabber Arasteh
- Department of Psychiatry, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Yousef Moradi
- Social Determinants of the Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| |
Collapse
|
3
|
Lewis CP, Nakonezny PA, Sonmez AI, Ozger C, Garzon JF, Camsari DD, Yuruk D, Romanowicz M, Shekunov J, Zaccariello MJ, Vande Voort JL, Croarkin PE. A Dose-Finding, Biomarker Validation, and Effectiveness Study of Transcranial Magnetic Stimulation for Adolescents With Depression. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)01839-2. [PMID: 39245178 DOI: 10.1016/j.jaac.2024.08.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Revised: 08/11/2024] [Accepted: 08/30/2024] [Indexed: 09/10/2024]
Abstract
OBJECTIVE Research and clinical application of transcranial magnetic stimulation (TMS) for adolescents with major depressive disorder (MDD) has advanced slowly. Significant gaps persist in our understanding of optimized, age-specific protocols and dosing strategies. This study aimed to compare the clinical effects of 1 Hz versus 10 Hz TMS regimens and examine a biomarker-informed treatment approach with glutamatergic intracortical facilitation (ICF). METHOD Participants with moderate-to-severe symptoms of MDD were randomized to 30 sessions of left prefrontal 1 Hz or 10 Hz TMS, stratified by baseline ICF measures. The primary clinical outcome measure was the Children's Depression Rating Scale, Revised (CDRS-R). The CDRS-R and ICF biomarker were collected weekly. RESULTS Forty-one participants received either 1 Hz (n = 22) or 10 Hz (n = 19) TMS treatments. CDRS-R scores improved compared to baseline in both 1 Hz and 10 Hz groups. For participants with low ICF at baseline, the overall least squares means of CDRS-R scores over the 6-week trial showed that depressive symptom severity was lower for the group treated with 1 Hz TMS than for those who received 10 Hz TMS. There were no significant changes in weekly ICF measurements across the 6 weeks of TMS treatment. CONCLUSION Low ICF may reflect optimal glutamatergic N-methyl-d-aspartate (NMDA) receptor activity that facilitates the therapeutic effect of 1 Hz TMS through long-term depression-like mechanisms on synaptic plasticity. The stability of ICF suggests that it is a tonic, trait-like measure of NMDA receptor-mediated neurotransmission, with potential utility to inform parameter selection for therapeutic TMS in adolescents with MDD.
Collapse
Affiliation(s)
- Charles P Lewis
- University of Minnesota, Minneapolis, Minnesota; Mayo Clinic, Rochester, Minnesota
| | | | - Ayse Irem Sonmez
- Mayo Clinic, Rochester, Minnesota; Columbia University, New York, New York
| | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Faries E, Mabe LA, Franzen RL, Murtaza S, Nathani K, Ahmed B, Prokop L, Mohammed K, Ahmed AT. Interventional approaches to treatment resistant depression (DTR) in children and adolescents: A systematic review and meta-analysis. J Affect Disord 2024; 367:519-529. [PMID: 39226935 DOI: 10.1016/j.jad.2024.08.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 08/18/2024] [Accepted: 08/30/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND Major depressive disorder (MDD) is highly prevalent in youth. Conventional treatment paradigms primarily involve selective serotonin reuptake inhibitors (SSRIs) and psychotherapy, yet a significant proportion of this population exhibits treatment-resistant depression (TRD). In adults, interventional therapies like Electroconvulsive Therapy (ECT), repetitive Transcranial Magnetic Stimulation (rTMS), and ketamine have shown promise for TRD, but their comparative efficacy remains underexplored in Adolescent and pediatric population. This systematic review and meta-analysis aims to assess the relative effectiveness of ECT, rTMS, and ketamine in treating TRD among adolescents. METHODS Following PRISMA guidelines, we systematically searched databases for studies of ECT, rTMS, or ketamine for treatment-resistant depression in youth ages 10-24. Three reviewers independently screened for inclusion based on predefined criteria. Included observational and randomized controlled trials reported depression symptoms with measures like HDRS and MADRS in youth treated with ECT, rTMS, or ketamine. Two reviewers extracted data on interventions, patients, and depression symptom outcomes. Chance-adjusted inter-reviewer agreement was calculated. For meta-analysis, we pooled standardized mean differences (SMDs) in depression scores using random effects models and assessed heterogeneity with I2 statistics. RESULTS Meta-analysis of 10 observational studies examined SMD in depression scores for treatment resistant depression patients treated with ECT, ketamine, or rTMS. Patients treated with ECT had a significantly lower SMD of 1.99 (95 % CI 0.92-3.05, p < 0.001) compared to baseline. Patients treated with ketamine also had a significantly lower SMD of 1.58 (95 % CI 1.04-2.12, p < 0.001). Patients treated with rTMS had the lowest SMD of 2.79 (95 % CI 0.79-4.80, p = 0.006). There was no significant difference between the three groups overall (p > 0.05). Comparative analysis between ECT and ketamine found no significant difference in SMD (p = 0.387). Comparison of ECT versus rTMS found a significant difference in SMD favoring rTMS (p = 0.004). Comparison of ketamine versus rTMS suggested a potential difference in SMD favoring rTMS (p = 0.058). In summary, rTMS resulted in significantly larger reductions in depression scores than ECT, and potentially larger reductions than ketamine. CONCLUSIONS This meta-analysis illustrates the ability of rTMS, ECT, and ketamine to improve depression in youth. rTMS resulted in the largest improvements, highlighting its potential as a first-line treatment for pediatric treatment-resistant depression given its favorable side effect profile compared to ECT. Further research directly comparing these modalities is needed.
Collapse
Affiliation(s)
- Ethan Faries
- McGovern Medical School at UTHealth Houston, Houston, TX, USA.
| | - Landon A Mabe
- School of Medicine, Baylor College of Medicine, Houston, TX, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | | | - Syed Murtaza
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Komal Nathani
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Burhan Ahmed
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Larry Prokop
- Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, USA
| | - Khaled Mohammed
- Division of Community Pediatric and Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ahmed T Ahmed
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey VA Medical Center, Houston, TX, USA
| |
Collapse
|
5
|
Li S, Li S, Ding T, Liu S, Guo X, Liu Z. Effects of attentional deployment training for relieving negative emotion in individuals with subthreshold depression. Clin Neurophysiol 2024; 165:97-106. [PMID: 38996613 DOI: 10.1016/j.clinph.2024.06.009] [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: 12/07/2023] [Revised: 05/24/2024] [Accepted: 06/10/2024] [Indexed: 07/14/2024]
Abstract
OBJECTIVE As a prodromal stage to major depressive disorder (MDD), subthreshold depression (StD) has a higher prevalence in the population, resulting in a greater healthcare burden. StD individuals' current negative emotion could be moderated by attentional deployment. However, it remains unclear whether attentional deployment training can mitigate subsequent negative emotion in StD individuals. METHODS Based on 160 participants, we combined decision task (Experiment 1, N = 69), eye-tracking (Experiment 2, N = 40), and EEG (Experiment 3, N = 51) techniques to investigate how one-week attentional deployment (gain-focus, GF) training modulated the emotional processing of negative stimulus and its underlying neural correlates in StD individuals. RESULTS After one-week GF training, StD individuals significantly reduced the first fixation time and total fixation time on the negative part (missed opportunities) of decision outcome and showed a decrease in emotional sensitivity to missed opportunities. An increase in N1 and decrease in P3 and LPP (late positive potentials) amplitudes, as well as a decrease in alpha oscillation, were observed when StD individuals faced missed opportunities after training. Additionally, the extent of reduction in StD individuals' emotional sensitivity to missed opportunities could be significantly predicted by the degree of decrease in alpha oscillation. CONCLUSION One-week attentional deployment training could modulate negative emotion in StD individuals and the degree of change in alpha oscillation might act as an objective indicator for the effectiveness of training. SIGNIFICANCE Our study provides a convenient and effective approach to alleviate the negative emotion of StD individuals.
Collapse
Affiliation(s)
- Shuyu Li
- Shaanxi Key Laboratory of Behavior and Cognitive Neuroscience, School of Psychology, Shaanxi Normal University, Xi'an 710062, China
| | - Shuang Li
- Department of Mental Health Education for College Students, School of Marxism, Nanjing Forestry University, Nanjing 210037, China
| | - Tao Ding
- Shaanxi Key Laboratory of Behavior and Cognitive Neuroscience, School of Psychology, Shaanxi Normal University, Xi'an 710062, China
| | - Sijia Liu
- Fudan Institute on Ageing, Fudan University, Shanghai 200433, China; MOE Laboratory for National Development and Intelligent Governance, Fudan University, Shanghai 200433, China
| | - Xiuyan Guo
- Fudan Institute on Ageing, Fudan University, Shanghai 200433, China; MOE Laboratory for National Development and Intelligent Governance, Fudan University, Shanghai 200433, China
| | - Zhiyuan Liu
- Shaanxi Key Laboratory of Behavior and Cognitive Neuroscience, School of Psychology, Shaanxi Normal University, Xi'an 710062, China.
| |
Collapse
|
6
|
Huang Y, Zelmann R, Hadar P, Dezha-Peralta J, Richardson RM, Williams ZM, Cash SS, Keller CJ, Paulk AC. Theta-burst direct electrical stimulation remodels human brain networks. Nat Commun 2024; 15:6982. [PMID: 39143083 PMCID: PMC11324911 DOI: 10.1038/s41467-024-51443-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 08/07/2024] [Indexed: 08/16/2024] Open
Abstract
Theta-burst stimulation (TBS), a patterned brain stimulation technique that mimics rhythmic bursts of 3-8 Hz endogenous brain rhythms, has emerged as a promising therapeutic approach for treating a wide range of brain disorders, though the neural mechanism of TBS action remains poorly understood. We investigated the neural effects of TBS using intracranial EEG (iEEG) in 10 pre-surgical epilepsy participants undergoing intracranial monitoring. Here we show that individual bursts of direct electrical TBS at 29 frontal and temporal sites evoked strong neural responses spanning broad cortical regions. These responses exhibited dynamic local field potential voltage changes over the course of stimulation presentations, including either increasing or decreasing responses, suggestive of short-term plasticity. Stronger stimulation augmented the mean TBS response amplitude and spread with more recording sites demonstrating short-term plasticity. TBS responses were stimulation site-specific with stronger TBS responses observed in regions with strong baseline stimulation effective (cortico-cortical evoked potentials) and functional (low frequency phase locking) connectivity. Further, we could use these measures to predict stable and varying (e.g. short-term plasticity) TBS response locations. Future work may integrate pre-treatment connectivity alongside other biophysical factors to personalize stimulation parameters, thereby optimizing induction of neuroplasticity within disease-relevant brain networks.
Collapse
Affiliation(s)
- Yuhao Huang
- Department of Neurosurgery, Stanford University, Palo Alto, CA, USA
| | - Rina Zelmann
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Peter Hadar
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jaquelin Dezha-Peralta
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ziv M Williams
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Sydney S Cash
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Corey J Keller
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA.
- Wu Tsai Neurosciences Institute, Stanford University, Palo Alto, CA, USA.
- Veterans Affairs Palo Alto Healthcare System, and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, USA.
| | - Angelique C Paulk
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
| |
Collapse
|
7
|
Sathappan A, Yudkoff B. Empowering understanding: navigating consent to ketamine treatment in adolescent mental health. Front Psychiatry 2024; 15:1433348. [PMID: 39193578 PMCID: PMC11347886 DOI: 10.3389/fpsyt.2024.1433348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 07/24/2024] [Indexed: 08/29/2024] Open
Abstract
The rising prevalence of mental health disorders in adolescents, compounded by treatment resistance, underscores the need for innovative interventions. Ketamine, recognized for its rapid antidepressant and anti-suicidal effects in adults, has recently emerged as a potential treatment for adolescents with treatment-resistant depression and suicidality. This paper aims to highlight key elements of the informed consent process, including obtaining parental consent and adolescent assent, and discussing the nature of ketamine treatment, its benefits, and potential risks. Obtaining informed consent for ketamine treatment in this demographic poses unique challenges. During the informed consent process, clinicians should balance an adolescent's growing autonomy with parental consent and address the distinct features of treatment, including ketamine's potential to induce psychedelic-like effects. Additionally, clinicians should highlight the "off-label" use in this population and the uncertainty inherent to treatment at this time, including the lack of data on repeated ketamine exposure on the developing brain. This paper also addresses challenging scenarios related to informed consent for this treatment, such as instances when parents are willing to consent but the adolescent refuses. Alternative treatment strategies such as transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT) are also considered. In conclusion, while an emerging body of evidence suggests that ketamine shows potential for the acute treatment of adolescents with severe depression and suicidality, adherence to informed consent principles is paramount to ensure best clinical practices and uphold ethical standards amidst the current landscape of ongoing research.
Collapse
Affiliation(s)
- Aakash Sathappan
- Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Benjamin Yudkoff
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
- Lumin Health, Boston, MA, United States
| |
Collapse
|
8
|
Valter Y, Rapallo F, Burlando B, Crossen M, Baeken C, Datta A, Deblieck C. Efficacy of non-invasive brain stimulation and neuronavigation for major depressive disorder: a systematic review and meta-analysis. Expert Rev Med Devices 2024; 21:643-658. [PMID: 38902968 DOI: 10.1080/17434440.2024.2370820] [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: 03/14/2024] [Accepted: 05/28/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are increasingly used for major depressive disorder (MDD). Most tDCS and rTMS studies target the left dorsolateral prefrontal cortex, either with or without neuronavigation. We examined the effect of rTMS and tDCS, and the added value of neuronavigation in the treatment of MDD. METHODS A search on PubMed, Embase, and Cochrane databases for rTMS or tDCS randomized controlled trials of MDD up to 1 February 2023, yielded 89 studies. We then performed meta-analyses comparing tDCS efficacy to non-neuronavigated rTMS, tDCS to neuronavigated rTMS, and neuronavigated rTMS to non-neuronavigated rTMS. We assessed the significance of the effect in subgroups and in the whole meta-analysis with a z-test and subgroup differences with a chi-square test. RESULTS We found small-to-medium effects of both tDCS and rTMS on MDD, with a slightly greater effect from rTMS. No significant difference was found between neuronavigation and non-neuronavigation. CONCLUSION Although both tDCS and rTMS are effective in treating MDD, many patients do not respond. Additionally, current neuronavigation methods are not significantly improving MDD treatment. It is therefore imperative to seek personalized methods for these interventions.
Collapse
Affiliation(s)
- Yishai Valter
- Research and Development, Soterix Medical, Inc, Woodbridge, NJ, USA
- Department of Biomedical Engineering, City College of the City University of New York, New York, NY, USA
| | - Fabio Rapallo
- Faculty of Economics, University of Genoa, Genova, Italy
| | - Bruno Burlando
- Department of Pharmacy, University of Genoa, Genova, Italy
| | - Miah Crossen
- Research and Development, Soterix Medical, Inc, Woodbridge, NJ, USA
| | - Chris Baeken
- Faculty of Medicine and Health Sciences, Department of Head and Skin, Ghent Experimental Psychiatry (GHEP) lab, Ghent University, Ghent, Belgium
- Department of Psychiatry, University Hospital (UZBrussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Abhishek Datta
- Research and Development, Soterix Medical, Inc, Woodbridge, NJ, USA
- Department of Biomedical Engineering, City College of the City University of New York, New York, NY, USA
| | - Choi Deblieck
- Lab for Equilibrium Investigations and Aerospace (LEIA), University of Antwerp, Antwerp, Belgium
| |
Collapse
|
9
|
Pardossi S, Fagiolini A, Scheggi S, Cuomo A. A Systematic Review on Ketamine and Esketamine for Treatment-Resistant Depression and Suicidality in Adolescents: A New Hope? CHILDREN (BASEL, SWITZERLAND) 2024; 11:801. [PMID: 39062250 PMCID: PMC11274655 DOI: 10.3390/children11070801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 06/27/2024] [Accepted: 06/28/2024] [Indexed: 07/28/2024]
Abstract
Treating depression in adolescents is a significant challenge, and major depressive disorder (MDD) with suicidal ideation and treatment-resistant depression (TRD) are common and potentially devastating to optimal psychological and physical development in this age group. Suicide is among the leading causes of youth mortality, and TRD occurs in up to 40% of adolescents with MDD. TRD involves severe, persistent symptoms that are hard to treat, significantly reducing functioning and quality of life. We conducted a literature search focusing on key terms related to ketamine and esketamine for MDD with suicidal ideation and TRD in adolescents, aiming to review the potential utility of these molecules in adolescents for these conditions. Ketamine has shown efficacy in reducing depressive symptoms in adolescents with TRD. Esketamine has shown efficacy in reducing depressive symptoms and treating suicidal ideation in adolescents. Both ketamine and esketamine have demonstrated favorable safety and tolerability profiles. Using these drugs for serious conditions like adolescent MDD with suicidal thoughts and TRD can effectively treat symptoms, reduce self-harm and suicide risks, and provide a window for longer-term therapeutic interventions. The prompt and effective treatment of TRD could improve adolescents' quality of life. However, more research is needed to optimize treatment protocols and evaluate long-term effects.
Collapse
Affiliation(s)
- Simone Pardossi
- Department of Molecular Medicine, University of Siena School of Medicine, 53100 Siena, Italy; (A.F.); (S.S.); (A.C.)
| | | | | | | |
Collapse
|
10
|
Singh P, Vasundhara B, Das N, Sharma R, Kumar A, Datusalia AK. Metabolomics in Depression: What We Learn from Preclinical and Clinical Evidences. Mol Neurobiol 2024:10.1007/s12035-024-04302-5. [PMID: 38898199 DOI: 10.1007/s12035-024-04302-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 06/11/2024] [Indexed: 06/21/2024]
Abstract
Depression is one of the predominant common mental illnesses that affects millions of people of all ages worldwide. Random mood changes, loss of interest in routine activities, and prevalent unpleasant senses often characterize this common depreciated mental illness. Subjects with depressive disorders have a likelihood of developing cardiovascular complications, diabesity, and stroke. The exact genesis and pathogenesis of this disease are still questionable. A significant proportion of subjects with clinical depression display inadequate response to antidepressant therapies. Hence, clinicians often face challenges in predicting the treatment response. Emerging reports have indicated the association of depression with metabolic alterations. Metabolomics is one of the promising approaches that can offer fresh perspectives into the diagnosis, treatment, and prognosis of depression at the metabolic level. Despite numerous studies exploring metabolite profiles post-pharmacological interventions, a quantitative understanding of consistently altered metabolites is not yet established. The article gives a brief discussion on different biomarkers in depression and the degree to which biomarkers can improve treatment outcomes. In this review article, we have systemically reviewed the role of metabolomics in depression along with current challenges and future perspectives.
Collapse
Affiliation(s)
- Pooja Singh
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Raebareli, 226002, India
| | - Boosani Vasundhara
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Raebareli, 226002, India
| | - Nabanita Das
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Raebareli, 226002, India
| | - Ruchika Sharma
- Centre for Precision Medicine and Centre, Delhi Pharmaceutical Sciences and Research University (DPSRU), New Delhi, 110017, India
| | - Anoop Kumar
- Department of Pharmacology, Delhi Pharmaceutical Sciences and Research University (DPSRU), New Delhi, 110017, India
| | - Ashok Kumar Datusalia
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Raebareli, 226002, India.
- Department of Regulatory Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Raebareli, 226002, India.
| |
Collapse
|
11
|
Thai M, Nair AU, Klimes-Dougan B, Albott CS, Silamongkol T, Corkrum M, Hill D, Roemer JW, Lewis CP, Croarkin PE, Lim KO, Widge AS, Nahas Z, Eberly LE, Cullen KR. Deep transcranial magnetic stimulation for adolescents with treatment-resistant depression: A preliminary dose-finding study exploring safety and clinical effectiveness. J Affect Disord 2024; 354:589-600. [PMID: 38484878 PMCID: PMC11163675 DOI: 10.1016/j.jad.2024.03.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 02/20/2024] [Accepted: 03/09/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) is an intervention for treatment-resistant depression (TRD) that modulates neural activity. Deep TMS (dTMS) can target not only cortical but also deeper limbic structures implicated in depression. Although TMS has demonstrated safety in adolescents, dTMS has yet to be applied to adolescent TRD. OBJECTIVE/HYPOTHESIS This pilot study evaluated the safety, tolerability, and clinical effects of dTMS in adolescents with TRD. We hypothesized dTMS would be safe, tolerable, and efficacious for adolescent TRD. METHODS 15 adolescents with TRD (Age, years: M = 16.4, SD = 1.42) completed a six-week daily dTMS protocol targeting the left dorsolateral prefrontal cortex (BrainsWay H1 coil, 30 sessions, 10 Hz, 3.6 s train duration, 20s inter-train interval, 55 trains; 1980 total pulses per session, 80 % to 120 % of motor threshold). Participants completed clinical, safety, and neurocognitive assessments before and after treatment. The primary outcome was depression symptom severity measured by the Children's Depression Rating Scale-Revised (CDRS-R). RESULTS 14 out of 15 participants completed the dTMS treatments. One participant experienced a convulsive syncope; the other participants only experienced mild side effects (e.g., headaches). There were no serious adverse events and minimal to no change in cognitive performance. Depression symptom severity significantly improved pre- to post-treatment and decreased to a clinically significant degree after 10 treatment sessions. Six participants met criteria for treatment response. LIMITATIONS Main limitations include a small sample size and open-label design. CONCLUSIONS These findings provide preliminary evidence that dTMS may be tolerable and associated with clinical improvement in adolescent TRD.
Collapse
Affiliation(s)
- Michelle Thai
- Department of Psychology, University of Minnesota, Twin Cities, MN, United States of America; Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA, United States of America; Department of Psychiatry, Harvard Medical School, United States of America.
| | - Aparna U Nair
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Bonnie Klimes-Dougan
- Department of Psychology, University of Minnesota, Twin Cities, MN, United States of America
| | - C Sophia Albott
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Thanharat Silamongkol
- Graduate School of Applied and Professional Psychology, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States of America
| | - Michelle Corkrum
- Columbia University Medical Center, New York, NY, United States of America
| | - Dawson Hill
- University of Michigan Medical School, Ann Arbor, MI, United States of America
| | - Justin W Roemer
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Charles P Lewis
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States of America
| | - Kelvin O Lim
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Alik S Widge
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Ziad Nahas
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Lynn E Eberly
- Division of Biostatistics, School of Public Health, University of Minnesota, United States of America
| | - Kathryn R Cullen
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| |
Collapse
|
12
|
Gallop L, Westwood SJ, Hemmings A, Lewis Y, Campbell IC, Schmidt U. Effects of repetitive transcranial magnetic stimulation in children and young people with psychiatric disorders: a systematic review. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02475-x. [PMID: 38809301 DOI: 10.1007/s00787-024-02475-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 05/18/2024] [Indexed: 05/30/2024]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) has demonstrated benefits in adults with psychiatric disorders, but its clinical utility in children and young people (CYP) is unclear. This PRISMA systematic review used published and ongoing studies to examine the effects of rTMS on disorder-specific symptoms, mood and neurocognition in CYP with psychiatric disorders. We searched Medline via PubMed, Embase, PsychINFO via OVID, and Clinicaltrials.gov up to July 2023. Eligible studies involved multiple-session (i.e., treatment) rTMS in CYP (≤ 25 years-old) with psychiatric disorders. Two independent raters assessed the eligibility of studies and extracted data using a custom-built form. Out of 78 eligible studies (participant N = 1389), the majority (k = 54; 69%) reported an improvement in at least one outcome measure of disorder-specific core symptoms. Some studies (k = 21) examined rTMS effects on mood or neurocognition,: findings were largely positive. Overall, rTMS was well-tolerated with minimal side-effects. Of 17 ongoing or recently completed studies, many are sham-controlled RCTs with better blinding techniques and a larger estimated participant enrolment. Findings provide encouraging evidence for rTMS-related improvements in disorder-specific symptoms in CYP with different psychiatric disorders. However, in terms of both mood (for conditions other than depression) and neurocognitive outcomes, evidence is limited. Importantly, rTMS is well-tolerated and safe. Ongoing studies appear to be of improved methodological quality; however, future studies should broaden outcome measures to more comprehensively assess the effects of rTMS and develop guidance on dosage (i.e., treatment regimens).
Collapse
Affiliation(s)
- Lucy Gallop
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, PO Box 59, London, SE5 8AF, UK.
| | - Samuel J Westwood
- Department of Psychology, School of Social Science, University of Westminster, London, W1W 6UW, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AB, UK
| | - Amelia Hemmings
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, PO Box 59, London, SE5 8AF, UK
| | - Yael Lewis
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, PO Box 59, London, SE5 8AF, UK
- Hadarim Eating Disorder Unit, Shalvata Mental Health Centre, Hod Hasharon, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Iain C Campbell
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, PO Box 59, London, SE5 8AF, UK
| | - Ulrike Schmidt
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, PO Box 59, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
13
|
Havlik JL, Wahid S, Teopiz KM, McIntyre RS, Krystal JH, Rhee TG. Recent Advances in the Treatment of Treatment-Resistant Depression: A Narrative Review of Literature Published from 2018 to 2023. Curr Psychiatry Rep 2024; 26:176-213. [PMID: 38386251 DOI: 10.1007/s11920-024-01494-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE OF REVIEW We review recent advances in the treatment of treatment-resistant depression (TRD), a disorder with very limited treatment options until recently. We examine advances in psychotherapeutic, psychopharmacologic, and interventional psychiatry approaches to treatment of TRD. We also highlight various definitions of TRD in recent scientific literature. RECENT FINDINGS Recent evidence suggests some forms of psychotherapy can be effective as adjunctive treatments for TRD, but not as monotherapies alone. Little recent evidence supports the use of adjunctive non-antidepressant pharmacotherapies such as buprenorphine and antipsychotics for the treatment of TRD; side effects and increased medication discontinuation rates may outweigh the benefits of these adjunctive pharmacotherapies. Finally, a wealth of recent evidence supports the use of interventional approaches such as electroconvulsive therapy, ketamine/esketamine, and transcranial magnetic stimulation for TRD. Recent advances in our understanding of how to treat TRD have largely expanded our knowledge of best practices in, and efficacy of, interventional psychiatric approaches. Recent research has used a variety of TRD definitions for study inclusion criteria; research on TRD should adhere to inclusion criteria based on internationally defined guidelines for more meaningfully generalizable results.
Collapse
Affiliation(s)
- John L Havlik
- Yale University School of Medicine, New Haven, CT, USA
| | - Syed Wahid
- The University of Chicago, Chicago, IL, USA
| | - Kayla M Teopiz
- Brain and Cognition Discovery Foundation, Toronto, Canada
| | - Roger S McIntyre
- Brain and Cognition Discovery Foundation, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Pharmacology, University of Toronto, Toronto, Canada
| | - John H Krystal
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
- Department of Public Health Sciences, University of Connecticut, Farmington, CT, USA.
| |
Collapse
|
14
|
Johnson KA, Okun MS, Scangos KW, Mayberg HS, de Hemptinne C. Deep brain stimulation for refractory major depressive disorder: a comprehensive review. Mol Psychiatry 2024; 29:1075-1087. [PMID: 38287101 PMCID: PMC11348289 DOI: 10.1038/s41380-023-02394-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 12/18/2023] [Accepted: 12/21/2023] [Indexed: 01/31/2024]
Abstract
Deep brain stimulation (DBS) has emerged as a promising treatment for select patients with refractory major depressive disorder (MDD). The clinical effectiveness of DBS for MDD has been demonstrated in meta-analyses, open-label studies, and a few controlled studies. However, randomized controlled trials have yielded mixed outcomes, highlighting challenges that must be addressed prior to widespread adoption of DBS for MDD. These challenges include tracking MDD symptoms objectively to evaluate the clinical effectiveness of DBS with sensitivity and specificity, identifying the patient population that is most likely to benefit from DBS, selecting the optimal patient-specific surgical target and stimulation parameters, and understanding the mechanisms underpinning the therapeutic benefits of DBS in the context of MDD pathophysiology. In this review, we provide an overview of the latest clinical evidence of MDD DBS effectiveness and the recent technological advancements that could transform our understanding of MDD pathophysiology, improve the clinical outcomes for MDD DBS, and establish a path forward to develop more effective neuromodulation therapies to alleviate depressive symptoms.
Collapse
Affiliation(s)
- Kara A Johnson
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
- Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Michael S Okun
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
- Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Katherine W Scangos
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Helen S Mayberg
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Coralie de Hemptinne
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA.
- Department of Neurology, University of Florida, Gainesville, FL, USA.
| |
Collapse
|
15
|
Zhang M, Li W, Ye Y, Hu Z, Zhou Y, Ning Y. Efficacy and safety of intermittent theta burst stimulation on adolescents and young adults with major depressive disorder: A randomized, double blinded, controlled trial. J Affect Disord 2024; 350:214-221. [PMID: 38199406 DOI: 10.1016/j.jad.2024.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/02/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Intermittent theta burst stimulation (iTBS) is a newer form of Repetitive Transcranial Magnetic Stimulation (rTMS) for depression. However, its efficacy and safety in adolescents and young adults with major depressive disorder (AYA-MDD) have not been well studied, especially when applied with a strategy that combines neuronavigation targeting and accelerated iTBS. METHODS In this study, ninety patients were randomly assigned to twice-daily (two 600-pulse sessions spaced out by 10 min, n = 31), once-daily (one 600-pulse session, n = 29) or sham iTBS (no pulses, n = 30) groups for 10 treatment days. The primary outcome measure was the change in depression scores on the Hamilton Rating Scale for Depression (HAMD-17). Other clinical symptoms, such as anxiety, were also evaluated. RESULTS Linear mixed model analysis found that scores on the HAMD-17 and its factors improved in all three groups, but these improvements did not significantly differ among groups. Other clinical symptoms such as anxiety also improved. Response and remission rates were relatively low and did not differ among groups at any time point. The most common adverse event was headache, and the proportion of participants who reported headache in the twice-daily and once-daily groups was significantly higher than that in the sham group. CONCLUSIONS The current results indicated that twice-daily and once-daily iTBS under neuronavigation are safe and well tolerated in AYA-MDD, but the overall efficacy was not superior to that of sham treatment. We speculated several possible reasons such as the high placebo response of the young population, inadequate iTBS pulses and so on.
Collapse
Affiliation(s)
- Min Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weicheng Li
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yanxiang Ye
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Zhibo Hu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yanling Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Yuping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; The First School of Clinical Medicine, Southern Medical University, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.
| |
Collapse
|
16
|
Lisanby SH. Transcranial Magnetic Stimulation in Psychiatry: Historical Reflections and Future Directions. Biol Psychiatry 2024; 95:488-490. [PMID: 37169276 DOI: 10.1016/j.biopsych.2023.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/03/2023] [Accepted: 05/03/2023] [Indexed: 05/13/2023]
Affiliation(s)
- Sarah H Lisanby
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, Maryland.
| |
Collapse
|
17
|
Oberman LM, Benussi A. Transcranial Magnetic Stimulation Across the Lifespan: Impact of Developmental and Degenerative Processes. Biol Psychiatry 2024; 95:581-591. [PMID: 37517703 PMCID: PMC10823041 DOI: 10.1016/j.biopsych.2023.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/01/2023]
Abstract
Transcranial magnetic stimulation (TMS) has emerged as a pivotal noninvasive technique for investigating cortical excitability and plasticity across the lifespan, offering valuable insights into neurodevelopmental and neurodegenerative processes. In this review, we explore the impact of TMS applications on our understanding of normal development, healthy aging, neurodevelopmental disorders, and adult-onset neurodegenerative diseases. By presenting key developmental milestones and age-related changes in TMS measures, we provide a foundation for understanding the maturation of neurotransmitter systems and the trajectory of cognitive functions throughout the lifespan. Building on this foundation, the paper delves into the pathophysiology of neurodevelopmental disorders, including autism spectrum disorder, attention-deficit/hyperactivity disorder, Tourette syndrome, and adolescent depression. Highlighting recent findings on altered neurotransmitter circuits and dysfunctional cortical plasticity, we underscore the potential of TMS as a valuable tool for unraveling underlying mechanisms and informing future therapeutic interventions. We also review the emerging role of TMS in investigating and treating the most common adult-onset neurodegenerative disorders and late-onset depression. By outlining the therapeutic applications of noninvasive brain stimulation techniques in these disorders, we discuss the growing body of evidence supporting their use as therapeutic tools for symptom management and potentially slowing disease progression. The insights gained from TMS studies have advanced our understanding of the underlying mechanisms in both healthy and disease states, ultimately informing the development of more targeted diagnostic and therapeutic strategies for a wide range of neuropsychiatric conditions.
Collapse
Affiliation(s)
- Lindsay M Oberman
- National Institute of Mental Health Intramural Research Program, National Institutes of Health, Bethesda, Maryland
| | - Alberto Benussi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| |
Collapse
|
18
|
Dannhauer M, Gomez LJ, Robins PL, Wang D, Hasan NI, Thielscher A, Siebner HR, Fan Y, Deng ZD. Electric Field Modeling in Personalizing Transcranial Magnetic Stimulation Interventions. Biol Psychiatry 2024; 95:494-501. [PMID: 38061463 PMCID: PMC10922371 DOI: 10.1016/j.biopsych.2023.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/21/2023] [Accepted: 11/25/2023] [Indexed: 01/21/2024]
Abstract
The modeling of transcranial magnetic stimulation (TMS)-induced electric fields (E-fields) is a versatile technique for evaluating and refining brain targeting and dosing strategies, while also providing insights into dose-response relationships in the brain. This review outlines the methodologies employed to derive E-field estimations, covering TMS physics, modeling assumptions, and aspects of subject-specific head tissue and coil modeling. We also summarize various numerical methods for solving the E-field and their suitability for various applications. Modeling methodologies have been optimized to efficiently execute numerous TMS simulations across diverse scalp coil configurations, facilitating the identification of optimal setups or rapid cortical E-field visualization for specific brain targets. These brain targets are extrapolated from neurophysiological measurements and neuroimaging, enabling precise and individualized E-field dosing in experimental and clinical applications. This necessitates the quantification of E-field estimates using metrics that enable the comparison of brain target engagement, functional localization, and TMS intensity adjustments across subjects. The integration of E-field modeling with empirical data has the potential to uncover pivotal insights into the aspects of E-fields responsible for stimulating and modulating brain function and states, enhancing behavioral task performance, and impacting the clinical outcomes of personalized TMS interventions.
Collapse
Affiliation(s)
- Moritz Dannhauer
- Computational Neurostimulation Research Program, Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, Maryland
| | - Luis J Gomez
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, Indiana
| | - Pei L Robins
- Computational Neurostimulation Research Program, Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, Maryland
| | - Dezhi Wang
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, Indiana
| | - Nahian I Hasan
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, Indiana
| | - Axel Thielscher
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Hartwig R Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark; Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Yong Fan
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zhi-De Deng
- Computational Neurostimulation Research Program, Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, Maryland.
| |
Collapse
|
19
|
Croarkin PE, Zuckerman S, Middleton VJ, Monira N, Kriske J, Bowman J, Kriske J, Donachie N, Downar J. Clinical outcomes in adolescents undergoing sequential bilateral 1 Hz/20 Hz transcranial magnetic stimulation for treatment resistant depression. Brain Stimul 2024; 17:431-433. [PMID: 38570160 DOI: 10.1016/j.brs.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 03/24/2024] [Indexed: 04/05/2024] Open
Affiliation(s)
- Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
| | - Seth Zuckerman
- Salience Timothy J. Kriske Research Institute, Plano, TX, USA
| | | | - Naima Monira
- Salience Timothy J. Kriske Research Institute, Plano, TX, USA
| | | | - Jennifer Bowman
- Salience Timothy J. Kriske Research Institute, Plano, TX, USA
| | - John Kriske
- Salience TMS Neuro Solutions, Plano, TX, USA
| | | | - Jonathan Downar
- Institute of Medical Science and Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
20
|
Zugman A, Winkler AM, Qamar P, Pine DS. Current and Future Approaches to Pediatric Anxiety Disorder Treatment. Am J Psychiatry 2024; 181:189-200. [PMID: 38425255 PMCID: PMC11256210 DOI: 10.1176/appi.ajp.20231037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
This overview critically appraises the literature on the treatment of pediatric anxiety disorders. The two established treatments for these conditions comprise cognitive-behavioral therapy (CBT) and antidepressant medications. Many youths receiving these treatments fail to achieve remission, which creates a need for new treatments. After summarizing the literature on CBT and currently available medications, the authors describe research that lays a foundation for improvements in the treatment of pediatric anxiety disorders. This foundation leverages neuroscientific investigations, also described in the overview, which provide insights on mechanisms of successful treatment.
Collapse
Affiliation(s)
- Andre Zugman
- Section on Development and Affective Neuroscience (SDAN), Emotion and Development Branch (EDB), National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States
| | - Anderson M. Winkler
- Section on Development and Affective Neuroscience (SDAN), Emotion and Development Branch (EDB), National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States
- Division of Human Genetics, School of Medicine, The University of Texas Rio Grande Valley, Brownsville, Texas, United States
| | - Purnima Qamar
- Section on Development and Affective Neuroscience (SDAN), Emotion and Development Branch (EDB), National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States
| | - Daniel S. Pine
- Section on Development and Affective Neuroscience (SDAN), Emotion and Development Branch (EDB), National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States
| |
Collapse
|
21
|
Yam P. Brain stimulation poised to move from last resort to frontline treatment. Proc Natl Acad Sci U S A 2024; 121:e2401731121. [PMID: 38330017 PMCID: PMC10873550 DOI: 10.1073/pnas.2401731121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
|
22
|
Sylvester CM, Luby JL, Pine DS. Novel mechanism-based treatments for pediatric anxiety and depressive disorders. Neuropsychopharmacology 2024; 49:262-275. [PMID: 37608220 PMCID: PMC10700626 DOI: 10.1038/s41386-023-01709-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023]
Abstract
Pediatric anxiety and depressive disorders are common, can be highly impairing, and can persist despite the best available treatments. Here, we review research into novel treatments for childhood anxiety and depressive disorders designed to target underlying cognitive, emotional, and neural circuit mechanisms. We highlight three novel treatments lying along a continuum relating to clinical impact of the disorder and the intensity of clinical management required. We review cognitive training, which involves the lowest risk and may be applicable for problems with mild to moderate impact; psychotherapy, which includes a higher level of clinical involvement and may be sufficient for problems with moderate impact; and brain stimulation, which has the highest potential risks and is therefore most appropriate for problems with high impact. For each treatment, we review the specific underlying cognitive, emotional, and brain circuit mechanisms that are being targeted, whether treatments modify those underlying mechanisms, and efficacy in reducing symptoms. We conclude by highlighting future directions, including the importance of work that leverages developmental windows of high brain plasticity to time interventions to the specific epochs in childhood that have the largest and most enduring life-long impact.
Collapse
Affiliation(s)
- Chad M Sylvester
- Washington University Department of Psychiatry, St. Louis, MO, USA.
- Washington University Department of Radiology, St. Louis, MO, USA.
| | - Joan L Luby
- Washington University Department of Psychiatry, St. Louis, MO, USA
| | - Daniel S Pine
- National Institute of Mental Health, Emotion and Development Branch, St. Louis, MO, USA
| |
Collapse
|
23
|
Naguy A, Pridmore S, Alhazeem H, Alamiri B. Treatment-Resistant Juvenile Depression-A Quicksand? PSYCHOPHARMACOLOGY BULLETIN 2023; 53:54-56. [PMID: 38076664 PMCID: PMC10698857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Though research in juvenile depression is advancing, evidence examining effective treatments for Treatment-resistant juvenile depression remains at large limited. There is a dire need for more studies to help guide clinicians navigating these challenging cases.
Collapse
Affiliation(s)
- Ahmed Naguy
- Naguy, MBBch, MSc, Al-Manara CAP Centre, Kuwait Centre for Mental Health (KCMH), Shuwaikh, State of Kuwait
| | - Saxby Pridmore
- Pridmore, MD, FRANZCP, Discipline of Psychiatry, University of Tasmania, Hobart, Tasmania, Australia and TMS Unit, Saint Helens Private Hospital, Hobart, Tasmania
| | - Hessa Alhazeem
- Alhazeem, MD, College of Medicine, Kuwait University, Kuwait
| | - Bibi Alamiri
- Alamiri, MD, ABPN, ScD, PADA (Public Authority for Disabled Affairs), Al-Manara CAP Centre, KCMH, Kuwait, and Tufts University, Medford, United States
| |
Collapse
|
24
|
Smith JR, DiSalvo M, Green A, Ceranoglu TA, Anteraper SA, Croarkin P, Joshi G. Treatment Response of Transcranial Magnetic Stimulation in Intellectually Capable Youth and Young Adults with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis. Neuropsychol Rev 2023; 33:834-855. [PMID: 36161554 PMCID: PMC10039963 DOI: 10.1007/s11065-022-09564-1] [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: 11/01/2021] [Accepted: 08/31/2022] [Indexed: 11/26/2022]
Abstract
To examine current clinical research on the use of transcranial magnetic stimulation (TMS) in the treatment of pediatric and young adult autism spectrum disorder in intellectually capable persons (IC-ASD). We searched peer-reviewed international literature to identify clinical trials investigating TMS as a treatment for behavioral and cognitive symptoms of IC-ASD. We identified sixteen studies and were able to conduct a meta-analysis on twelve of these studies. Seven were open-label or used neurotypical controls for baseline cognitive data, and nine were controlled trials. In the latter, waitlist control groups were often used over sham TMS. Only one study conducted a randomized, parallel, double-blind, and sham controlled trial. Favorable safety data was reported in low frequency repetitive TMS, high frequency repetitive TMS, and intermittent theta burst studies. Compared to TMS research of other neuropsychiatric conditions, significantly lower total TMS pulses were delivered in treatment and neuronavigation was not regularly utilized. Quantitatively, our multivariate meta-analysis results report improvement in cognitive outcomes (pooled Hedges' g = 0.735, 95% CI = 0.242, 1.228; p = 0.009) and primarily Criterion B symptomology of IC-ASD (pooled Hedges' g = 0.435, 95% CI = 0.359, 0.511; p < 0.001) with low frequency repetitive TMS to the dorsolateral prefrontal cortex. The results of our systematic review and meta-analysis data indicate that TMS may offer a promising and safe treatment option for pediatric and young adult patients with IC-ASD. However, future work should include use of neuronavigation software, theta burst protocols, targeting of various brain regions, and robust study design before clinical recommendations can be made.
Collapse
Affiliation(s)
- Joshua R Smith
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, 1500 21st Avenue South, Suite 2200, Nashville, TN, 37212, USA.
- Vanderbilt Kennedy Center, 110 Magnolia Circle, Nashville, TN, 37203, USA.
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
- Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Maura DiSalvo
- Clinical and Research Programs in Pediatric Psychopharmacology, and Adult ADHD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Alan and Lorraine Bressler Clinical and Research Program for Autism Spectrum Disorder, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Allison Green
- Clinical and Research Programs in Pediatric Psychopharmacology, and Adult ADHD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Alan and Lorraine Bressler Clinical and Research Program for Autism Spectrum Disorder, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Psychological and Brain Sciences, Indiana University, 1101 East 10th Street, Bloomington, IN, 47405, USA
| | - Tolga Atilla Ceranoglu
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
- Clinical and Research Programs in Pediatric Psychopharmacology, and Adult ADHD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Alan and Lorraine Bressler Clinical and Research Program for Autism Spectrum Disorder, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | | | - Paul Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, 1216 2nd Street Southwest, Rochester, MN, 55902, USA
| | - Gagan Joshi
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
- Clinical and Research Programs in Pediatric Psychopharmacology, and Adult ADHD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Alan and Lorraine Bressler Clinical and Research Program for Autism Spectrum Disorder, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| |
Collapse
|
25
|
Lu F, Cui Q, Zou Y, Guo Y, Luo W, Yu Y, Gao J, Cai X, Fu L, Yuan S, Huang J, Zhang Y, Xie J, Sheng W, Tang Q, Gao Q, He Z, Chen H. Effects of rTMS Intervention on Functional Neuroimaging Activities in Adolescents with Major Depressive Disorder Measured Using Resting-State fMRI. Bioengineering (Basel) 2023; 10:1374. [PMID: 38135965 PMCID: PMC10740826 DOI: 10.3390/bioengineering10121374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/10/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) to the left dorsolateral prefrontal cortex (L-DLPFC) is commonly used for the clinical treatment of major depressive disorder (MDD). The neuroimaging biomarkers and mechanisms of rTMS are still not completely understood. This study aimed to explore the functional neuroimaging changes induced by rTMS in adolescents with MDD. A total of ten sessions of rTMS were administrated to the L-DLPFC in thirteen adolescents with MDD once a day for two weeks. All of them were scanned using resting-state functional magnetic resonance imaging at baseline and after rTMS treatment. The regional homogeneity (ReHo), amplitude of low-frequency fluctuation (ALFF), and the subgenual anterior cingulate cortex (sgACC)-based functional connectivity (FC) were computed as neuroimaging indicators. The correlation between changes in the sgACC-based FC and the improvement in depressive symptoms was also analyzed. After rTMS treatment, ReHo and ALFF were significantly increased in the L-DLPFC, the left medial prefrontal cortex, bilateral medial orbital frontal cortex, and the left ACC. ReHo and ALFF decreased mainly in the left middle occipital gyrus, the right middle cingulate cortex (MCC), bilateral calcarine, the left cuneus, and the left superior occipital gyrus. Furthermore, the FCs between the left sgACC and the L-DLPFC, the right IFGoper, the left MCC, the left precuneus, bilateral post-central gyrus, the left supplementary motor area, and the left superior marginal gyrus were enhanced after rTMS treatment. Moreover, the changes in the left sgACC-left MCC FC were associated with an improvement in depressive symptoms in early improvers. This study showed that rTMS treatment in adolescents with MDD causes changes in brain activities and sgACC-based FC, which may provide basic neural biomarkers for rTMS clinical trials.
Collapse
Affiliation(s)
- Fengmei Lu
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China; (F.L.); (Y.Z.); (Y.G.); (W.L.); (Y.Y.); (X.C.); (L.F.); (S.Y.); (J.H.); (Y.Z.); (J.X.); (W.S.); (Q.T.)
| | - Qian Cui
- School of Public Affairs and Administration, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Yang Zou
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China; (F.L.); (Y.Z.); (Y.G.); (W.L.); (Y.Y.); (X.C.); (L.F.); (S.Y.); (J.H.); (Y.Z.); (J.X.); (W.S.); (Q.T.)
| | - Yuanhong Guo
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China; (F.L.); (Y.Z.); (Y.G.); (W.L.); (Y.Y.); (X.C.); (L.F.); (S.Y.); (J.H.); (Y.Z.); (J.X.); (W.S.); (Q.T.)
| | - Wei Luo
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China; (F.L.); (Y.Z.); (Y.G.); (W.L.); (Y.Y.); (X.C.); (L.F.); (S.Y.); (J.H.); (Y.Z.); (J.X.); (W.S.); (Q.T.)
| | - Yue Yu
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China; (F.L.); (Y.Z.); (Y.G.); (W.L.); (Y.Y.); (X.C.); (L.F.); (S.Y.); (J.H.); (Y.Z.); (J.X.); (W.S.); (Q.T.)
| | - Jingjing Gao
- School of Information and Communication Engineering, University of Electronic Science and Technology of China, Chengdu 611731, China;
| | - Xiao Cai
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China; (F.L.); (Y.Z.); (Y.G.); (W.L.); (Y.Y.); (X.C.); (L.F.); (S.Y.); (J.H.); (Y.Z.); (J.X.); (W.S.); (Q.T.)
| | - Linna Fu
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China; (F.L.); (Y.Z.); (Y.G.); (W.L.); (Y.Y.); (X.C.); (L.F.); (S.Y.); (J.H.); (Y.Z.); (J.X.); (W.S.); (Q.T.)
| | - Shuai Yuan
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China; (F.L.); (Y.Z.); (Y.G.); (W.L.); (Y.Y.); (X.C.); (L.F.); (S.Y.); (J.H.); (Y.Z.); (J.X.); (W.S.); (Q.T.)
| | - Juan Huang
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China; (F.L.); (Y.Z.); (Y.G.); (W.L.); (Y.Y.); (X.C.); (L.F.); (S.Y.); (J.H.); (Y.Z.); (J.X.); (W.S.); (Q.T.)
| | - Yajun Zhang
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China; (F.L.); (Y.Z.); (Y.G.); (W.L.); (Y.Y.); (X.C.); (L.F.); (S.Y.); (J.H.); (Y.Z.); (J.X.); (W.S.); (Q.T.)
| | - Jing Xie
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China; (F.L.); (Y.Z.); (Y.G.); (W.L.); (Y.Y.); (X.C.); (L.F.); (S.Y.); (J.H.); (Y.Z.); (J.X.); (W.S.); (Q.T.)
| | - Wei Sheng
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China; (F.L.); (Y.Z.); (Y.G.); (W.L.); (Y.Y.); (X.C.); (L.F.); (S.Y.); (J.H.); (Y.Z.); (J.X.); (W.S.); (Q.T.)
| | - Qin Tang
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China; (F.L.); (Y.Z.); (Y.G.); (W.L.); (Y.Y.); (X.C.); (L.F.); (S.Y.); (J.H.); (Y.Z.); (J.X.); (W.S.); (Q.T.)
| | - Qing Gao
- School of Mathematical Sciences, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Zongling He
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China; (F.L.); (Y.Z.); (Y.G.); (W.L.); (Y.Y.); (X.C.); (L.F.); (S.Y.); (J.H.); (Y.Z.); (J.X.); (W.S.); (Q.T.)
| | - Huafu Chen
- The Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China; (F.L.); (Y.Z.); (Y.G.); (W.L.); (Y.Y.); (X.C.); (L.F.); (S.Y.); (J.H.); (Y.Z.); (J.X.); (W.S.); (Q.T.)
- MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 611731, China
- High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu 611731, China
| |
Collapse
|
26
|
Munot S, Kim N, Huang Y, Keller CJ. Direct cortical stimulation induces short-term plasticity of neural oscillations in humans. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.11.15.567302. [PMID: 38014071 PMCID: PMC10680685 DOI: 10.1101/2023.11.15.567302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Patterned brain stimulation is commonly employed as a tool for eliciting plasticity in brain circuits and treating neuropsychiatric disorders. Although widely used in clinical settings, there remains a limited understanding of how stimulation-induced plasticity influences neural oscillations and their interplay with the underlying baseline functional architecture. To address this question, we applied 15 minutes of 10Hz focal electrical simulation, a pattern identical to 'excitatory' repetitive transcranial magnetic stimulation (rTMS), to 14 medically-intractable epilepsy patients undergoing intracranial electroencephalographic (iEEG). We quantified the spectral features of the cortico-cortical evoked potential (CCEPs) in these patients before and after stimulation. We hypothesized that for a given region the temporal and spectral components of the CCEP predicted the location and degree of stimulation-induced plasticity. Across patients, low frequency power (alpha and beta) showed the broadest change, while the magnitude of change was stronger in high frequencies (beta and gamma). Next we demonstrated that regions with stronger baseline evoked spectral responses were more likely to undergo plasticity after stimulation. These findings were specific to a given frequency in a specific temporal window. Post-stimulation power changes were driven by the interaction between direction of change in baseline power and temporal window of change. Finally, regions exhibiting early increases and late decreases in evoked baseline power exhibited power changes after stimulation and were independent of stimulation location. Together, these findings that time-frequency baseline features predict post-stimulation plasticity effects demonstrate properties akin to Hebbian learning in humans and extend this theory to the temporal and spectral window of interest. These findings can help improve our understanding of human brain plasticity and lead to more effective brain stimulation techniques. Significance Statement Brain stimulation is increasingly used to treat neuropsychiatric disorders by inducing changes in neural activity at specific brain regions. Despite their effectiveness, how these changes occur, specifically in the spectral domain, is unknown. To better understand how brain oscillations change after patterned stimulation, we performed focused stimulation in epilepsy patients and measured intracranial brain recordings. We found strong and predictable changes in brain oscillations (plasticity) after patterned stimulation. Specifically, low frequencies showing widespread effects and high frequencies exhibiting a greater magnitude of change. These changes were directly related to the temporal and spectral structure of brain responses prior to stimulation. Our study reveals that baseline brain activity patterns can predict how stimulation will induce plasticity in the spectral domain. These findings can help improve our understanding of human brain plasticity and lead to more effective brain stimulation techniques. Highlights We applied 15 minutes of repetitive 10Hz focal electrical stimulation and assessed the evoked brain-wide spectral changes with intracranial EEG.10Hz stimulation induced short-term plasticity in low frequency alpha evoked power broadly across regions and time windows and high frequency (beta, gamma) power specifically in early evoked time windows (10-50ms).Across patients, frequency bands, and time windows, brain regions with stronger baseline evoked power were more likely to undergo greater spectral changes after 10Hz stimulation.Post-stimulation spectral changes were specific; that is, for a given frequency band in a specific time window, baseline evoked power predicted post-stimulation change in the same frequency band and time window.Post-stimulation spectral change was driven by an interaction between direction of change and temporal window of baseline power; that is, regions exhibiting baseline evoked early (10-100ms) increases and late (100-200ms) decreases in power correlated with observed post-stimulation spectral changes.These results were independent of stimulation location.
Collapse
|
27
|
Vaishnavi S. Transcranial Magnetic Stimulation for Developmental Neuropsychiatric Disorders with Inflammation. Dev Neurosci 2023; 45:342-348. [PMID: 37944502 PMCID: PMC10664335 DOI: 10.1159/000535103] [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: 11/10/2022] [Accepted: 11/07/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) is a noninvasive brain stimulation technique that may potentially be helpful for neuropsychiatric symptoms of developmental disorders with inflammatory aspects. TMS utilizes a varying magnetic field to induce electrical changes in the brain. Repetitive use of TMS modulates plasticity at multiple levels, particularly at the synapse and network level. SUMMARY As inflammation can affect synaptic plasticity negatively, TMS may theoretically be a tool to address this inflammation-induced dysfunction. There are also data to suggest that TMS can directly downregulate inflammation. Neuropsychiatric consequences of multiple disorders with inflammatory aspects, particularly neurodevelopmental disorders like autism, Tourette syndrome, and obsessive-compulsive disorder (OCD), maybe treated effectively with TMS. Treatment of OCD, treatment-resistant major depression, and nicotine cessation (all in adults) are currently FDA-cleared indications, while migraine is cleared for ages 12 and above. KEY MESSAGES TMS will likely continue to grow in terms of indications as research continues to assess what brain networks are dysfunctional in various disorders and it becomes clearer how to modulate these networks. TMS may thus be best understood as a technology platform that can be utilized to modulate different brain networks affected in neuropsychiatric disorders. TMS is likely to become an increasingly important tool in targeting brain networks that could become dysfunctional in part due to inflammation in the developing brain and addressing consequent neuropsychiatric symptoms.
Collapse
Affiliation(s)
- Sandeep Vaishnavi
- Duke Institute for Brain Sciences, Duke University, Durham, NC, USA
- Center for Neuropsychiatry and Brain Stimulation, ARC Health, Cary, NC, USA
| |
Collapse
|
28
|
Yuan H, Liu B, Li F, Jin Y, Zheng S, Ma Z, Wu Z, Chen C, Zhang L, Gu Y, Gao X, Yang Q. Effects of intermittent theta-burst transcranial magnetic stimulation on post-traumatic stress disorder symptoms: A randomized controlled trial. Psychiatry Res 2023; 329:115533. [PMID: 37826976 DOI: 10.1016/j.psychres.2023.115533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 10/14/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a prevalent and debilitating illness, which can be alleviated by transcranial magnetic stimulation (TMS). Intermittent theta burst stimulation (iTBS), a newer form of repetitive transcranial magnetic stimulation (rTMS), offers the advantage of shorter treatment sessions compared to the standard 10 Hz rTMS treatment. In order to compare the two forms of TMS, we enrolled 75 participants aged between 18 and 55 years who presented with (PCL-C) scale score of at least 50. Participants were randomly assigned to groups in a ratio of 1:1:1, receiving either 10 Hz rTMS, iTBS, or sham-controlled iTBS. Participants in the two treatment groups underwent 15 therapies which consisted of 1800 pulses and targeted the right dorsolateral prefrontal cortex (DLPFC). The main outcomes included changes in scores on the PCL-C and the Post-Traumatic Growth Inventory (PTGI). After intervention, the PCL-C and PTGI scores in iTBS and rTMS groups were significantly different from those in sham-controlled iTBS group. No significant differences in PCL-C and PTGI were found between the two active treatment groups. ITBS, with a shorter treatment duration, can effectively improve the symptoms of PTSD, with no significant difference in effect from that of rTMS. Future studies need to further elucidate the mechanisms, optimize the parameters and investigate the therapeutic potential and efficacy of iTBS in PTSD.
Collapse
Affiliation(s)
- Huiling Yuan
- Department of Military Medical Psychology, Air Force Medical University, Xi'an 710032, China; Department of Psychiatry, Xi'an International Medical Center Hospital, Xi'an, Shaanxi 710100, China
| | - Bin Liu
- Department of Military Medical Psychology, Air Force Medical University, Xi'an 710032, China
| | - Fengzhan Li
- Department of Military Medical Psychology, Air Force Medical University, Xi'an 710032, China
| | - Yinchuan Jin
- Department of Military Medical Psychology, Air Force Medical University, Xi'an 710032, China
| | - Shi Zheng
- State key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, China
| | - Zhujing Ma
- Department of Military Medical Psychology, Air Force Medical University, Xi'an 710032, China
| | - Zhongying Wu
- Department of Military Medical Psychology, Air Force Medical University, Xi'an 710032, China
| | - Chen Chen
- Department of Military Medical Psychology, Air Force Medical University, Xi'an 710032, China
| | - Liang Zhang
- Department of Military Medical Psychology, Air Force Medical University, Xi'an 710032, China
| | - Yanan Gu
- Department of Military Medical Psychology, Air Force Medical University, Xi'an 710032, China
| | - Xing Gao
- Department of Military Medical Psychology, Air Force Medical University, Xi'an 710032, China
| | - Qun Yang
- Department of Military Medical Psychology, Air Force Medical University, Xi'an 710032, China.
| |
Collapse
|
29
|
Deng ZD, Robins PL, Dannhauer M, Haugen LM, Port JD, Croarkin PE. Optimizing TMS Coil Placement Approaches for Targeting the Dorsolateral Prefrontal Cortex in Depressed Adolescents: An Electric Field Modeling Study. Biomedicines 2023; 11:2320. [PMID: 37626817 PMCID: PMC10452519 DOI: 10.3390/biomedicines11082320] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/18/2023] [Accepted: 07/23/2023] [Indexed: 08/27/2023] Open
Abstract
High-frequency repetitive transcranial magnetic stimulation (rTMS) to the left dorsolateral prefrontal cortex (L-DLPFC) shows promise as a treatment for treatment-resistant depression in adolescents. Conventional rTMS coil placement strategies include the 5 cm, the Beam F3, and the magnetic resonance imaging (MRI) neuronavigation methods. The purpose of this study was to use electric field (E-field) models to compare the three targeting approaches to a computational E-field optimization coil placement method in depressed adolescents. Ten depressed adolescents (4 females, age: 15.9±1.1) participated in an open-label rTMS treatment study and were offered MRI-guided rTMS five times per week over 6-8 weeks. Head models were generated based on individual MRI images, and E-fields were simulated for the four targeting approaches. Results showed a significant difference in the induced E-fields at the L-DLPFC between the four targeting methods (χ2=24.7, p<0.001). Post hoc pairwise comparisons showed that there was a significant difference between any two of the targeting methods (Holm adjusted p<0.05), with the 5 cm rule producing the weakest E-field (46.0±17.4V/m), followed by the F3 method (87.4±35.4V/m), followed by MRI-guided (112.1±14.6V/m), and followed by the computational approach (130.1±18.1V/m). Variance analysis showed that there was a significant difference in sample variance between the groups (K2=8.0, p<0.05), with F3 having the largest variance. Participants who completed the full course of treatment had median E-fields correlated with depression symptom improvement (r=-0.77, p<0.05). E-field models revealed limitations of scalp-based methods compared to MRI guidance, suggesting computational optimization could enhance dose delivery to the target.
Collapse
Affiliation(s)
- Zhi-De Deng
- Computational Neurostimulation Research Program, Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD 20892, USA; (P.L.R.); (M.D.)
| | - Pei L. Robins
- Computational Neurostimulation Research Program, Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD 20892, USA; (P.L.R.); (M.D.)
| | - Moritz Dannhauer
- Computational Neurostimulation Research Program, Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD 20892, USA; (P.L.R.); (M.D.)
| | - Laura M. Haugen
- Department of Neurosurgery, Mayo Clinic, Rochester, MN 55905, USA;
| | - John D. Port
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA;
- Mayo Clinic Depression Center, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA;
| | - Paul E. Croarkin
- Mayo Clinic Depression Center, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA;
| |
Collapse
|
30
|
Chang JC, Hai-Ti-Lin, Wang YC, Gau SSF. Treatment-resistant depression in children and adolescents. PROGRESS IN BRAIN RESEARCH 2023; 281:1-24. [PMID: 37806711 DOI: 10.1016/bs.pbr.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Major depressive disorder (MDD) in children and adolescents is a significant health problem, causing profound impairments in social, academic, and family functioning and substantial morbidity and mortality. Up to 15% of children and adolescents suffer from MDD, and a proportion, around 30 to 40% of them, failed to respond to initial selective serotonin reuptake inhibitor (SSRI) treatment. The only evidence-based recommendation is medication switching to another SSRI and augmentation with cognitive behavioral therapy. Newly developing treatment, including ketamine, transcranial magnetic stimulation, psychotherapy other than cognitive behavioral therapy, and combined pharmacotherapy with other interventions, requires further longitudinal controlled trials regarding efficacy and safety in this vulnerable population.
Collapse
Affiliation(s)
- Jung-Chi Chang
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hai-Ti-Lin
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yen-Ching Wang
- Department of Psychiatry, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Susan Shur-Fen Gau
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| |
Collapse
|
31
|
Abstract
Major depressive disorder is a substantial public health challenge impacting at least 3 million adolescents annually in the United States. Depressive symptoms do not improve in approximately 30% of adolescents who receive evidence-based treatments. Treatment-resistant depression in adolescents is broadly defined as a depressive disorder that does not respond to a 2-month course of an antidepressant medication at a dose equivalent of 40 mg of fluoxetine daily or 8 to 16 sessions of a cognitive behavioral or interpersonal therapy. This article reviews historical work, recent literature on classification, current evidence-based approaches, and emerging interventional research.
Collapse
Affiliation(s)
- Emine Rabia Ayvaci
- Department of Psychiatry, UT Southwestern Medical Center, 6300 Harry Hines Boulevard, Dallas, TX 75235, USA. https://twitter.com/AyvaciRabia
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| |
Collapse
|
32
|
Dong L, Chen WC, Su H, Wang ML, Du C, Jiang XR, Mei SF, Chen SJ, Liu XJ, Liu XB. Intermittent theta burst stimulation to the left dorsolateral prefrontal cortex improves cognitive function in polydrug use disorder patients: a randomized controlled trial. Front Psychiatry 2023; 14:1156149. [PMID: 37304431 PMCID: PMC10248467 DOI: 10.3389/fpsyt.2023.1156149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/10/2023] [Indexed: 06/13/2023] Open
Abstract
Background Polydrug abuse is common among opioid users. Individuals who use both heroin and methamphetamine (MA) have been shown to experience a wide range of cognitive deficits. Previous research shows that repetitive transcranial magnetic stimulation (rTMS) can change cerebral cortical excitability and regulate neurotransmitter concentration, which could improve cognitive function in drug addiction. However, the stimulation time, location, and possible mechanisms of rTMS are uncertain. Methods 56 patients with polydrug use disorder were randomized to receive 20 sessions of 10 Hz rTMS (n = 19), iTBS (n = 19), or sham iTBS (n = 18) to the left DLPFC. All patients used MA and heroin concurrently. Cognitive function was assessed and several related proteins including EPI, GABA-Aα5, IL-10, etc. were quantified by ELISA before and after the treatment. Results Baseline RBANS scores were lower than normal for age (77.25; IQR 71.5-85.5). After 20 treatment sessions, in the iTBS group, the RBANS score increased by 11.95 (95% CI 0.02-13.90, p = 0.05). In particular, there were improvements in memory and attention as well as social cognition. Following treatment, serum EPI and GABA-Aα5 were reduced and IL-10 was elevated. The improvement of immediate memory was negatively correlated with GABA-Aα5 (r = -0.646, p = 0.017), and attention was positively correlated with IL-10 (r = 0.610, p = 0.027). In the 10 Hz rTMS group, the improvement of the RBANS total score (80.21 ± 14.08 before vs.84.32 ± 13.80 after) and immediate memory (74.53 ± 16.65 before vs.77.53 ± 17.78 after) was statistically significant compared with the baseline (p < 0.05). However, compared with the iTBS group, the improvement was small and the difference was statistically significant. There was no statistically significant change in the sham group (78.00 ± 12.91 before vs.79.89 ± 10.92 after; p > 0.05). Conclusion Intermittent theta burst stimulation to the left DLPFC may improve cognitive function in polydrug use disorder patients. Its efficacy appears to be better than that of 10 Hz rTMS. The improvement of cognitive function may be related to GABA-Aα5 and IL-10. Our findings preliminarily demonstrate the clinical value of iTBS to the DLPFC to augment neurocognitive recovery in polydrug use disorders.
Collapse
Affiliation(s)
- Ling Dong
- Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
| | - Wen-Cai Chen
- Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
| | - Hang Su
- Shanghai Mental Health Center, Shanghai, China
| | - Mei-Ling Wang
- Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
| | - Cong Du
- Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
| | - Xing-ren Jiang
- Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
| | - Shu-fang Mei
- Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
| | - Si-Jing Chen
- Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
| | - Xiu-Jun Liu
- Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
| | - Xue-Bing Liu
- Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
| |
Collapse
|
33
|
Schulte-Körne G, Klingele C, Zsigo C, Kloek M. [The German S3 guideline for depressive disorders in childhood and adolescence: new developments]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023:10.1007/s00103-023-03721-4. [PMID: 37227472 DOI: 10.1007/s00103-023-03721-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 05/10/2023] [Indexed: 05/26/2023]
Abstract
The German guideline for the treatment of depressive disorders in children and adolescents was first published in July 2013. Currently, this guideline is undergoing revision, in which the recommendations of the original version of the guideline are revisited and updated. This report aims to give an overview of the current status and the next steps for this revision.As part of the revision process, the key questions posited in the original version were expanded upon. In this, new questions were added regarding complementary therapies, that is, therapies meant to be administered in addition to the usual treatment, as well as regarding the transitionary period from adolescence into adulthood. For all key questions, new systematic literature searches were conducted in order to update the relevant evidence. For this, randomized controlled studies, systematic reviews, and non-controlled intervention studies were included and rated according to their relevance as well as possible risks of bias. Thus, all studies could be assigned a level of evidence that takes into account both the quality and the importance of the study to the guideline.This report will give a brief overview of the most important insights resulting from the new evidence base identified for the revision. While insights regarding psychotherapy are largely unchanged, there are changes in the evidence for certain antidepressants. In the field of complementary therapies, new evidence has been found for physical activity. In general, it is likely that most recommendations of the original guideline regarding first- and second-line treatments will be updated. The completion of the revision and the publishing of the revised guideline are expected to take until the end of 2023.
Collapse
Affiliation(s)
- Gerd Schulte-Körne
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, LMU Klinikum, Nußbaumstr. 5a, 80336, München, Deutschland.
| | - Cosima Klingele
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, LMU Klinikum, Nußbaumstr. 5a, 80336, München, Deutschland
| | - Carolin Zsigo
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, LMU Klinikum, Nußbaumstr. 5a, 80336, München, Deutschland
| | - Maria Kloek
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, LMU Klinikum, Nußbaumstr. 5a, 80336, München, Deutschland
| |
Collapse
|
34
|
Yu T, Chen W, Huo L, Luo X, Wang J, Zhang B. Association between daily dose and efficacy of rTMS over the left dorsolateral prefrontal cortex in depression: A meta-analysis. Psychiatry Res 2023; 325:115260. [PMID: 37229909 DOI: 10.1016/j.psychres.2023.115260] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 05/27/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a well-established, safe, and effective brain stimulation technique for depression; however, uniform parameters have not been used in clinical practice. The aim of this study was to identify the parameters that affect rTMS effectiveness and ascertain the range in which that parameter has optimal efficacy. A meta-analysis of sham-controlled trials using rTMS delivered over the left dorsolateral prefrontal cortex (DLPFC) in depression was conducted. In the meta-regression and subgroup analyses, all rTMS stimulation parameters were extracted and their association with efficacy was investigated. Of the 17,800 references, 52 sham-controlled trials were included. Compared to sham controls, our results demonstrated a significant improvement in depressive symptoms at the end of treatment. According to the results of meta-regression, the number of pulses and sessions per day correlated with rTMS efficacy; however, the positioning method, stimulation intensity, frequency, number of treatment days, and total pulses did not. Furthermore, subgroup analysis revealed that the efficacy was correspondingly better in the group with higher daily pulses. In clinical practice, increasing the number of daily pulses and sessions may improve the effectiveness of rTMS.
Collapse
Affiliation(s)
- Tong Yu
- Department of Psychiatry, Guangzhou Medical University, Guangzhou, PR. China; The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, PR. China
| | - Wangni Chen
- Department of Psychiatry, Guangzhou Medical University, Guangzhou, PR. China; The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, PR. China
| | - Lijuan Huo
- Department of Psychiatry, Guangzhou Medical University, Guangzhou, PR. China; The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, PR. China
| | - Xin Luo
- Department of Psychiatry, Guangzhou Medical University, Guangzhou, PR. China; The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, PR. China
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR. China
| | - Bin Zhang
- Tianjin Anding Hospital, Tianjin Medical University, Tianjin, PR. China.
| |
Collapse
|
35
|
Saliba M, Drapeau N, Skime M, Hu X, Accardi CJ, Athreya AP, Kolacz J, Shekunov J, Jones DP, Croarkin PE, Romanowicz M. PISTACHIo (PreemptIon of diSrupTive behAvior in CHIldren): real-time monitoring of sleep and behavior of children 3-7 years old receiving parent-child interaction therapy augment with artificial intelligence - the study protocol, pilot study. Pilot Feasibility Stud 2023; 9:23. [PMID: 36759915 PMCID: PMC9909978 DOI: 10.1186/s40814-023-01254-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 01/28/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Emotional behavior problems (EBP) are the most common and persistent mental health issues in early childhood. Early intervention programs are crucial in helping children with EBP. Parent-child interaction therapy (PCIT) is an evidence-based therapy designed to address personal difficulties of parent-child dyads as well as reduce externalizing behaviors. In clinical practice, parents consistently struggle to provide accurate characterizations of EBP symptoms (number, timing of tantrums, precipitating events) even from the week before in their young children. The main aim of the study is to evaluate feasibility of the use of smartwatches in children aged 3-7 years with EBP. METHODS This randomized double-blind controlled study aims to recruit a total of 100 participants, consisting of 50 children aged 3-7 years with an EBP measure rated above the clinically significant range (T-score ≥ 60) (Eyberg Child Behavior Inventory-ECBI; Eyberg & Pincus, 1999) and their parents who are at least 18 years old. Participants are randomly assigned to the artificial intelligence-PCIT group (AI-PCIT) or the PCIT-sham biometric group. Outcome parameters include weekly ECBI and Pediatric Sleep Questionnaire (PSQ) as well as Child Behavior Checklist (CBCL) obtained weeks 1, 6, and 12 of the study. Two smartphone applications (Garmin connect and mEMA) and a wearable Garmin smartwatch are used collect the data to monitor step count, sleep, heart rate, and activity intensity. In the AI-PCIT group, the mEMA application will allow for the ecological momentary assessment (EMA) and will send behavioral alerts to the parent. DISCUSSION Real-time predictive technologies to engage patients rely on daily commitment on behalf of the participant and recurrent frequent smartphone notifications. Ecological momentary assessment (EMA) provides a way to digitally phenotype in-the-moment behavior and functioning of the parent-child dyad. One of the study's goals is to determine if AI-PCIT outcomes are superior in comparison with standard PCIT. Overall, we believe that the PISTACHIo study will also be able to determine tolerability of smartwatches in children aged 3-7 with EBP and could participate in a fundamental shift from the traditional way of assessing and treating EBP to a more individualized treatment plan based on real-time information about the child's behavior. TRIAL REGISTRATION The ongoing clinical trial study protocol conforms to the international Consolidated Standards of Reporting Trials (CONSORT) guidelines and is registered in clinicaltrials.gov (ID: NCT05077722), an international clinical trial registry.
Collapse
Affiliation(s)
- Maria Saliba
- grid.66875.3a0000 0004 0459 167XDepartment of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905 USA
| | - Noelle Drapeau
- grid.66875.3a0000 0004 0459 167XDepartment of Pediatrics, Mayo Clinic, Rochester, MN 55905 USA
| | - Michelle Skime
- grid.66875.3a0000 0004 0459 167XDepartment of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905 USA
| | - Xin Hu
- grid.189967.80000 0001 0941 6502Clinical Biomarkers Laboratory, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA 30322 USA
| | - Carolyn Jonas Accardi
- grid.189967.80000 0001 0941 6502Clinical Biomarkers Laboratory, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA 30322 USA
| | - Arjun P. Athreya
- grid.66875.3a0000 0004 0459 167XDepartment of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905 USA ,grid.66875.3a0000 0004 0459 167XDepartment of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN 55905 USA
| | - Jacek Kolacz
- grid.412332.50000 0001 1545 0811Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
| | - Julia Shekunov
- grid.66875.3a0000 0004 0459 167XDepartment of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905 USA
| | - Dean P. Jones
- grid.189967.80000 0001 0941 6502Clinical Biomarkers Laboratory, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA 30322 USA
| | - Paul E. Croarkin
- grid.66875.3a0000 0004 0459 167XDepartment of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905 USA
| | - Magdalena Romanowicz
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, 55905, USA.
| |
Collapse
|
36
|
Deng ZD, Robins PL, Dannhauer M, Haugen LM, Port JD, Croarkin PE. Comparison of coil placement approaches targeting dorsolateral prefrontal cortex in depressed adolescents receiving repetitive transcranial magnetic stimulation: an electric field modeling study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.06.23285526. [PMID: 36798297 PMCID: PMC9934718 DOI: 10.1101/2023.02.06.23285526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Background A promising treatment option for adolescents with treatment-resistant depression is high-frequency repetitive transcranial magnetic stimulation (rTMS) delivered to the left dorsolateral prefrontal cortex (L-DLPFC). Conventional coil placement strategies for rTMS in adults include the 5-cm rule, the Beam F3 method, and the magnetic resonance imaging (MRI) neuronavigation method. The purpose of this study was to compare the three targeting approaches to a computational E-field optimization coil placement method in depressed adolescents. Methods Ten consenting and assenting depressed adolescents (4 females, age: 15.9 ± 1.1) participated in an open-label rTMS treatment study. Participants were offered MRI-guided rTMS 5 times per week over 6-8 weeks. To compute the induced E-field, a head model was generated based on MRI images, and a figure-8 TMS coil (Neuronetics) was placed over the L-DLPFC using the four targeting approaches. Results Results show that there was a significant difference in the induced E-field at the L-DLPFC between the four targeting methods ( χ 2 = 24.7, p < 0.001). Post hoc pairwise comparisons show that there was a significant difference between any two of the targeting methods (Holm adjusted p < 0.05), with the 5-cm rule producing the weakest E-field (46.0 ± 17.4 V/m), followed by the F3 method (87.4 ± 35.4 V/m), followed by the MRI-guided (112.1 ± 14.6 V/m), and followed by the computationally optimized method (130.1 ± 18.1 V/m). The Bartlett test of homogeneity of variances show that there was a significant difference in sample variance between the groups ( K 2 = 8.0, p < 0.05), with F3 having the largest variance. In participants who completed the full course of treatment, the median E-field strength in the L-DLPFC was correlated with the change in depression severity ( r = - 0.77, p < 0.05). Conclusions The E-field models revealed inadequacies of scalp-based targeting methods compared to MRI-guidance. Computational optimization may further enhance E-field dose delivery to the treatment target.
Collapse
|
37
|
Marwaha S, Palmer E, Suppes T, Cons E, Young AH, Upthegrove R. Novel and emerging treatments for major depression. Lancet 2023; 401:141-153. [PMID: 36535295 DOI: 10.1016/s0140-6736(22)02080-3] [Citation(s) in RCA: 152] [Impact Index Per Article: 152.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/09/2022] [Accepted: 10/19/2022] [Indexed: 12/23/2022]
Abstract
Depression is common, costly, debilitating, and associated with increased risk of suicide. It is one of the leading global public health problems. Although existing available pharmacological treatments can be effective, their onset of action can take up to 6 weeks, side-effects are common, and recovery can require treatment with multiple different agents. Although psychosocial interventions might also be recommended, more effective treatments than those currently available are needed for people with moderate or severe depression. In the past 10 years, treatment trials have developed and tested many new targeted interventions. In this Review, we assess novel and emerging biological treatments for major depressive disorder, evaluate their putative brain and body mechanisms, and highlight how close each might be to clinical use.
Collapse
Affiliation(s)
- Steven Marwaha
- Institute for Mental Health, University of Birmingham, Birmingham, UK; Birmingham and Solihull Mental Health NHS Trust, Birmingham, UK
| | - Edward Palmer
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Trisha Suppes
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Emily Cons
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Allan H Young
- Centre for Affective Disorders, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, UK; Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Edgbaston, UK.
| |
Collapse
|
38
|
Zheng W, Lan XJ, Qin ZJ, Yang XH, Shi ZM. Low-frequency repetitive transcranial magnetic stimulation for children and adolescents with first-episode and drug-naïve major depressive disorder: A systematic review. Front Psychiatry 2023; 14:1111754. [PMID: 36911139 PMCID: PMC10000294 DOI: 10.3389/fpsyt.2023.1111754] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/20/2023] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVE This systematic review of randomized controlled trials (RCTs) was conducted to explore the therapeutic effects and safety of active low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) versus sham LF-rTMS in children and adolescent patients with first-episode and drug-naïve (FEDN) major depressive disorder (MDD). METHODS A systematic literature search was performed, and data were extracted by two independent researchers. The coprimary outcomes were study-defined response and remission. RESULTS A systematic search of the literature yielded 442 references, of which 3 RCTs (130 children and adolescents with FEDN MDD, 50.8% male, and mean age range from 14.5 to 17.5 years) met the inclusion criteria. Among the two RCTs (66.7%, 2/3) examining the effects of LF-rTMS on study-defined response and remission and cognitive function, active LF-rTMS was more efficacious than sham LF-rTMS in terms of study-defined response rate and cognitive function (all p < 0.05) but not regarding study-defined remission rate (all p > 0.05). No significant group differences were found with regard to adverse reactions. None of the included RCTs reported the dropout rate. CONCLUSION These findings preliminarily found that LF-rTMS could benefit children and adolescents with FEDN MDD in a relatively safe manner, although further studies are warranted.
Collapse
Affiliation(s)
- Wei Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xian-Jun Lan
- The Brain Hospital of Guangxi Zhuang Autonomous Region, LiuZhou, China
| | - Zhen-Juan Qin
- The Brain Hospital of Guangxi Zhuang Autonomous Region, LiuZhou, China
| | - Xin-Hu Yang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhan-Ming Shi
- Chongqing Jiangbei Mental Health Center, Chongqing, China
| |
Collapse
|
39
|
A retrospective examination of adjunctive L-methylfolate in children and adolescents with unipolar depression. J Affect Disord 2022; 312:315-321. [PMID: 35753502 DOI: 10.1016/j.jad.2022.06.039] [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: 12/13/2021] [Revised: 05/18/2022] [Accepted: 06/20/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Adjunctive l-methylfolate is commonly prescribed for children and adolescents with treatment-resistant mood disorders; however, the relationship between l-methylfolate augmentation across methylenetetrahydrofolate reductase (MTHFR) genotypes in youths with depressive symptoms is unclear. METHODS We retrospectively examined the electronic health records of patients (N = 412) with depressive symptoms associated with unipolar depressive disorders and their MTHFR C677T genotypes from 2013 to 2019. Patients were ≤18 years of age at the time of MTHFR pharmacogenetic testing. Treatment response was assessed with Clinical Global Impression-Improvement (CGI-I) score reported in the medical record. RESULTS Patients with an MTHFR C677T C/T or T/T genotype were more likely to be prescribed l-methylfolate when the clinician knew their MTHFR genotype (p < 0.0001, OR: 15.1, 95 % CI: [5.1, 44.2]), but not when the clinician did not know their genotype (p = 0.4, OR: 2.1, 95 % CI: [0.4, 11.4]). Change in baseline and endpoint CGI-I scores between patients with an MTHFR C677T variant who were prescribed and not prescribed l-methylfolate did not significantly differ (p = 0.39). Response rate was not associated with l-methylfolate prescription (p = 0.17) or l-methylfolate dose (p = 0.69). LIMITATIONS This was a retrospective study, which yielded a heterogeneous patient population and limited data availability (e.g., adherence). Patients are severely ill and may have a refractory illness that limits response to adjunctive l-methylfolate. CONCLUSION Clinicians prescribe l-methylfolate to children and adolescents with depressive symptoms associated with unipolar depressive disorders who have an MTHFR C677T variant, although augmentation may not be associated with treatment response, regardless of MTHFR genotype or dose.
Collapse
|
40
|
Nour MM, Liu Y, Dolan RJ. Functional neuroimaging in psychiatry and the case for failing better. Neuron 2022; 110:2524-2544. [PMID: 35981525 DOI: 10.1016/j.neuron.2022.07.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/06/2022] [Accepted: 07/08/2022] [Indexed: 12/27/2022]
Abstract
Psychiatric disorders encompass complex aberrations of cognition and affect and are among the most debilitating and poorly understood of any medical condition. Current treatments rely primarily on interventions that target brain function (drugs) or learning processes (psychotherapy). A mechanistic understanding of how these interventions mediate their therapeutic effects remains elusive. From the early 1990s, non-invasive functional neuroimaging, coupled with parallel developments in the cognitive neurosciences, seemed to signal a new era of neurobiologically grounded diagnosis and treatment in psychiatry. Yet, despite three decades of intense neuroimaging research, we still lack a neurobiological account for any psychiatric condition. Likewise, functional neuroimaging plays no role in clinical decision making. Here, we offer a critical commentary on this impasse and suggest how the field might fare better and deliver impactful neurobiological insights.
Collapse
Affiliation(s)
- Matthew M Nour
- Max Planck University College London Centre for Computational Psychiatry and Ageing Research, London WC1B 5EH, UK; Wellcome Trust Centre for Human Neuroimaging, University College London, London WC1N 3AR, UK; Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK.
| | - Yunzhe Liu
- Max Planck University College London Centre for Computational Psychiatry and Ageing Research, London WC1B 5EH, UK; State Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China; Chinese Institute for Brain Research, Beijing 102206, China
| | - Raymond J Dolan
- Max Planck University College London Centre for Computational Psychiatry and Ageing Research, London WC1B 5EH, UK; Wellcome Trust Centre for Human Neuroimaging, University College London, London WC1N 3AR, UK; State Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China.
| |
Collapse
|
41
|
Seewoo BJ, Rodger J, Demitrack MA, Heart KL, Port JD, Strawn JR, Croarkin PE. Neurostructural Differences in Adolescents With Treatment-Resistant Depression and Treatment Effects of Transcranial Magnetic Stimulation. Int J Neuropsychopharmacol 2022; 25:619-630. [PMID: 35089358 PMCID: PMC9380715 DOI: 10.1093/ijnp/pyac007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 01/11/2022] [Accepted: 01/26/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Despite its morbidity and mortality, the neurobiology of treatment-resistant depression (TRD) in adolescents and the impact of treatment on this neurobiology is poorly understood. METHODS Using automatic segmentation in FreeSurfer, we examined brain magnetic resonance imaging baseline volumetric differences among healthy adolescents (n = 30), adolescents with major depressive disorder (MDD) (n = 19), and adolescents with TRD (n = 34) based on objective antidepressant treatment rating criteria. A pooled subsample of adolescents with TRD were treated with 6 weeks of active (n = 18) or sham (n = 7) 10-Hz transcranial magnetic stimulation (TMS) applied to the left dorsolateral prefrontal cortex. Ten of the adolescents treated with active TMS were part of an open-label trial. The other adolescents treated with active (n = 8) or sham (n = 7) were participants from a randomized controlled trial. RESULTS Adolescents with TRD and adolescents with MDD had decreased total amygdala (TRD and MDD: -5%, P = .032) and caudal anterior cingulate cortex volumes (TRD: -3%, P = .030; MDD: -.03%, P = .041) compared with healthy adolescents. Six weeks of active TMS increased total amygdala volumes (+4%, P < .001) and the volume of the stimulated left dorsolateral prefrontal cortex (+.4%, P = .026) in adolescents with TRD. CONCLUSIONS Amygdala volumes were reduced in this sample of adolescents with MDD and TRD. TMS may normalize this volumetric finding, raising the possibility that TMS has neurostructural frontolimbic effects in adolescents with TRD. TMS also appears to have positive effects proximal to the site of stimulation.
Collapse
Affiliation(s)
- Bhedita J Seewoo
- Experimental and Regenerative Neurosciences, School of Biological Sciences, The University of Western Australia, WA, Australia
- Brain Plasticity Group, Perron Institute for Neurological and Translational Science, WA, Australia
- Centre for Microscopy, Characterisation and Analysis, Research Infrastructure Centre, The University of Western Australia, Perth, WA, Australia
| | - Jennifer Rodger
- Experimental and Regenerative Neurosciences, School of Biological Sciences, The University of Western Australia, WA, Australia
- Brain Plasticity Group, Perron Institute for Neurological and Translational Science, WA, Australia
| | - Mark A Demitrack
- Mayo Clinic, Rochester, Minnesota, USA; Trevena, Inc. Chesterbrook, Pennsylvania, USA
| | | | - John D Port
- Department of Radiology
Chesterbrook, Pennsylvania, USA
- Department of Psychiatry and Psychology
Chesterbrook, Pennsylvania, USA
| | - Jeffrey R Strawn
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio, USA
| | - Paul E Croarkin
- Department of Psychiatry and Psychology
Chesterbrook, Pennsylvania, USA
| |
Collapse
|
42
|
Adu MK, Shalaby R, Chue P, Agyapong VIO. Repetitive Transcranial Magnetic Stimulation for the Treatment of Resistant Depression: A Scoping Review. Behav Sci (Basel) 2022; 12:bs12060195. [PMID: 35735405 PMCID: PMC9220129 DOI: 10.3390/bs12060195] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/07/2022] [Accepted: 06/13/2022] [Indexed: 12/28/2022] Open
Abstract
Treatment-resistant depression (TRD) is associated with significant disability, and due to its high prevalence, it results in a substantive socio-economic burden at a global level. TRD is the inability to accomplish and/or achieve remission after an adequate trial of antidepressant treatments. Studies comparing repetitive transcranial magnetic stimulation (rTMS) with electroconvulsive therapy (ECT) and pharmacotherapy have revealed evidence of the therapeutic efficacy of rTMS in TRD. These findings suggest a crucial role for rTMS in the management of TRD. This article aims to conduct a comprehensive scoping review of the current literature concerning the use of rTMS and its therapeutic efficacy as a treatment modality for TRD. PubMed, PsycINFO, Medline, Embase, and Cinahl were used to identify important articles on rTMS for TRD. The search strategy was limited to English articles within the last five years of data publication. Articles were included if they reported on a completed randomized controlled trial (RCT) of rTMS intervention for TRD. The exclusion criteria involved studies with rTMS for the treatment of conditions other than TRD, and study and experimental protocols of rTMS on TRD. In total, 17 studies were eligible for inclusion in this review. The search strategy spanned studies published in the last five years, to the date of the data search (14 February 2022). The regional breakdown of the extracted studies was North American (n = 9), European (n = 5), Asian (n = 2) and Australian (n = 1). The applied frequencies of rTMS ranged from 5 Hz to 50 Hz, with stimulation intensities ranging from 80% MT to 120% MT. Overall, 16 out of the 17 studies suggested that rTMS treatment was effective, safe and tolerated in TRD. For patients with TRD, rTMS appears to provide significant benefits through the reduction of depressive symptoms, and while there is progressive evidence in support of the same, more research is needed in order to define standardized protocols of rTMS application in terms of localization, frequency, intensity, and pulse parameters.
Collapse
Affiliation(s)
- Medard Kofi Adu
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre (WMC), 8440 112 St NW, Edmonton, AB T6G 2B7, Canada; (R.S.); (P.C.); (V.I.O.A.)
- Correspondence:
| | - Reham Shalaby
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre (WMC), 8440 112 St NW, Edmonton, AB T6G 2B7, Canada; (R.S.); (P.C.); (V.I.O.A.)
| | - Pierre Chue
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre (WMC), 8440 112 St NW, Edmonton, AB T6G 2B7, Canada; (R.S.); (P.C.); (V.I.O.A.)
| | - Vincent I. O. Agyapong
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre (WMC), 8440 112 St NW, Edmonton, AB T6G 2B7, Canada; (R.S.); (P.C.); (V.I.O.A.)
- Department of Psychiatry, Dalhousie University, Halifax, NS B3H 4R2, Canada
| |
Collapse
|
43
|
Jivraj J, Ameis SH. Is Repetitive Transcranial Magnetic Stimulation (rTMS) Ready for Clinical Use as a Treatment Tool for Mental Health Targets in Children and Youth? JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2022; 31:93-99. [PMID: 35614951 PMCID: PMC9084373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 03/10/2022] [Indexed: 06/15/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation tool with potential for broad application in individuals with neuropsychiatric conditions. As in adults, most rTMS research in youth has focused on treatment-resistant depression. A limited number of rTMS studies have also been conducted in children and youth with primary diagnoses of Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder (ADHD) or Tourette's syndrome. Across the available rTMS literature, rTMS appears to be well tolerated with few adverse effects reported when applied to child and youth research samples. However, the potential efficacy of rTMS treatment for a variety of targets in children and youth remains unclear, due in part to limitations of the current literature, including studies using diverse protocols, potential for bias in existing clinical trial designs, variability in the research samples, and the use of heterogenous outcome measures. While rTMS is unlikely to take the place of more accessible treatments (e.g., psychopharmacological, psychosocial, psychotherapeutic), rTMS may provide a valuable alternative treatment option, particularly for those individuals where conventional treatments are inaccessible, poorly tolerated, or ineffective. A more robust body of well-designed, controlled trials, is needed in order to clarify rTMS treatment efficacy across relevant neuropsychiatric conditions, optimize treatment protocols, and meet the critical need for novel mental health interventions in children and youth.
Collapse
Affiliation(s)
- Jamil Jivraj
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Stephanie H Ameis
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario
- The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario
- Centre for Brain and Mental Health, Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario
| |
Collapse
|
44
|
Seewoo BJ, Hennessy LA, Jaeschke LA, Mackie LA, Etherington SJ, Dunlop SA, Croarkin PE, Rodger J. A Preclinical Study of Standard Versus Accelerated Transcranial Magnetic Stimulation for Depression in Adolescents. J Child Adolesc Psychopharmacol 2022; 32:187-193. [PMID: 34978846 PMCID: PMC9057889 DOI: 10.1089/cap.2021.0100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective: Ongoing studies are focused on adapting transcranial magnetic stimulation (TMS) for the treatment of major depressive disorder in adolescent humans. Most protocols in adolescent humans to date have delivered daily 10 Hz prefrontal stimulation with mixed results. Novel TMS dosing strategies such as accelerated TMS have recently been considered. There are knowledge gaps related to the potential clinical and pragmatic advantages of accelerated TMS. This pilot study compared the behavioral effects of a standard daily and accelerated low-intensity TMS (LI-TMS) protocol in an adolescent murine model of depression. Methods: Male adolescent Sprague Dawley rats were placed in transparent plexiglass tubes for 2.5 hours daily for 13 days as part of a study to validate the chronic restraint stress (CRS) protocol. Rats subsequently received 10 minutes of active or sham 10 Hz LI-TMS daily for 2 weeks (standard) or three times daily for 1 week (accelerated). Behavior was assessed using the elevated plus maze and forced swim test (FST). Hippocampal neurogenesis was assessed by injection of the thymidine analogue 5-ethynyl-2'-deoxyuridine at the end of LI-TMS treatment (2 weeks standard, 1 week accelerated), followed by postmortem histological analysis. Results: There were no significant differences in behavioral outcomes among animals receiving once-daily sham or active LI-TMS treatment. However, animals treated with accelerated LI-TMS demonstrated significant improvements in behavioral outcomes compared with sham treatment. Specifically, animals receiving active accelerated treatment showed greater latency to the first immobility behavior (p < 0.05; active: 130 ± 46 seconds; sham: 54 ± 39 seconds) and increased climbing behaviors (p < 0.05; active: 16 ± 5; sham: 9 ± 5) during FST. There were no changes in hippocampal neurogenesis nor any evidence of cell death in histological sections. Conclusions: An accelerated LI-TMS protocol outperformed the standard (once-daily) protocol in adolescent male animals with depression-like behaviors induced by CRS and was not accompanied by any toxicity or tolerability concerns. These preliminary findings support the speculation that novel TMS dosing strategies should be studied in adolescent humans and will inform future clinical protocols.
Collapse
Affiliation(s)
- Bhedita J. Seewoo
- Experimental and Regenerative Neurosciences, School of Biological Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Brain Plasticity Group, Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia.,Centre for Microscopy, Characterisation and Analysis, Research Infrastructure Centres, The University of Western Australia, Perth, Western Australia, Australia
| | - Lauren A. Hennessy
- Experimental and Regenerative Neurosciences, School of Biological Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Brain Plasticity Group, Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
| | - Liz A. Jaeschke
- Experimental and Regenerative Neurosciences, School of Biological Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Leah A. Mackie
- Experimental and Regenerative Neurosciences, School of Biological Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Sarah J. Etherington
- Medical, Molecular and Forensic Sciences, Murdoch University, Perth, Western Australia, Australia
| | - Sarah A. Dunlop
- Experimental and Regenerative Neurosciences, School of Biological Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Minderoo Foundation, Perth, Western Australia, Australia
| | - Paul E. Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jennifer Rodger
- Experimental and Regenerative Neurosciences, School of Biological Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Brain Plasticity Group, Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia.,Address correspondence to: Jennifer Rodger, PhD, Experimental and Regenerative Neurosciences, School of Biological Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| |
Collapse
|
45
|
Chen H, Hu X, Gao J, Han H, Wang X, Xue C. Early Effects of Repetitive Transcranial Magnetic Stimulation Combined With Sertraline in Adolescents With First-Episode Major Depressive Disorder. Front Psychiatry 2022; 13:853961. [PMID: 35928782 PMCID: PMC9343750 DOI: 10.3389/fpsyt.2022.853961] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Adolescence is a period of high incidence for depression. However, there is a limited treatment option for the adolescent depression. For treatment-resistant major depressive disorder, HF-rTMS of the left dorsolateral prefrontal cortex (DLPFC) appears therapeutically effective. The aim of the study is to explore the early effects of repetitive transcranial magnetic stimulation in combination with sertraline in adolescents with first-episode major depressive disorder. METHODS A total of 100 teenage patients with first-episode depression were randomly divided into the study groups. Both groups were treated with sertraline. In addition, the study group was treated with ten sessions of add-on rTMS. The control group was given sertraline only. The depressive symptom and cognitive function were assessed by the Hamilton depression rating scale 17 version (HAMD-17), Children's Depression Rating Scale-Revised (CDRS-R), Integrated visual and auditory continuous performance test (IVA-CPT), and THINC-it. RESULTS The number of early improvers after 2 weeks of treatment in the study group was statistically significant higher compared to the control group (95.83% vs 73.47%, χ2 = 9.277, P = 0.002). There was significant difference observed in responder rates (62.50% vs. 28.57%, χ2 = 11.262, P = 0.001) or in remission rates (31.25% vs. 6.12%, χ2 = 10.130, P = 0.001) between the two groups at 4 weeks. The score of HAMD-17 and CDRS-R in the study group were significantly lower than the control group (Fgroup = 12.91 vs 10.21, P < 0.05). Attention Quotient (listening, visual and full-scale) attention quotient of IVA-CPT in the study group were higher than those in the control group after treatment, and the differences were statistically significant(P < 0.05). The study group showed higher score in Spotter than the control group after treatment (P < 0.05). DISCUSSION This is the most extensive blinded, randomized clinical study to date examining the efficacy of 10-Hz add-on rTMS for first-onset adolescent depression. Our results support that add-on rTMS accelerates the efficacy of the antidepressants, improving the depressive symptoms and cold cognitive function in first-episode adolescent depression. CLINICAL TRIAL REGISTRATION [www.ClinicalTrials.gov], identifier [ChiCTR2100048534].
Collapse
Affiliation(s)
- Haisi Chen
- Affiliated Mental Health Center and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiwen Hu
- Affiliated Mental Health Center and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingfang Gao
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China.,The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China
| | - Huan Han
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiaole Wang
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China
| | - Chuang Xue
- Affiliated Mental Health Center and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
46
|
Transcranial magnetic stimulation in the treatment of adolescent depression: a systematic review and meta-analysis of aggregated and individual-patient data from uncontrolled studies. Eur Child Adolesc Psychiatry 2022; 31:1501-1525. [PMID: 35751003 PMCID: PMC9532325 DOI: 10.1007/s00787-022-02021-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/01/2022] [Indexed: 12/31/2022]
Abstract
Transcranial magnetic stimulation (TMS) is a non-invasive treatment for adolescent major depressive disorder (MDD). Existing evidence on the efficacy of TMS in adolescent MDD awaits quantitative synthesis. A systematic literature search was conducted, and data from eligible studies were synthesized using random-effects models. Treatment-covariate interactions were examined in exploratory analyses of individual-patient data (IPD). Systematic search of the literature yielded 1264 hits, of which 10 individual studies (2 randomized trials) were included for quantitative synthesis of mainly uncontrolled studies. Individual patient data (IPD) were available from five trials (all uncontrolled studies). Quantitative synthesis of aggregated data revealed a statistically significant negative overall standardized mean change (pooled SMCC = 2.04, 95% CI [1.46; 2.61], SE = 0.29, p < .001), as well as a significant overall treatment response rate (Transformed Proportion = 41.30%, 95% CI [31.03; 51.57], SE = 0.05; p < 0.001), considering data from baseline to post-treatment. Exploratory IPD analyses suggests TMS might be more effective in younger individuals and individuals with more severe depression, and efficacy might be enhanced with certain treatment modality settings, including higher number of TMS sessions, longer treatment durations, and unilateral and not bilateral stimulation. Existing studies exhibit methodological shortcomings, including small-study effects and lack of control group, blinding, and randomization-compromising the credibility of the present results. To date, two randomized controlled trials on TMS in adolescent depression have been published, and the only large-scale randomized trial suggests TMS is not more effective than sham stimulation. Future large-scale, randomized, and sham-controlled trials are warranted. Future trials should ensure appropriate selection of patients for TMS treatment and guide precision medicine approaches for stimulation protocols.
Collapse
|
47
|
Majumder P, Balan S, Gupta V, Wadhwa R, Perera TD. The Safety and Efficacy of Repetitive Transcranial Magnetic Stimulation in the Treatment of Major Depression Among Children and Adolescents: A Systematic Review. Cureus 2021; 13:e14564. [PMID: 34026380 PMCID: PMC8133761 DOI: 10.7759/cureus.14564] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2021] [Indexed: 12/29/2022] Open
Abstract
Major depression is a chronic debilitating condition affecting people of all ages and is rising over the past decade. Major depression among children and adolescents is often resistant to traditional treatments, thus necessitating the exploration of novel strategies. Repetitive transcranial magnetic stimulation (rTMS) is gaining increasing attention as a useful tool in treating various conditions and has received the US Food and Drug Administration (FDA) approval to treat depression and obsessive-compulsive disorder among adults. Favorable outcomes among adults generated interest in using it among children. Until recently, the existing literature lacked randomized sham-controlled trials on this topic among children and adolescents. The newest additions in the literature necessitated another in-depth look at the data to explore the safety and efficacy of rTMS in the context of depression among children and adolescents. We searched the Medline and Cochrane databases and included 18 articles for our systematic review. Our systematic review indicates level 1 evidence that rTMS is safe but failed to show its superiority to placebo as a stand-alone treatment for resistant depression among children and adolescents. However, there is level 2 evidence favoring add-on rTMS to treat major depression among children and adolescents. The study subjects appear to tolerate the rTMS treatment well with some minor and mostly self-limited side effects. Risks of treatment-emergent hypomanic symptoms and seizure appear to be very low. There is no evidence of worsening of suicidal ideation or cognitive decline during rTMS treatment.
Collapse
Affiliation(s)
| | | | - Vikas Gupta
- Psychiatry, South Carolina Department of Mental Health, Columbia, USA
| | - Roopma Wadhwa
- Psychiatry and Behavioral Sciences, South Carolina Department of Mental Health, South Carolina, USA
| | - Tarique D Perera
- Psychiatry and Behavioral Sciences, Contemporary Care, Greenwich, USA
| |
Collapse
|
48
|
Oberman LM, Hynd M, Nielson DM, Towbin KE, Lisanby SH, Stringaris A. Repetitive Transcranial Magnetic Stimulation for Adolescent Major Depressive Disorder: A Focus on Neurodevelopment. Front Psychiatry 2021; 12:642847. [PMID: 33927653 PMCID: PMC8076574 DOI: 10.3389/fpsyt.2021.642847] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/18/2021] [Indexed: 12/31/2022] Open
Abstract
Adolescent depression is a potentially lethal condition and a leading cause of disability for this age group. There is an urgent need for novel efficacious treatments since half of adolescents with depression fail to respond to current therapies and up to 70% of those who respond will relapse within 5 years. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising treatment for major depressive disorder (MDD) in adults who do not respond to pharmacological or behavioral interventions. In contrast, rTMS has not demonstrated the same degree of efficacy in adolescent MDD. We argue that this is due, in part, to conceptual and methodological shortcomings in the existing literature. In our review, we first provide a neurodevelopmentally focused overview of adolescent depression. We then summarize the rTMS literature in adult and adolescent MDD focusing on both the putative mechanisms of action and neurodevelopmental factors that may influence efficacy in adolescents. We then identify limitations in the existing adolescent MDD rTMS literature and propose specific parameters and approaches that may be used to optimize efficacy in this uniquely vulnerable age group. Specifically, we suggest ways in which future studies reduce clinical and neural heterogeneity, optimize neuronavigation by drawing from functional brain imaging, apply current knowledge of rTMS parameters and neurodevelopment, and employ an experimental therapeutics platform to identify neural targets and biomarkers for response. We conclude that rTMS is worthy of further investigation. Furthermore, we suggest that following these recommendations in future studies will offer a more rigorous test of rTMS as an effective treatment for adolescent depression.
Collapse
|