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Reddy PV, Basavaraju R, Sanjay TN, Ramesh A, Chowdhury P, Mehta UM, Venkatasubramanian G, Thirthalli J, Kesavan M. Investigational applications of transcranial magnetic stimulation (TMS) in Mood Disorders: Studies from a tertiary care center in India. Asian J Psychiatr 2024; 97:104054. [PMID: 38728813 DOI: 10.1016/j.ajp.2024.104054] [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: 11/30/2023] [Revised: 04/16/2024] [Accepted: 04/19/2024] [Indexed: 05/12/2024]
Abstract
The investigational potential of TMS in psychiatry is largely underutilized. In the current article, we present the results of five studies with similar TMS protocols that looked at the investigative applications of TMS via measuring cortical reactivity as potential biomarkers in mood disorders. The first two studies, evaluate potential of TMS parameters and Motor neuron system (MNS) as state or trait markers of BD. Third and fourth studies evaluate these as endophenotypic markers of BD. The fifth study which is an RCT evaluating add-on yoga in UD, evaluates if markers of CI can index the therapeutic response of yoga. In study one MT1 was significantly greater in the SM (symptomatic-mania) group compared to HC (healthy-control) (P=0.032). The cortical inhibition measures SICI was reduced in SM(P=0.021) and BD (remitted Bipolar) (P=0.023) groups compared to HC. LICI was increased in the SM(0.021) and BD(P=0.06) groups compared to HC. In study two, a significant group x time interaction effect was observed indicating higher putative MNS-activity mediation in patients compared to HC on SlCl(P=0.024), LlCl(P=0.033). There were no significant group differences noted in the endophenotype studies. The fifth study showed a significant time X group interaction for CSP, favoring improvement in YG (yoga-group) (p<0.01).No significant change was observed for LICI(p=0.2), SICI(p=0.5). Limitations of these studies notwithstanding, we conclude that cortical reactivity measured using TMS is a potential biomarker across the course of mood disorders, starting from state and trait markers to understanding the therapeutic mechanism of a particular treatment modality in these disorders.
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Affiliation(s)
- Preethi V Reddy
- Department of Psychiatry, NIMHANS, Hosur Road, Bengaluru 560029, India
| | | | - Tarasingh N Sanjay
- Department of Psychiatry, NIMHANS, Hosur Road, Bengaluru 560029, India; Psychiatry Registrar, North West Area Mental Health (NWAMH), Melbourne Health, Melbourne, Victoria, Australia
| | - Abhishek Ramesh
- Department of Psychiatry, NIMHANS, Hosur Road, Bengaluru 560029, India
| | - Praerna Chowdhury
- Center for Consciousness Studies, Department of Neurophysiology, Hosur Road NIMHANS, Bengaluru 560029, India
| | - Urvakhsh M Mehta
- Department of Psychiatry, NIMHANS, Hosur Road, Bengaluru 560029, India
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Smith SE, Kosik EL, van Engen Q, Kohn J, Hill AT, Zomorrodi R, Blumberger DM, Daskalakis ZJ, Hadas I, Voytek B. Magnetic seizure therapy and electroconvulsive therapy increase aperiodic activity. Transl Psychiatry 2023; 13:347. [PMID: 37968260 PMCID: PMC10651875 DOI: 10.1038/s41398-023-02631-y] [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: 08/24/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 11/17/2023] Open
Abstract
Major depressive disorder (MDD) is a leading cause of disability worldwide. One of the most efficacious treatments for treatment-resistant MDD is electroconvulsive therapy (ECT). Recently, magnetic seizure therapy (MST) was developed as an alternative to ECT due to its more favorable side effect profile. While these approaches have been very successful clinically, the neural mechanisms underlying their therapeutic effects are unknown. For example, clinical "slowing" of the electroencephalogram beginning in the postictal state and extending days to weeks post-treatment has been observed in both treatment modalities. However, a recent longitudinal study of a small cohort of ECT patients revealed that, rather than delta oscillations, clinical slowing was better explained by increases in aperiodic activity, an emerging EEG signal linked to neural inhibition. Here we investigate the role of aperiodic activity in a cohort of patients who received ECT and a cohort of patients who received MST treatment. We find that aperiodic neural activity increases significantly in patients receiving either ECT or MST. Although not directly related to clinical efficacy in this dataset, increased aperiodic activity is linked to greater amounts of neural inhibition, which is suggestive of a potential shared neural mechanism of action across ECT and MST.
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Affiliation(s)
- Sydney E Smith
- Neurosciences Graduate Program, University of California, San Diego, La Jolla, CA, USA.
| | - Eena L Kosik
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA, USA
| | - Quirine van Engen
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA, USA
| | - Jordan Kohn
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Aron T Hill
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, VIC, Australia
- Department of Psychiatry, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Reza Zomorrodi
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Itay Hadas
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Bradley Voytek
- Neurosciences Graduate Program, University of California, San Diego, La Jolla, CA, USA
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA, USA
- Halıcıoğlu Data Science Institute, University of California, San Diego, La Jolla, CA, USA
- Kavli Institute for Brain and Mind, University of California, San Diego, La Jolla, CA, USA
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Smith SE, Ma V, Gonzalez C, Chapman A, Printz D, Voytek B, Soltani M. Clinical EEG slowing induced by electroconvulsive therapy is better described by increased frontal aperiodic activity. Transl Psychiatry 2023; 13:348. [PMID: 37968263 PMCID: PMC10651871 DOI: 10.1038/s41398-023-02634-9] [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: 08/30/2023] [Revised: 10/03/2023] [Accepted: 10/18/2023] [Indexed: 11/17/2023] Open
Abstract
Electroconvulsive therapy (ECT) is one of the most efficacious interventions for treatment-resistant depression. Despite its efficacy, ECT's neural mechanism of action remains unknown. Although ECT has been associated with "slowing" in the electroencephalogram (EEG), how this change relates to clinical improvement is unresolved. Until now, increases in slow-frequency power have been assumed to indicate increases in slow oscillations, without considering the contribution of aperiodic activity, a process with a different physiological mechanism. In this exploratory study of nine MDD patients, we show that aperiodic activity, indexed by the aperiodic exponent, increases with ECT treatment. This increase better explains EEG "slowing" when compared to power in oscillatory peaks in the delta (1-3 Hz) range and is correlated to clinical improvement. In accordance with computational models of excitation-inhibition balance, these increases in aperiodic exponent are linked to increasing levels of inhibitory activity, suggesting that ECT might ameliorate depressive symptoms by restoring healthy levels of inhibition in frontal cortices.
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Affiliation(s)
- Sydney E Smith
- Neurosciences Graduate Program, University of California, San Diego, La Jolla, CA, USA.
| | - Vincent Ma
- Los Angeles General Medical Center, Los Angeles, CA, USA
| | - Celene Gonzalez
- Department of Radiology, University of California, San Diego Health, La Jolla, CA, USA
| | - Angela Chapman
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - David Printz
- Department of Psychiatry, VA San Diego Health, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Bradley Voytek
- Neurosciences Graduate Program, University of California, San Diego, La Jolla, CA, USA
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA, USA
- Halıcıoğlu Data Science Institute, University of California, San Diego, La Jolla, CA, USA
- Kavli Institute for Brain and Mind, University of California, San Diego, La Jolla, CA, USA
| | - Maryam Soltani
- Department of Psychiatry, VA San Diego Health, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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Smith SE, Kosik EL, van Engen Q, Kohn J, Hill AT, Zomorrodi R, Blumberger DM, Daskalakis ZJ, Hadas I, Voytek B. Magnetic seizure therapy and electroconvulsive therapy increase aperiodic activity. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.01.11.23284450. [PMID: 36711765 PMCID: PMC9882553 DOI: 10.1101/2023.01.11.23284450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Major depressive disorder (MDD) is a leading cause of disability worldwide. One of the most efficacious treatments for treatment-resistant MDD is electroconvulsive therapy (ECT). Recently, magnetic seizure therapy (MST) was developed as an alternative to ECT due to its more favorable side effect profile. While these approaches have been very successful clinically, the neural mechanisms underlying their therapeutic effects are unknown. For example, clinical "slowing" of the electroencephalogram beginning in the postictal state and extending days to weeks post-treatment has been observed in both treatment modalities. However, a recent longitudinal study of a small cohort of ECT patients revealed that, rather than delta oscillations, clinical slowing was better explained by increases in aperiodic activity, an emerging EEG signal linked to neural inhibition. Here we investigate the role of aperiodic activity in a cohort of patients who received ECT and a cohort of patients who received MST treatment. We find that aperiodic neural activity increases significantly in patients receiving either ECT or MST. Although not directly related to clinical efficacy in this dataset, increased aperiodic activity is linked to greater amounts of neural inhibition, which is suggestive of a potential shared neural mechanism of action across ECT and MST.
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Affiliation(s)
- Sydney E. Smith
- Neurosciences Graduate Program, University of California, San Diego, La Jolla, CA, USA
| | - Eena L. Kosik
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA, USA
| | - Quirine van Engen
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA, USA
| | - Jordan Kohn
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Aron T. Hill
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Victoria, Australia
- Department of Psychiatry, Central Clinical School, Monash University, Melbourne, Australia
| | - Reza Zomorrodi
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Daniel M. Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Zafiris J. Daskalakis
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Itay Hadas
- Department of Psychiatry, Central Clinical School, Monash University, Melbourne, Australia
| | - Bradley Voytek
- Neurosciences Graduate Program, University of California, San Diego, La Jolla, CA, USA
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA, USA
- Halıcıoğlu Data Science Institute, University of California, San Diego, La Jolla, CA, USA
- Kavli Institute for Brain and Mind, University of California, San Diego, La Jolla, CA, USA
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田 树, 徐 桂, 杨 新, Paul BF, Alan W. [Effect of electroconvulsive therapy on brain functional network in major depressive disorder]. SHENG WU YI XUE GONG CHENG XUE ZA ZHI = JOURNAL OF BIOMEDICAL ENGINEERING = SHENGWU YIXUE GONGCHENGXUE ZAZHI 2023; 40:426-433. [PMID: 37380380 PMCID: PMC10307598 DOI: 10.7507/1001-5515.202201032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/30/2023] [Indexed: 06/30/2023]
Abstract
Electroconvulsive therapy (ECT) is an interventional technique capable of highly effective neuromodulation in major depressive disorder (MDD), but its antidepressant mechanism remains unclear. By recording the resting-state electroencephalogram (RS-EEG) of 19 MDD patients before and after ECT, we analyzed the modulation effect of ECT on the resting-state brain functional network of MDD patients from multiple perspectives: estimating spontaneous EEG activity power spectral density (PSD) using Welch algorithm; constructing brain functional network based on imaginary part coherence (iCoh) and calculate functional connectivity; using minimum spanning tree theory to explore the topological characteristics of brain functional network. The results show that PSD, functional connectivity, and topology in multiple frequency bands were significantly changed after ECT in MDD patients. The results of this study reveal that ECT changes the brain activity of MDD patients, which provides an important reference in the clinical treatment and mechanism analysis of MDD.
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Affiliation(s)
- 树香 田
- 河北工业大学 河北省生物电磁与神经工程重点实验室(天津 300401)Key Laboratory of Bioelectromagnetic and Neural Engineering of Hebei Province, Hebei University of Technology, Tianjin 300401, P. R. China
- 河北工业大学 天津市生物电工与智能健康重点实验室(天津 300401)Tianjin Key Laboratory of Bioelectricity and Intelligent Health, Hebei University of Technology, Tianjin 300401, P. R. China
- 河北工业大学 省部共建电工装备可靠性与智能化国家重点实验室(天津 300130 )State Key Laboratory of Reliability and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin 300130, P.R.China
- 北京大学 中国药物依赖性研究所(北京 100191)National Institute on Drug Dependence, Peking University, Beijing 100191, P.R. China
| | - 桂芝 徐
- 河北工业大学 河北省生物电磁与神经工程重点实验室(天津 300401)Key Laboratory of Bioelectromagnetic and Neural Engineering of Hebei Province, Hebei University of Technology, Tianjin 300401, P. R. China
- 河北工业大学 天津市生物电工与智能健康重点实验室(天津 300401)Tianjin Key Laboratory of Bioelectricity and Intelligent Health, Hebei University of Technology, Tianjin 300401, P. R. China
- 河北工业大学 省部共建电工装备可靠性与智能化国家重点实验室(天津 300130 )State Key Laboratory of Reliability and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin 300130, P.R.China
| | - 新生 杨
- 河北工业大学 河北省生物电磁与神经工程重点实验室(天津 300401)Key Laboratory of Bioelectromagnetic and Neural Engineering of Hebei Province, Hebei University of Technology, Tianjin 300401, P. R. China
- 河北工业大学 天津市生物电工与智能健康重点实验室(天津 300401)Tianjin Key Laboratory of Bioelectricity and Intelligent Health, Hebei University of Technology, Tianjin 300401, P. R. China
- 河北工业大学 省部共建电工装备可靠性与智能化国家重点实验室(天津 300130 )State Key Laboratory of Reliability and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin 300130, P.R.China
| | - B Fitzgerald Paul
- 河北工业大学 河北省生物电磁与神经工程重点实验室(天津 300401)Key Laboratory of Bioelectromagnetic and Neural Engineering of Hebei Province, Hebei University of Technology, Tianjin 300401, P. R. China
| | - Wang Alan
- 河北工业大学 河北省生物电磁与神经工程重点实验室(天津 300401)Key Laboratory of Bioelectromagnetic and Neural Engineering of Hebei Province, Hebei University of Technology, Tianjin 300401, P. R. China
- 河北工业大学 天津市生物电工与智能健康重点实验室(天津 300401)Tianjin Key Laboratory of Bioelectricity and Intelligent Health, Hebei University of Technology, Tianjin 300401, P. R. China
- 河北工业大学 省部共建电工装备可靠性与智能化国家重点实验室(天津 300130 )State Key Laboratory of Reliability and Intelligence of Electrical Equipment, Hebei University of Technology, Tianjin 300130, P.R.China
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Transcranial Magnetic Stimulation Indices of Cortical Excitability Enhance the Prediction of Response to Pharmacotherapy in Late-Life Depression. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:265-275. [PMID: 34311121 PMCID: PMC8783923 DOI: 10.1016/j.bpsc.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/16/2021] [Accepted: 07/14/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Older adults with late-life depression (LLD) often experience incomplete or lack of response to first-line pharmacotherapy. The treatment of LLD could be improved using objective biological measures to predict response. Transcranial magnetic stimulation (TMS) can be used to measure cortical excitability, inhibition, and plasticity, which have been implicated in LLD pathophysiology and associated with brain stimulation treatment outcomes in younger adults with depression. TMS measures have not yet been investigated as predictors of treatment outcomes in LLD or pharmacotherapy outcomes in adults of any age with depression. METHODS We assessed whether pretreatment single-pulse and paired-pulse TMS measures, combined with clinical and demographic measures, predict venlafaxine treatment response in 76 outpatients with LLD. We compared the predictive performance of machine learning models including or excluding TMS predictors. RESULTS Two single-pulse TMS measures predicted venlafaxine response: cortical excitability (neuronal membrane excitability) and the variability of cortical excitability (dynamic fluctuations in excitability levels). In cross-validation, models using a combination of these TMS predictors, clinical markers of treatment resistance, and age classified patients with 73% ± 11% balanced accuracy (average correct classification rate of responders and nonresponders; permutation testing, p < .005); these models significantly outperformed (corrected t test, p = .025) models using clinical and demographic predictors alone (60% ± 10% balanced accuracy). CONCLUSIONS These preliminary findings suggest that single-pulse TMS measures of cortical excitability may be useful predictors of response to pharmacotherapy in LLD. Future studies are needed to confirm these findings and determine whether combining TMS predictors with other biomarkers further improves the accuracy of predicting LLD treatment outcome.
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Characterizing Cortical Oscillatory Responses in Major Depressive Disorder Before and After Convulsive Therapy: A TMS-EEG Study. J Affect Disord 2021; 287:78-88. [PMID: 33774319 DOI: 10.1016/j.jad.2021.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/24/2021] [Accepted: 03/02/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Combined transcranial magnetic stimulation and electroencephalography (TMS-EEG) is emerging as a powerful technique for interrogating neural circuit dysfunction in psychiatric disorders. Here, we utilized time-frequency analyses to characterize differences in neural oscillatory dynamics between subjects with major depressive disorder (MDD) and healthy controls (HC). We further examined changes in TMS-related oscillatory power following convulsive therapy. METHODS Oscillatory power was examined following TMS over the dorsolateral prefrontal and motor cortices (DLPFC and M1) in 38 MDD subjects, and 22 HCs. We further investigated how these responses changed in the MDD group following an acute course of convulsive therapy (either magnetic seizure therapy [MST, n = 24] or electroconvulsive therapy [ECT, n = 14]). RESULTS Prior to treatment, MDD subjects exhibited increased oscillatory power within delta, theta, and alpha frequency bands with TMS-EEG over the DLPFC, but showed no differences to HCs with stimulation over M1. Following MST, DLPFC stimulation revealed attenuated baseline-normalized power in the delta and theta bands, with reductions in the delta, theta, and alpha power following ECT. TMS over M1 revealed reduced delta and theta power following ECT, with no changes observed following MST. An association was also observed between the treatment- induced change in alpha power and depression severity score. LIMITATIONS Limitations include the modest sample size, open-label MST and ECT treatment designs, and lack of a placebo condition. CONCLUSIONS These results provide evidence of alterations in TMS-related oscillatory activity in MDD, and further suggest modulation of oscillatory power following ECT and MST.
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Kuhn M, Maier JG, Wolf E, Mainberger F, Feige B, Maywald S, Bredl A, Michel M, Sendelbach N, Normann C, Klöppel S, Eckert A, Riemann D, Nissen C. Indices of cortical plasticity after therapeutic sleep deprivation in patients with major depressive disorder. J Affect Disord 2020; 277:425-435. [PMID: 32866801 DOI: 10.1016/j.jad.2020.08.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/02/2020] [Accepted: 08/20/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Therapeutic sleep deprivation (SD) presents a unique paradigm to study the neurobiology of major depressive disorder (MDD). However, the rapid antidepressant mechanism, which differs from today's slow first-line treatments, is not sufficiently understood. We recently integrated two prominent hypotheses of MDD and sleep, the synaptic plasticity hypothesis of MDD and the synaptic homeostasis hypothesis of sleep-wake regulation, into a synaptic plasticity model of therapeutic SD in MDD. Here, we further tested this model positing that homeostatically elevating net synaptic strength through therapeutic SD shifts the initially deficient inducibility of associative synaptic long-term potentiation (LTP)-like plasticity in patients with MDD into a more favorable window of associative plasticity. METHODS We used paired associative stimulation (PAS), a transcranial magnetic stimulation protocol (TMS), to quantify cortical LTP-like plasticity after one night of therapeutic sleep deprivation in 28 patients with MDD. RESULTS We demonstrate a significantly different inducibility of associative plasticity in clinical responders to therapeutic SD (> 50% improvement on the 6-item Hamilton-Rating-Scale for Depression, n=13) compared to non-responders (n=15), which was driven by a long-term depression (LTD)-like response in SD-non-responders. Indices of global net synaptic strength (wake EEG theta activity, intracortical inhibition and BDNF serum levels) were increased after SD in both groups, with responders showing a generally lower intracortical inhibition than non-responders. LIMITATIONS Repetitive assessments prior to and after treatment would be needed to further determine potential mechanisms. CONCLUSION After a night of therapeutic SD, clinical responders show a significantly higher inducibility of associative LTP-like plasticity than non-responders.
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Affiliation(s)
- Marion Kuhn
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Jonathan G Maier
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Elias Wolf
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Florian Mainberger
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Bernd Feige
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Sarah Maywald
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Aliza Bredl
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Maike Michel
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Nicola Sendelbach
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Claus Normann
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Anne Eckert
- Neurobiology Lab for Brain Aging and Mental Health, Transfaculty Research Platform, Molecular & Cognitive Neuroscience, University of Basel, Basel, Switzerland; Psychiatric University Clinics, University of Basel, Basel, Switzerland
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Christoph Nissen
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
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Hill AT, Hadas I, Zomorrodi R, Voineskos D, Farzan F, Fitzgerald PB, Blumberger DM, Daskalakis ZJ. Modulation of functional network properties in major depressive disorder following electroconvulsive therapy (ECT): a resting-state EEG analysis. Sci Rep 2020; 10:17057. [PMID: 33051528 PMCID: PMC7555809 DOI: 10.1038/s41598-020-74103-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/12/2020] [Indexed: 12/18/2022] Open
Abstract
Electroconvulsive therapy (ECT) is a highly effective neuromodulatory intervention for treatment-resistant major depressive disorder (MDD). Presently, however, understanding of its neurophysiological effects remains incomplete. In the present study, we utilised resting-state electroencephalography (RS-EEG) to explore changes in functional connectivity, network topology, and spectral power elicited by an acute open-label course of ECT in a cohort of 23 patients with treatment-resistant MDD. RS-EEG was recorded prior to commencement of ECT and again within 48 h following each patient’s final treatment session. Our results show that ECT was able to enhance connectivity within lower (delta and theta) frequency bands across subnetworks largely confined to fronto-central channels, while, conversely, more widespread subnetworks of reduced connectivity emerged within faster (alpha and beta) bands following treatment. Graph-based topological analyses revealed changes in measures of functional segregation (clustering coefficient), integration (characteristic path length), and small-world architecture following ECT. Finally, post-treatment enhancement of delta and theta spectral power was observed, which showed a positive association with the number of ECT sessions received. Overall, our findings indicate that RS-EEG can provide a sensitive measure of dynamic neural activity following ECT and highlight network-based analyses as a promising avenue for furthering mechanistic understanding of the effects of convulsive therapies.
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Affiliation(s)
- Aron T Hill
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, 1001 Queen Street West, Unit 4-1, Toronto, ON, M6J 1H4, Canada
| | - Itay Hadas
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, 1001 Queen Street West, Unit 4-1, Toronto, ON, M6J 1H4, Canada
| | - Reza Zomorrodi
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, 1001 Queen Street West, Unit 4-1, Toronto, ON, M6J 1H4, Canada
| | - Daphne Voineskos
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, 1001 Queen Street West, Unit 4-1, Toronto, ON, M6J 1H4, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Faranak Farzan
- School of Mechatronic Systems Engineering, Centre for Engineering-Led Brain Research, Simon Fraser University, Surrey, BC, Canada
| | - Paul B Fitzgerald
- Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Commercial Rd, Melbourne, VIC, Australia
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, 1001 Queen Street West, Unit 4-1, Toronto, ON, M6J 1H4, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, 1001 Queen Street West, Unit 4-1, Toronto, ON, M6J 1H4, Canada. .,Institute of Medical Science, University of Toronto, Toronto, ON, Canada. .,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Jakhar J, Mehta UM, Ektare A, Vidyasagar PD, Varambally S, Thirthalli J, Gangadhar BN. Cortical inhibition in major depression: Investigating the acute effect of single-session yoga versus walking. Brain Stimul 2019; 12:1597-1599. [PMID: 31401073 DOI: 10.1016/j.brs.2019.07.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 07/25/2019] [Accepted: 07/31/2019] [Indexed: 12/27/2022] Open
Affiliation(s)
- Jitender Jakhar
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India.
| | - Aboli Ektare
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Pilli Devi Vidyasagar
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Shivarama Varambally
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Bangalore N Gangadhar
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
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11
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Voineskos D. After Electroconvulsive Therapy, Is a Bigger Hippocampus Always Better? Biol Psychiatry 2018; 84:e59-e60. [PMID: 30261978 DOI: 10.1016/j.biopsych.2018.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 07/17/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Daphne Voineskos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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12
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Kaster TS, Daskalakis ZJ, Noda Y, Knyahnytska Y, Downar J, Rajji TK, Levkovitz Y, Zangen A, Butters MA, Mulsant BH, Blumberger DM. Efficacy, tolerability, and cognitive effects of deep transcranial magnetic stimulation for late-life depression: a prospective randomized controlled trial. Neuropsychopharmacology 2018; 43:2231-2238. [PMID: 29946106 PMCID: PMC6135812 DOI: 10.1038/s41386-018-0121-x] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 12/22/2022]
Abstract
Late-life depression (LLD) is a growing worldwide problem due to demographic changes, with limited treatment options due to high rates of pharmacotherapy adverse effects, accessibility of psychotherapy, and tolerability of electroconvulsive therapy. Novel neuromodulation techniques, such as repetitive transcranial magnetic stimulation (rTMS), may overcome these limitations. The objective of this study is to determine the efficacy, tolerability, and cognitive effects of high-dose deep rTMS in LLD. In this study we randomized older adults between 60 and 85 years old with major depressive disorder (MDD) to sham or active deep rTMS (H1 coil, 6012 pulses, 18 Hz, 120% of resting motor threshold) delivered over the dorsolateral and ventrolateral prefrontal cortex 5 days per week over 4 weeks. Our primary outcome was remission of depression in an intention-to-treat analysis. We also assessed change in cognitive functioning with rTMS treatment and tolerability based on adverse effects. Fifty-two participants were randomized to active (n = 25) or sham H1 coil (n = 27). Remission rate was significantly higher with active than sham rTMS (40.0% vs 14.8%) with a number needed to treat of 4.0 (95% CI: 2.1-56.5). There was no change on any measure of executive function and no serious adverse events. Adverse effect profiles were similar between active and sham rTMS, except for reports of pain being significantly more common in the active condition (16.0% vs 0%). High-dose deep rTMS appears to be safe, well tolerated, and efficacious in the treatment of LLD.
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Affiliation(s)
- Tyler S. Kaster
- 0000 0000 8793 5925grid.155956.bTemerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON Canada ,0000 0001 2157 2938grid.17063.33Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Zafiris J. Daskalakis
- 0000 0000 8793 5925grid.155956.bTemerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON Canada ,0000 0001 2157 2938grid.17063.33Department of Psychiatry, University of Toronto, Toronto, ON Canada ,0000 0000 8793 5925grid.155956.bCampbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Yoshihiro Noda
- 0000 0004 1936 9959grid.26091.3cDepartment of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yuliya Knyahnytska
- 0000 0000 8793 5925grid.155956.bTemerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON Canada ,0000 0001 2157 2938grid.17063.33Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Jonathan Downar
- 0000 0001 2157 2938grid.17063.33Department of Psychiatry, University of Toronto, Toronto, ON Canada ,0000 0001 0012 4167grid.417188.3MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto, ON Canada
| | - Tarek K. Rajji
- 0000 0001 2157 2938grid.17063.33Department of Psychiatry, University of Toronto, Toronto, ON Canada ,0000 0000 8793 5925grid.155956.bCampbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,0000 0000 8793 5925grid.155956.bGeriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Yechiel Levkovitz
- 0000 0004 1937 0546grid.12136.37Be’er-Ya’akov Mental Health Center, Tel Aviv University, Be’er-Ya’akov, Israel
| | - Abraham Zangen
- 0000 0004 1937 0511grid.7489.2Department of Life Sciences and the Zlotowsky Neuroscience Center, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Meryl A. Butters
- 0000 0004 1936 9000grid.21925.3dDepartment of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Benoit H. Mulsant
- 0000 0001 2157 2938grid.17063.33Department of Psychiatry, University of Toronto, Toronto, ON Canada ,0000 0000 8793 5925grid.155956.bCampbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,0000 0000 8793 5925grid.155956.bGeriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Daniel M. Blumberger
- 0000 0000 8793 5925grid.155956.bTemerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON Canada ,0000 0001 2157 2938grid.17063.33Department of Psychiatry, University of Toronto, Toronto, ON Canada ,0000 0000 8793 5925grid.155956.bCampbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada ,0000 0000 8793 5925grid.155956.bGeriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON Canada
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