1
|
Dalhuisen I, van Oostrom I, Spijker J, Wijnen B, van Exel E, van Mierlo H, de Waardt D, Arns M, Tendolkar I, van Eijndhoven P. rTMS as a Next Step in Antidepressant Nonresponders: A Randomized Comparison With Current Antidepressant Treatment Approaches. Am J Psychiatry 2024; 181:806-814. [PMID: 39108161 DOI: 10.1176/appi.ajp.20230556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2024]
Abstract
OBJECTIVE Although repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for depression, little is known about the comparative effectiveness of rTMS and other treatment options, such as antidepressants. In this multicenter randomized controlled trial, rTMS was compared with the next pharmacological treatment step in patients with treatment-resistant depression. METHODS Patients with unipolar nonpsychotic depression (N=89) with an inadequate response to at least two treatment trials were randomized to treatment with rTMS or to a switch of antidepressants, both in combination with psychotherapy. Treatment duration was 8 weeks and consisted of either 25 high-frequency rTMS sessions to the left dorsolateral prefrontal cortex or a switch of antidepressant medication following the Dutch treatment algorithm. The primary outcome was change in depression severity based on the Hamilton Depression Rating Scale (HAM-D). Secondary outcomes were response and remission rates as well as change in symptom dimensions (anhedonia, anxiety, sleep, rumination, and cognitive reactivity). Finally, expectations regarding treatment were assessed. RESULTS rTMS resulted in a significantly larger reduction in depressive symptoms than medication, which was also reflected in higher response (37.5% vs. 14.6%) and remission (27.1% vs. 4.9%) rates. A larger decrease in symptoms of anxiety and anhedonia was observed after rTMS compared with a switch in antidepressants, and no difference from the medication group was seen for symptom reductions in rumination, cognitive reactivity, and sleep disorders. Expectations regarding treatment correlated with changes in HAM-D scores. CONCLUSIONS In a sample of patients with moderately treatment-resistant depression, rTMS was more effective in reducing depressive symptoms than a switch of antidepressant medication. In addition, the findings suggest that the choice of treatment may be guided by specific symptom dimensions.
Collapse
Affiliation(s)
- Iris Dalhuisen
- Department of Psychiatry, Radboud University Medical Center, and Donders Institute for Brain, Cognition, and Behavior, Centre for Medical Neuroscience, Nijmegen, the Netherlands (Dalhuisen, Tendolkar, van Eijndhoven); Neurocare Clinics, Nijmegen, the Netherlands (van Oostrom); Depression Expertise Centre, Pro Persona Mental Health Care, and Behavioral Science Institute, Radboud University, Nijmegen, the Netherlands (Spijker); Center for Economic Evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands (Wijnen); GGZ inGeest Specialized Mental Health Care, and Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (van Exel); Department of Psychiatry and Psychology, St. Antonius Hospital, Utrecht/Nieuwegein, the Netherlands (van Mierlo); Department of Psychiatry, Elisabeth-TweeSteden Ziekenhuis Hospital, Tilburg, the Netherlands (de Waardt); Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands (Arns); Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Arns)
| | - Iris van Oostrom
- Department of Psychiatry, Radboud University Medical Center, and Donders Institute for Brain, Cognition, and Behavior, Centre for Medical Neuroscience, Nijmegen, the Netherlands (Dalhuisen, Tendolkar, van Eijndhoven); Neurocare Clinics, Nijmegen, the Netherlands (van Oostrom); Depression Expertise Centre, Pro Persona Mental Health Care, and Behavioral Science Institute, Radboud University, Nijmegen, the Netherlands (Spijker); Center for Economic Evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands (Wijnen); GGZ inGeest Specialized Mental Health Care, and Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (van Exel); Department of Psychiatry and Psychology, St. Antonius Hospital, Utrecht/Nieuwegein, the Netherlands (van Mierlo); Department of Psychiatry, Elisabeth-TweeSteden Ziekenhuis Hospital, Tilburg, the Netherlands (de Waardt); Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands (Arns); Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Arns)
| | - Jan Spijker
- Department of Psychiatry, Radboud University Medical Center, and Donders Institute for Brain, Cognition, and Behavior, Centre for Medical Neuroscience, Nijmegen, the Netherlands (Dalhuisen, Tendolkar, van Eijndhoven); Neurocare Clinics, Nijmegen, the Netherlands (van Oostrom); Depression Expertise Centre, Pro Persona Mental Health Care, and Behavioral Science Institute, Radboud University, Nijmegen, the Netherlands (Spijker); Center for Economic Evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands (Wijnen); GGZ inGeest Specialized Mental Health Care, and Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (van Exel); Department of Psychiatry and Psychology, St. Antonius Hospital, Utrecht/Nieuwegein, the Netherlands (van Mierlo); Department of Psychiatry, Elisabeth-TweeSteden Ziekenhuis Hospital, Tilburg, the Netherlands (de Waardt); Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands (Arns); Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Arns)
| | - Ben Wijnen
- Department of Psychiatry, Radboud University Medical Center, and Donders Institute for Brain, Cognition, and Behavior, Centre for Medical Neuroscience, Nijmegen, the Netherlands (Dalhuisen, Tendolkar, van Eijndhoven); Neurocare Clinics, Nijmegen, the Netherlands (van Oostrom); Depression Expertise Centre, Pro Persona Mental Health Care, and Behavioral Science Institute, Radboud University, Nijmegen, the Netherlands (Spijker); Center for Economic Evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands (Wijnen); GGZ inGeest Specialized Mental Health Care, and Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (van Exel); Department of Psychiatry and Psychology, St. Antonius Hospital, Utrecht/Nieuwegein, the Netherlands (van Mierlo); Department of Psychiatry, Elisabeth-TweeSteden Ziekenhuis Hospital, Tilburg, the Netherlands (de Waardt); Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands (Arns); Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Arns)
| | - Eric van Exel
- Department of Psychiatry, Radboud University Medical Center, and Donders Institute for Brain, Cognition, and Behavior, Centre for Medical Neuroscience, Nijmegen, the Netherlands (Dalhuisen, Tendolkar, van Eijndhoven); Neurocare Clinics, Nijmegen, the Netherlands (van Oostrom); Depression Expertise Centre, Pro Persona Mental Health Care, and Behavioral Science Institute, Radboud University, Nijmegen, the Netherlands (Spijker); Center for Economic Evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands (Wijnen); GGZ inGeest Specialized Mental Health Care, and Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (van Exel); Department of Psychiatry and Psychology, St. Antonius Hospital, Utrecht/Nieuwegein, the Netherlands (van Mierlo); Department of Psychiatry, Elisabeth-TweeSteden Ziekenhuis Hospital, Tilburg, the Netherlands (de Waardt); Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands (Arns); Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Arns)
| | - Hans van Mierlo
- Department of Psychiatry, Radboud University Medical Center, and Donders Institute for Brain, Cognition, and Behavior, Centre for Medical Neuroscience, Nijmegen, the Netherlands (Dalhuisen, Tendolkar, van Eijndhoven); Neurocare Clinics, Nijmegen, the Netherlands (van Oostrom); Depression Expertise Centre, Pro Persona Mental Health Care, and Behavioral Science Institute, Radboud University, Nijmegen, the Netherlands (Spijker); Center for Economic Evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands (Wijnen); GGZ inGeest Specialized Mental Health Care, and Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (van Exel); Department of Psychiatry and Psychology, St. Antonius Hospital, Utrecht/Nieuwegein, the Netherlands (van Mierlo); Department of Psychiatry, Elisabeth-TweeSteden Ziekenhuis Hospital, Tilburg, the Netherlands (de Waardt); Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands (Arns); Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Arns)
| | - Dieuwertje de Waardt
- Department of Psychiatry, Radboud University Medical Center, and Donders Institute for Brain, Cognition, and Behavior, Centre for Medical Neuroscience, Nijmegen, the Netherlands (Dalhuisen, Tendolkar, van Eijndhoven); Neurocare Clinics, Nijmegen, the Netherlands (van Oostrom); Depression Expertise Centre, Pro Persona Mental Health Care, and Behavioral Science Institute, Radboud University, Nijmegen, the Netherlands (Spijker); Center for Economic Evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands (Wijnen); GGZ inGeest Specialized Mental Health Care, and Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (van Exel); Department of Psychiatry and Psychology, St. Antonius Hospital, Utrecht/Nieuwegein, the Netherlands (van Mierlo); Department of Psychiatry, Elisabeth-TweeSteden Ziekenhuis Hospital, Tilburg, the Netherlands (de Waardt); Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands (Arns); Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Arns)
| | - Martijn Arns
- Department of Psychiatry, Radboud University Medical Center, and Donders Institute for Brain, Cognition, and Behavior, Centre for Medical Neuroscience, Nijmegen, the Netherlands (Dalhuisen, Tendolkar, van Eijndhoven); Neurocare Clinics, Nijmegen, the Netherlands (van Oostrom); Depression Expertise Centre, Pro Persona Mental Health Care, and Behavioral Science Institute, Radboud University, Nijmegen, the Netherlands (Spijker); Center for Economic Evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands (Wijnen); GGZ inGeest Specialized Mental Health Care, and Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (van Exel); Department of Psychiatry and Psychology, St. Antonius Hospital, Utrecht/Nieuwegein, the Netherlands (van Mierlo); Department of Psychiatry, Elisabeth-TweeSteden Ziekenhuis Hospital, Tilburg, the Netherlands (de Waardt); Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands (Arns); Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Arns)
| | - Indira Tendolkar
- Department of Psychiatry, Radboud University Medical Center, and Donders Institute for Brain, Cognition, and Behavior, Centre for Medical Neuroscience, Nijmegen, the Netherlands (Dalhuisen, Tendolkar, van Eijndhoven); Neurocare Clinics, Nijmegen, the Netherlands (van Oostrom); Depression Expertise Centre, Pro Persona Mental Health Care, and Behavioral Science Institute, Radboud University, Nijmegen, the Netherlands (Spijker); Center for Economic Evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands (Wijnen); GGZ inGeest Specialized Mental Health Care, and Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (van Exel); Department of Psychiatry and Psychology, St. Antonius Hospital, Utrecht/Nieuwegein, the Netherlands (van Mierlo); Department of Psychiatry, Elisabeth-TweeSteden Ziekenhuis Hospital, Tilburg, the Netherlands (de Waardt); Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands (Arns); Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Arns)
| | - Philip van Eijndhoven
- Department of Psychiatry, Radboud University Medical Center, and Donders Institute for Brain, Cognition, and Behavior, Centre for Medical Neuroscience, Nijmegen, the Netherlands (Dalhuisen, Tendolkar, van Eijndhoven); Neurocare Clinics, Nijmegen, the Netherlands (van Oostrom); Depression Expertise Centre, Pro Persona Mental Health Care, and Behavioral Science Institute, Radboud University, Nijmegen, the Netherlands (Spijker); Center for Economic Evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands (Wijnen); GGZ inGeest Specialized Mental Health Care, and Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (van Exel); Department of Psychiatry and Psychology, St. Antonius Hospital, Utrecht/Nieuwegein, the Netherlands (van Mierlo); Department of Psychiatry, Elisabeth-TweeSteden Ziekenhuis Hospital, Tilburg, the Netherlands (de Waardt); Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands (Arns); Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Arns)
| |
Collapse
|
2
|
Wardle MC, Webber HE, Yoon JH, Heads AM, Stotts AL, Lane SD, Schmitz JM. Behavioral therapies targeting reward mechanisms in substance use disorders. Pharmacol Biochem Behav 2024; 240:173787. [PMID: 38705285 DOI: 10.1016/j.pbb.2024.173787] [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: 01/17/2024] [Revised: 04/04/2024] [Accepted: 05/02/2024] [Indexed: 05/07/2024]
Abstract
Behavioral therapies are considered best practices in the treatment of substance use disorders (SUD) and used as first-line approaches for SUDs without FDA-approved pharmacotherapies. Decades of research on the neuroscience of drug reward and addiction have informed the development of current leading behavioral therapies that, while differing in focus and technique, have in common the overarching goal of shifting reward responding away from drug and toward natural non-drug rewards. This review begins by describing key neurobiological processes of reward in addiction, followed by a description of how various behavioral therapies address specific reward processes. Based on this review, a conceptual 'map' is crafted to pinpoint gaps and areas of overlap, serving as a guide for selecting and integrating behavioral therapies.
Collapse
Affiliation(s)
- Margaret C Wardle
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Heather E Webber
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Jin H Yoon
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Angela M Heads
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Angela L Stotts
- Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, United States of America
| | - Scott D Lane
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Joy M Schmitz
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States of America.
| |
Collapse
|
3
|
Tang SJ, Holle J, Dadario NB, Lesslar O, Teo C, Ryan M, Sughrue M, Yeung JT. Personalized, parcel-guided rTMS for the treatment of major depressive disorder: Safety and proof of concept. Brain Behav 2023; 13:e3268. [PMID: 37798655 PMCID: PMC10636393 DOI: 10.1002/brb3.3268] [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: 07/04/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Not all patients with major depressive disorder (MDD) benefit from the US Food and Drug Administration-approved use of repetitive transcranial magnetic stimulation (rTMS) at the dorsolateral prefrontal cortex. We may be undertreating depression with this one-size-fits-all rTMS strategy. METHODS We present a retrospective review of targeted and connectome-guided rTMS in 26 patients from Cingulum Health from 2020 to 2023 with MDD or MDD with associated symptoms. rTMS was conducted by identifying multiple cortical targets based on anomalies in individual functional connectivity networks as determined by machine learning connectomic software. Quality of life assessed by the EuroQol (EQ-5D) score and depression symptoms assessed by the Beck Depression Inventory (BDI) were administered prior to treatment, directly after, and at a follow-up consultation. RESULTS Of the 26 patients treated with rTMS, 16 (62%) attained remission after treatment. Of the 19 patients who completed follow-up assessments after an average interval of 2.6 months, 11 (58%) responded to treatment and 13 (68%) showed significant remission. Between patients classified with or without treatment-resistant depression, there was no difference in BDI improvement. Additionally, there was significant improvement in quality of life after treatment and during follow-up compared to baseline. LIMITATIONS This review is retrospective in nature, so there is no control group to assess the placebo effect on patient outcomes. CONCLUSION The personalized, connectome-guided approach of rTMS is safe and may be effective for depression. This personalized rTMS treatment allows for co-treatment of multiple disorders, such as the comorbidity of depression and anxiety.
Collapse
Affiliation(s)
- Si Jie Tang
- School of MedicineUniversity of California Davis Medical CenterSacramentoCaliforniaUSA
| | | | - Nicholas B. Dadario
- Robert Wood Johnson Medical SchoolRutgers UniversityNew BrunswickNew JerseyUSA
| | | | | | | | | | - Jacky T. Yeung
- Cingulum HealthSydneyAustralia
- Department of NeurosurgeryYale University School of MedicineNew HavenConnecticutUSA
| |
Collapse
|
4
|
Yuan S, Luo X, Zhang B. Individualized Repetitive Transcranial Magnetic Stimulation for Depression Based on Magnetic Resonance Imaging. ALPHA PSYCHIATRY 2023; 24:273-275. [PMID: 38313447 PMCID: PMC10837601 DOI: 10.5152/alphapsychiatry.2023.231412] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/17/2023] [Indexed: 02/06/2024]
Affiliation(s)
- Shiqi Yuan
- Psychiatric and Psychological Neuroimage Laboratory (PsyNI Lab), The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xin Luo
- Psychiatric and Psychological Neuroimage Laboratory (PsyNI Lab), The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Bin Zhang
- Tianjin Anding Hospital, Tianjin Medical University, Institute of Mental Health, Tianjin, China
| |
Collapse
|
5
|
Davis SW, Beynel L, Neacsiu AD, Luber BM, Bernhardt E, Lisanby SH, Strauman TJ. Network-level dynamics underlying a combined rTMS and psychotherapy treatment for major depressive disorder: An exploratory network analysis. Int J Clin Health Psychol 2023; 23:100382. [PMID: 36922930 PMCID: PMC10009060 DOI: 10.1016/j.ijchp.2023.100382] [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: 11/15/2022] [Accepted: 02/16/2023] [Indexed: 03/07/2023] Open
Abstract
Background Despite the growing use of repetitive transcranial magnetic stimulation (rTMS) as a treatment for depression, there is a limited understanding of the mechanisms of action and how potential treatment-related brain changes help to characterize treatment response. To address this gap in understanding we investigated the effects of an approach combining rTMS with simultaneous psychotherapy on global functional connectivity. Method We compared task-related functional connectomes based on an idiographic goal priming task tied to emotional regulation acquired before and after simultaneous rTMS/psychotherapy treatment for patients with major depressive disorders and compared these changes to normative connectivity patterns from a set of healthy volunteers (HV) performing the same task. Results At baseline, compared to HVs, patients demonstrated hyperconnectivity of the DMN, cerebellum and limbic system, and hypoconnectivity of the fronto-parietal dorsal-attention network and visual cortex. Simultaneous rTMS/psychotherapy helped to normalize these differences, which were reduced after treatment. This finding suggests that the rTMS/therapy treatment regularizes connectivity patterns in both hyperactive and hypoactive brain networks. Conclusions These results help to link treatment to a comprehensive model of the neurocircuitry underlying depression and pave the way for future studies using network-guided principles to significantly improve rTMS efficacy for depression.
Collapse
Affiliation(s)
- Simon W. Davis
- Department of Neurology, Duke University, Durham, NC, USA
| | | | - Andrada D. Neacsiu
- Psychiatry and Behavioral Neuroscience, Duke University, Durham, NC, USA
| | | | | | | | - Timothy J. Strauman
- Psychiatry and Behavioral Neuroscience, Duke University, Durham, NC, USA
- Psychology & Neuroscience, Duke University, Durham, NC, USA
| |
Collapse
|
6
|
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
|
7
|
Dalhuisen I, Schutte C, Bramson B, Roelofs K, van Eijndhoven P, Tendolkar I. Studying additive effects of combining rTMS with cognitive control training: a pilot investigation. Front Hum Neurosci 2023; 17:1201344. [PMID: 37584029 PMCID: PMC10423931 DOI: 10.3389/fnhum.2023.1201344] [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: 04/06/2023] [Accepted: 07/10/2023] [Indexed: 08/17/2023] Open
Abstract
Background Repetitive transcranial magnetic stimulation (rTMS) on the dorsolateral prefrontal cortex (DLPFC) is an effective treatment for depression that has been proposed to work via the enhancement of cognitive control. Cognitive control training (CCT) can also alleviate depression by relying on DLPFC activation. As the additive effects of rTMS and CCT are unclear, we set out to conduct a within-subject pilot study in healthy controls. Methods Seventeen participants received two sessions of individualized resting-state connectivity-guided high-frequency rTMS, while randomly performing CCT or a control task. After each session, a negative mood was induced. Results We found effects on mood and cognitive control after rTMS + CCT as well as rTMS + control, which were indiscriminative between conditions. Based on the statistical evidence for the absence of an additive effect of CCT, we did not perform a full study. Conclusion Our results demonstrate no differential effects of single sessions combining rTMS and CCT in a healthy population, even with the methodological improvement of individualized neuronavigation. The improvement in cognitive control seen in both conditions could indicate that a simple cognitive task is sufficient when studying additive rTMS effects. Future studies should focus on augmenting the effects of various cognitive tasks and compare the present interventions with rTMS or cognitive tasks alone.
Collapse
Affiliation(s)
- Iris Dalhuisen
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands
- Donders Institute for Brain Cognition and Behavior, Radboud University, Nijmegen, Netherlands
| | - Céline Schutte
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bob Bramson
- Donders Institute for Brain Cognition and Behavior, Radboud University, Nijmegen, Netherlands
- Behavioral Science Institute, Radboud University, Nijmegen, Netherlands
| | - Karin Roelofs
- Donders Institute for Brain Cognition and Behavior, Radboud University, Nijmegen, Netherlands
- Behavioral Science Institute, Radboud University, Nijmegen, Netherlands
| | - Philip van Eijndhoven
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands
- Donders Institute for Brain Cognition and Behavior, Radboud University, Nijmegen, Netherlands
| | - Indira Tendolkar
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands
- Donders Institute for Brain Cognition and Behavior, Radboud University, Nijmegen, Netherlands
| |
Collapse
|
8
|
Deng Y, Li W, Zhang B. Functional Activity in the Effect of Transcranial Magnetic Stimulation Therapy for Patients with Depression: A Meta-Analysis. J Pers Med 2023; 13:405. [PMID: 36983590 PMCID: PMC10051603 DOI: 10.3390/jpm13030405] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/22/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
Depression is a long-lasting mental disorder that affects more than 264 million people worldwide. Transcranial magnetic stimulation (TMS) can be a safe and effective choice for the treatment of depression. Functional neuroimaging provides unique insights into the neuropsychiatric effects of antidepressant TMS. In this meta-analysis, we aimed to assess the functional activity of brain regions caused by TMS for depression. A literature search was conducted from inception to 5 January 2022. Studies were then selected according to predetermined inclusion and exclusion criteria. Activation likelihood estimation was applied to analyze functional activation. Five articles were ultimately included after selection. The main analysis results indicated that TMS treatment for depression can alter the activity in the right precentral gyrus, right posterior cingulate, left inferior frontal gyrus and left middle frontal gyrus. In resting-state studies, increased activation was shown in the right precentral gyrus, right posterior cingulate, left inferior frontal gyrus and left superior frontal gyrus associated with TMS treatment. In task-related studies, clusters in the right middle frontal gyrus, left sub-gyrus, left middle frontal gyrus and left posterior cingulate were hyperactivated post-treatment. Our study offers an overview of brain activity changes in patients with depression after TMS treatment.
Collapse
Affiliation(s)
- Yongyan Deng
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou 510370, China
- Peking University Sixth Hospital, Beijing 100191, China
| | - Wenyue Li
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou 510370, China
| | - Bin Zhang
- Institute of Mental Health, Tianjin Anding Hospital, Tianjin Medical University, Tianjin 300222, China
| |
Collapse
|
9
|
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
|
10
|
Camacho‐Conde JA, del Rosario Gonzalez‐Bermudez M, Carretero‐Rey M, Khan ZU. Therapeutic potential of brain stimulation techniques in the treatment of mental, psychiatric, and cognitive disorders. CNS Neurosci Ther 2022; 29:8-23. [PMID: 36229994 PMCID: PMC9804057 DOI: 10.1111/cns.13971] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 02/06/2023] Open
Abstract
Treatment for brain diseases has been disappointing because available medications have failed to produce clinical response across all the patients. Many patients either do not respond or show partial and inconsistent effect, and even in patients who respond to the medications have high relapse rates. Brain stimulation has been seen as an alternative and effective remedy. As a result, brain stimulation has become one of the most valuable therapeutic tools for combating against brain diseases. In last decade, studies with the application of brain stimulation techniques not only have grown exponentially but also have expanded to wide range of brain disorders. Brain stimulation involves passing electric currents into the cortical and subcortical area brain cells with the use of noninvasive as well as invasive methods to amend brain functions. Over time, technological advancements have evolved into the development of precise devices; however, at present, most used noninvasive techniques are repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), whereas the most common invasive technique is deep brain stimulation (DBS). In the current review, we will provide an overview of the potential of noninvasive (rTMS and tDCS) and invasive (DBS) brain stimulation techniques focusing on the treatment of mental, psychiatric, and cognitive disorders.
Collapse
Affiliation(s)
- Jose Antonio Camacho‐Conde
- Laboratory of Neurobiology, CIMESUniversity of Malaga, Campus Teatinos s/nMalagaSpain,Department of Medicine, Faculty of MedicineUniversity of Malaga, Campus Teatinos s/nMalagaSpain
| | | | - Marta Carretero‐Rey
- Laboratory of Neurobiology, CIMESUniversity of Malaga, Campus Teatinos s/nMalagaSpain,Department of Medicine, Faculty of MedicineUniversity of Malaga, Campus Teatinos s/nMalagaSpain
| | - Zafar U. Khan
- Laboratory of Neurobiology, CIMESUniversity of Malaga, Campus Teatinos s/nMalagaSpain,Department of Medicine, Faculty of MedicineUniversity of Malaga, Campus Teatinos s/nMalagaSpain,CIBERNEDInstitute of Health Carlos IIIMadridSpain
| |
Collapse
|
11
|
Neacsiu AD, Szymkiewicz V, Galla JT, Li B, Kulkarni Y, Spector CW. The neurobiology of misophonia and implications for novel, neuroscience-driven interventions. Front Neurosci 2022; 16:893903. [PMID: 35958984 PMCID: PMC9359080 DOI: 10.3389/fnins.2022.893903] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/28/2022] [Indexed: 11/25/2022] Open
Abstract
Decreased tolerance in response to specific every-day sounds (misophonia) is a serious, debilitating disorder that is gaining rapid recognition within the mental health community. Emerging research findings suggest that misophonia may have a unique neural signature. Specifically, when examining responses to misophonic trigger sounds, differences emerge at a physiological and neural level from potentially overlapping psychopathologies. While these findings are preliminary and in need of replication, they support the hypothesis that misophonia is a unique disorder. In this theoretical paper, we begin by reviewing the candidate networks that may be at play in this complex disorder (e.g., regulatory, sensory, and auditory). We then summarize current neuroimaging findings in misophonia and present areas of overlap and divergence from other mental health disorders that are hypothesized to co-occur with misophonia (e.g., obsessive compulsive disorder). Future studies needed to further our understanding of the neuroscience of misophonia will also be discussed. Next, we introduce the potential of neurostimulation as a tool to treat neural dysfunction in misophonia. We describe how neurostimulation research has led to novel interventions in psychiatric disorders, targeting regions that may also be relevant to misophonia. The paper is concluded by presenting several options for how neurostimulation interventions for misophonia could be crafted.
Collapse
Affiliation(s)
- Andrada D. Neacsiu
- Duke Center for Misophonia and Emotion Regulation, Duke Brain Stimulation Research Center, Department of Psychiatry and Behavioral Neuroscience, School of Medicine, Duke University, Durham, NC, United States
| | - Victoria Szymkiewicz
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Jeffrey T. Galla
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Brenden Li
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Yashaswini Kulkarni
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Cade W. Spector
- Department of Philosophy, Duke University, Durham, NC, United States
| |
Collapse
|
12
|
Neacsiu AD, Beynel L, Graner JL, Szabo ST, Appelbaum LG, Smoski MJ, LaBar KS. Enhancing cognitive restructuring with concurrent fMRI-guided neurostimulation for emotional dysregulation-A randomized controlled trial. J Affect Disord 2022; 301:378-389. [PMID: 35038479 PMCID: PMC9937022 DOI: 10.1016/j.jad.2022.01.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/15/2021] [Accepted: 01/10/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND Transdiagnostic clinical emotional dysregulation is a key component of many mental health disorders and offers an avenue to address multiple disorders with one transdiagnostic treatment. In the current study, we pilot an intervention that combines a one-time teaching and practice of cognitive restructuring (CR) with repetitive transcranial magnetic stimulation (rTMS), targeted based on functional magnetic resonance imaging (fMRI). METHODS Thirty-seven clinical adults who self-reported high emotional dysregulation were enrolled in this randomized, double-blind, placebo-controlled trial. fMRI was collected as participants were reminded of lifetime stressors and asked to downregulate their distress using CR tactics. fMRI BOLD data were analyzed to identify the cluster of voxels within the left dorsolateral prefrontal cortex (dlPFC) with the highest activation when participants attempted to downregulate, versus passively remember, distressing memories. Participants underwent active or sham rTMS (10 Hz) over the left dlPFC target while practicing CR following emotional induction using recent autobiographical stressors. RESULTS Receiving active versus sham rTMS led to significantly higher high frequency heart rate variability during regulation, lower regulation duration during the intervention, and higher likelihood to use CR during the week following the intervention. There were no differences between conditions when administering neurostimulation alone without the CR skill and compared to sham. Participants in the sham versus active condition experienced less distress the week after the intervention. There were no differences between conditions at the one-month follow up. CONCLUSION This study demonstrated that combining active rTMS with emotion regulation training for one session significantly enhances emotion regulation and augments the impact of training for as long as a week. These findings are a promising step towards a combined intervention for transdiagnostic emotion dysregulation.
Collapse
|
13
|
rTMS Reduces Craving and Alcohol Use in Patients with Alcohol Use Disorder: Results of a Randomized, Sham-Controlled Clinical Trial. J Clin Med 2022; 11:jcm11040951. [PMID: 35207224 PMCID: PMC8878126 DOI: 10.3390/jcm11040951] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/27/2022] [Accepted: 02/08/2022] [Indexed: 12/18/2022] Open
Abstract
(1) Background: Current evidence-based treatments for alcohol use disorder (AUD) are moderately effective. Studies testing repetitive transcranial magnetic stimulation (rTMS) in AUD commonly apply a limited number of rTMS sessions with different rTMS settings, showing inconsistent effects on craving for alcohol. This study tested the efficacy of a robust rTMS protocol on craving and alcohol use. (2) Methods: In a single-blind randomized controlled trial in recently detoxified patients with AUD, ten days of high-frequency rTMS over the right dorsolateral prefrontal cortex on top of treatment as usual (n = 14) was compared with sham rTMS (n = 16). Outcome measures were alcohol craving and use over a follow-up period of one year. Analysis was performed by means of repeated measures multivariate analysis of variance. (3) Results: The results showed a main group-by-time interaction effect on craving (Wilks’ Λ = 0.348, F (12, 17) = 2.654, p = 0.032) and an effect of group on alcohol use (Wilk’s Λ = 0.44, F (6, 23) = 4.9, p = 0.002), with lower alcohol craving and use in the group with active rTMS compared to the control group. Differences in craving between groups were most prominent three months after treatment. At 12 months follow-up, there was no effect of rTMS on craving or abstinence. (4) Conclusions: This small-scale randomized controlled trial showed the efficacy of high-frequency rTMS over the right dlPFC diminished alcohol craving and use in recently detoxified patients with AUD during the first months after detoxification. These findings suggest that rTMS might be an effective add-on in treating patients with AUD and warrant replication in future large-scale studies.
Collapse
|
14
|
Regenold WT, Deng ZD, Lisanby SH. Noninvasive neuromodulation of the prefrontal cortex in mental health disorders. Neuropsychopharmacology 2022; 47:361-372. [PMID: 34272471 PMCID: PMC8617166 DOI: 10.1038/s41386-021-01094-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/22/2021] [Accepted: 06/29/2021] [Indexed: 02/06/2023]
Abstract
More than any other brain region, the prefrontal cortex (PFC) gives rise to the singularity of human experience. It is therefore frequently implicated in the most distinctly human of all disorders, those of mental health. Noninvasive neuromodulation, including electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS) among others, can-unlike pharmacotherapy-directly target the PFC and its neural circuits. Direct targeting enables significantly greater on-target therapeutic effects compared with off-target adverse effects. In contrast to invasive neuromodulation approaches, such as deep-brain stimulation (DBS), noninvasive neuromodulation can reversibly modulate neural activity from outside the scalp. This combination of direct targeting and reversibility enables noninvasive neuromodulation to iteratively change activity in the PFC and its neural circuits to reveal causal mechanisms of both disease processes and healthy function. When coupled with neuronavigation and neurophysiological readouts, noninvasive neuromodulation holds promise for personalizing PFC neuromodulation to relieve symptoms of mental health disorders by optimizing the function of the PFC and its neural circuits. ClinicalTrials.gov Identifier: NCT03191058.
Collapse
Affiliation(s)
- William T. Regenold
- grid.416868.50000 0004 0464 0574Noninvasive Neuromodulation Unit, Experimental Therapeutics & Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD USA
| | - Zhi-De Deng
- grid.416868.50000 0004 0464 0574Noninvasive Neuromodulation Unit, Experimental Therapeutics & Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD USA
| | - Sarah H. Lisanby
- grid.416868.50000 0004 0464 0574Noninvasive Neuromodulation Unit, Experimental Therapeutics & Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD USA
| |
Collapse
|
15
|
Neacsiu AD, Beynel L, Powers JP, Szabo ST, Appelbaum LG, Lisanby SH, LaBar KS. Enhancing Cognitive Restructuring with Concurrent Repetitive Transcranial Magnetic Stimulation: A Transdiagnostic Randomized Controlled Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2022; 91:94-106. [PMID: 34551415 PMCID: PMC8891052 DOI: 10.1159/000518957] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/19/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Emotional dysregulation constitutes a serious public health problem in need of novel transdiagnostic treatments. OBJECTIVE To this aim, we developed and tested a one-time intervention that integrates behavioral skills training with concurrent repetitive transcranial magnetic stimulation (rTMS). METHODS Forty-six adults who met criteria for at least one DSM-5 disorder and self-reported low use of cognitive restructuring (CR) were enrolled in a randomized, double-blind, sham-controlled trial that used a between-subjects design. Participants were taught CR and underwent active rTMS applied at 10 Hz over the right (n = 17) or left (n = 14) dorsolateral prefrontal cortex (dlPFC) or sham rTMS (n = 15) while practicing reframing and emotional distancing in response to autobiographical stressors. RESULTS Those who received active left or active right as opposed to sham rTMS exhibited enhanced regulation (ds = 0.21-0.62) as measured by psychophysiological indices during the intervention (higher high-frequency heart rate variability, lower regulation duration). Those who received active rTMS over the left dlPFC also self-reported reduced distress throughout the intervention (d = 0.30), higher likelihood to use CR, and lower daily distress during the week following the intervention. The procedures were acceptable and feasible with few side effects. CONCLUSIONS These findings show that engaging frontal circuits simultaneously with cognitive skills training and rTMS may be clinically feasible, well-tolerated and may show promise for the treatment of transdiagnostic emotional dysregulation. Larger follow-up studies are needed to confirm the efficacy of this novel therapeutic approach.
Collapse
|
16
|
Modak A, Fitzgerald PB. Personalising transcranial magnetic stimulation for depression using neuroimaging: A systematic review. World J Biol Psychiatry 2021; 22:647-669. [PMID: 33779486 DOI: 10.1080/15622975.2021.1907710] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Transcranial magnetic stimulation (TMS) is a well-established and effective treatment for depression, though response rates are suboptimal. Personalising TMS for depression with neuroimaging can take into account inter-individual differences in anatomical and electrophysiological characteristics; and thereby provide a potentially more efficacious form of treatment. The current systematic review aimed to critically appraise the literature relating to personalising TMS for depression with neuroimaging. METHODS PubMed, PsycINFO and Embase databases were used to identify relevant literature published up to November 2020. RESULTS A total of 37 studies were included in the review. Across these studies, a total of 1451 patients with depression received TMS that was personalised using neuroimaging. The majority of the studies used structural or functional neuroimaging to personalise treatment target (n = 30), primarily through neuronavigation methodologies. Fewer studies used electroencephalography to personalise treatment frequency or stimulus timing (n = 7). Only 6 studies directly compared neuroimaging-personalised TMS to standard TMS. CONCLUSIONS The findings from this review suggest that personalising TMS with neuroimaging may be more effective in the treatment of depression compared to standard TMS. Further research is required to directly compare neuroimaging-personalised TMS with standard TMS, and to identify the optimal parameters for treatment personalisation.
Collapse
Affiliation(s)
- Anish Modak
- Alfred Mental and Addiction Health, Alfred Health, Melbourne, Australia.,Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Department of Psychiatry, Monash University, Melbourne, Australia
| | - Paul B Fitzgerald
- Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Department of Psychiatry, Monash University, Melbourne, Australia
| |
Collapse
|
17
|
Zhang M, Wang R, Luo X, Zhang S, Zhong X, Ning Y, Zhang B. Repetitive Transcranial Magnetic Stimulation Target Location Methods for Depression. Front Neurosci 2021; 15:695423. [PMID: 34566561 PMCID: PMC8458642 DOI: 10.3389/fnins.2021.695423] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/03/2021] [Indexed: 01/18/2023] Open
Abstract
Major depressive disorder (MDD) is a substantial global public health problem in need of novel and effective treatment strategies. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive and promising treatment for depression that has been approved by the U.S. Food and Drug Administration (FDA). However, the methodological weaknesses of existing work impairs the universal clinical use of rTMS. The variation of stimulated targets across the dorsolateral prefrontal cortex may account for most of the heterogeneity in the efficacy of rTMS. Many rTMS target location methods for MDD have been developed in recent decades. This review was conducted to assess this emerging field and to improve treatment outcomes in clinical practice.
Collapse
Affiliation(s)
- Min Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Runhua Wang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xin Luo
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Si Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaomei Zhong
- 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.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Bin Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| |
Collapse
|
18
|
Singh A, Erwin-Grabner T, Goya-Maldonado R, Antal A. Transcranial Magnetic and Direct Current Stimulation in the Treatment of Depression: Basic Mechanisms and Challenges of Two Commonly Used Brain Stimulation Methods in Interventional Psychiatry. Neuropsychobiology 2021; 79:397-407. [PMID: 31487716 DOI: 10.1159/000502149] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 07/16/2019] [Indexed: 12/12/2022]
Abstract
Noninvasive neuromodulation, including repetitive trans-cranial magnetic stimulation (rTMS) and direct current stimulation (tDCS), provides researchers and health care professionals with the ability to gain unique insights into brain functions and treat several neurological and psychiatric conditions. Undeniably, the number of published research and clinical papers on this topic is increasing exponentially. In parallel, several methodological and scientific caveats have emerged in the transcranial stimulation field; these include less robust and reliable effects as well as contradictory clinical findings. These inconsistencies are maybe due to the fact that research exploring the relationship between the methodological aspects and clinical efficacy of rTMS and tDCS is far from conclusive. Hence, additional work is needed to understand the mechanisms underlying the effects of magnetic stimulation and low-intensity transcranial electrical stimulation (TES) in order to optimize dosing, methodological designs, and safety aspects.
Collapse
Affiliation(s)
- Aditya Singh
- Laboratory of Systems Neuroscience and Imaging in Psychiatry (SNIP-Lab), Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Tracy Erwin-Grabner
- Laboratory of Systems Neuroscience and Imaging in Psychiatry (SNIP-Lab), Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Roberto Goya-Maldonado
- Laboratory of Systems Neuroscience and Imaging in Psychiatry (SNIP-Lab), Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Andrea Antal
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany, .,Institute for Medical Psychology, Medical Faculty, Otto-v.-Guericke University Magdeburg, Magdeburg, Germany,
| |
Collapse
|
19
|
Strauman TJ. Modeling the onset of a depressive episode: A self-regulation perspective. Curr Opin Psychol 2021; 41:100-106. [PMID: 34051582 DOI: 10.1016/j.copsyc.2021.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 04/14/2021] [Indexed: 11/27/2022]
Abstract
Major depression is an episodic disorder which, for many individuals, has its onset in a distinct change of emotional state which then persists over time. The present article explores the utility of combining a dynamical systems approach to depression, focusing specifically on the change of state associated with episode onset, with a self-regulation perspective, which operationalizes how feedback received in the ongoing process of goal pursuit influences affect, motivation, and behavior, for understanding how a depressive episode begins. The goals of this review are to survey the recent literature modeling the onset of a depressive episode and to illustrate how a self-regulation perspective can provide a conceptual framework and testable hypotheses regarding episode onset within a dynamical systems model of depression.
Collapse
Affiliation(s)
- Timothy J Strauman
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States.
| |
Collapse
|
20
|
Bulteau S, Péré M, Blanchin M, Poulet E, Brunelin J, Sauvaget A, Sébille V. Higher Negative Self-Reference Level in Patients With Personality Disorders and Suicide Attempt(s) History During Biological Treatment for Major Depressive Disorder: Clinical Implications. Front Psychol 2021; 12:631614. [PMID: 33841260 PMCID: PMC8027059 DOI: 10.3389/fpsyg.2021.631614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/26/2021] [Indexed: 11/25/2022] Open
Abstract
Objective: The aim of the study was to identify clinical variables associated with changes in specific domains of self-reported depression during treatment by antidepressant and/or repetitive Transcranial Magnetic Stimulation (rTMS) in patients with Major Depressive Disorder (MDD). Methods: Data from a trial involving 170 patients with MDD receiving either venlafaxine, rTMS or both were re-analyzed. Depressive symptoms were assessed each week during the 2 to 6 weeks of treatment with the 13-item Beck Depression Inventory (BDI13). Associations between depression changes on BDI13 domains (Negative Self-Reference, Sad Mood, and Performance Impairment), treatment arm, time, and clinical variables were tested in a mixed linear model. Results: A significant decrease of self-reported depressive symptoms was observed over time. The main characteristics associated with persistent higher depressive symptomatology on Negative Self-Reference domain of the BDI13 were personality disorders (+2.1 points), a past history of suicide attempt(s) (+1.7 points), age under 65 years old (+1.5 points), and female sex (+1.1 points). Conclusions: Early cognitive intervention targeting specifically negative self-referencing process could be considered during pharmacological or rTMS treatment for patients with personality disorders and past history of suicide attempt(s).
Collapse
Affiliation(s)
- Samuel Bulteau
- UMR INSERM 1246, SPHERE MethodS in Patient-Centered Outcomes and HEalth ResEarch, University of Nantes, University of Tours, Nantes, France.,CHU Nantes, Department of Addictology and Psychiatry, Nantes, France
| | - Morgane Péré
- CHU Nantes, Department of Methodology and Biostatistics, Nantes, France
| | - Myriam Blanchin
- UMR INSERM 1246, SPHERE MethodS in Patient-Centered Outcomes and HEalth ResEarch, University of Nantes, University of Tours, Nantes, France
| | - Emmanuel Poulet
- INSERM-U1028, CNRS-UMR5292, Lyon Neuroscience Research Center, PSYR2 Team, University of Lyon, CH Le Vinatier, Lyon, France.,Department of Emergency Psychiatry, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jérôme Brunelin
- INSERM-U1028, CNRS-UMR5292, Lyon Neuroscience Research Center, PSYR2 Team, University of Lyon, CH Le Vinatier, Lyon, France
| | - Anne Sauvaget
- Nantes Université, CHU Nantes, Movement, Interactions, Performance (MIP), EA 4334, University of Nantes, Nantes, France
| | - Véronique Sébille
- UMR INSERM 1246, SPHERE MethodS in Patient-Centered Outcomes and HEalth ResEarch, University of Nantes, University of Tours, Nantes, France.,CHU Nantes, Department of Methodology and Biostatistics, Nantes, France
| |
Collapse
|
21
|
Deng ZD, Luber B, Balderston NL, Velez Afanador M, Noh MM, Thomas J, Altekruse WC, Exley SL, Awasthi S, Lisanby SH. Device-Based Modulation of Neurocircuits as a Therapeutic for Psychiatric Disorders. Annu Rev Pharmacol Toxicol 2020; 60:591-614. [PMID: 31914895 DOI: 10.1146/annurev-pharmtox-010919-023253] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Device-based neuromodulation of brain circuits is emerging as a promising new approach in the study and treatment of psychiatric disorders. This work presents recent advances in the development of tools for identifying neurocircuits as therapeutic targets and in tools for modulating neurocircuits. We review clinical evidence for the therapeutic efficacy of circuit modulation with a range of brain stimulation approaches, including subthreshold, subconvulsive, convulsive, and neurosurgical techniques. We further discuss strategies for enhancing the precision and efficacy of neuromodulatory techniques. Finally, we survey cutting-edge research in therapeutic circuit modulation using novel paradigms and next-generation devices.
Collapse
Affiliation(s)
- Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA; .,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina 27710, USA
| | - Bruce Luber
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA;
| | - Nicholas L Balderston
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Melbaliz Velez Afanador
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA;
| | - Michelle M Noh
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA;
| | - Jeena Thomas
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA;
| | - William C Altekruse
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA;
| | - Shannon L Exley
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA;
| | - Shriya Awasthi
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA;
| | - Sarah H Lisanby
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892, USA; .,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina 27710, USA
| |
Collapse
|
22
|
Transcranial magnetic stimulation in major depressive disorder: Response modulation and state dependency. J Affect Disord 2020; 266:793-801. [PMID: 32217261 DOI: 10.1016/j.jad.2020.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/13/2020] [Accepted: 02/01/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Transcranial Magnetic Stimulation (TMS) has emerged as a valid therapeutic option in the treatment of depression, especially in cases of inadequate response to antidepressant agents. Despite the recognized efficacy of this technique, its mechanisms of action are still debated and optimal protocols have not yet been established. METHODS The present review focuses on TMS protocols that either engage the targeted brain circuits or synchronize the stimulation frequency to individual neuronal oscillations to increase the antidepressant efficacy. RESULTS TMS efficacy was found to be enhanced by preliminary or concomitant modulation of the functional state of the targeted brain networks. Conversely, there is not enough evidence of higher efficacy of TMS protocols with individual selection of the stimulation frequency compared to standard ones. LIMITATIONS Most studies included small patient samples. CONCLUSIONS Our results suggest that a good option to enhance rTMS efficacy might be to follow synaptic potentiation and depression rules.
Collapse
|
23
|
Borrione L, Bellini H, Razza LB, Avila AG, Baeken C, Brem AK, Busatto G, Carvalho AF, Chekroud A, Daskalakis ZJ, Deng ZD, Downar J, Gattaz W, Loo C, Lotufo PA, Martin MDGM, McClintock SM, O'Shea J, Padberg F, Passos IC, Salum GA, Vanderhasselt MA, Fraguas R, Benseñor I, Valiengo L, Brunoni AR. Precision non-implantable neuromodulation therapies: a perspective for the depressed brain. ACTA ACUST UNITED AC 2020; 42:403-419. [PMID: 32187319 PMCID: PMC7430385 DOI: 10.1590/1516-4446-2019-0741] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/10/2019] [Indexed: 12/13/2022]
Abstract
Current first-line treatments for major depressive disorder (MDD) include pharmacotherapy and cognitive-behavioral therapy. However, one-third of depressed patients do not achieve remission after multiple medication trials, and psychotherapy can be costly and time-consuming. Although non-implantable neuromodulation (NIN) techniques such as transcranial magnetic stimulation, transcranial direct current stimulation, electroconvulsive therapy, and magnetic seizure therapy are gaining momentum for treating MDD, the efficacy of non-convulsive techniques is still modest, whereas use of convulsive modalities is limited by their cognitive side effects. In this context, we propose that NIN techniques could benefit from a precision-oriented approach. In this review, we discuss the challenges and opportunities in implementing such a framework, focusing on enhancing NIN effects via a combination of individualized cognitive interventions, using closed-loop approaches, identifying multimodal biomarkers, using computer electric field modeling to guide targeting and quantify dosage, and using machine learning algorithms to integrate data collected at multiple biological levels and identify clinical responders. Though promising, this framework is currently limited, as previous studies have employed small samples and did not sufficiently explore pathophysiological mechanisms associated with NIN response and side effects. Moreover, cost-effectiveness analyses have not been performed. Nevertheless, further advancements in clinical trials of NIN could shift the field toward a more “precision-oriented” practice.
Collapse
Affiliation(s)
- Lucas Borrione
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Helena Bellini
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Lais Boralli Razza
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Ana G Avila
- Centro de Neuropsicologia e Intervenção Cognitivo-Comportamental, Faculdade de Psicologia e Ciências da Educação, Universidade de Coimbra, Coimbra, Portugal
| | - Chris Baeken
- Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Psychiatry, University Hospital (UZ Brussel), Brussels, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Anna-Katharine Brem
- Max Planck Institute of Psychiatry, Munich, Germany.,Division of Interventional Cognitive Neurology, Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Geraldo Busatto
- Laboratório de Neuroimagem em Psiquiatria (LIM-21), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Adam Chekroud
- Spring Health, New York, NY, USA.,Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutic & Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.,Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Jonathan Downar
- Department of Psychiatry and Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Centre for Mental Health and Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Wagner Gattaz
- Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas,
Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Colleen Loo
- School of Psychiatry and Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Paulo A Lotufo
- Estudo Longitudinal de Saúde do Adulto (ELSA), Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, USP, São Paulo, SP, Brazil
| | - Maria da Graça M Martin
- Laboratório de Ressonância Magnética em Neurorradiologia (LIM-44) and Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Shawn M McClintock
- Neurocognitive Research Laboratory, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jacinta O'Shea
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Human Brain Activity, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Ives C Passos
- Laboratório de Psiquiatria Molecular e Programa de
Transtorno Bipolar, Hospital de Clínicas de Porto Alegre (HCPA), Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Giovanni A Salum
- Departamento de Psiquiatria, Seção de Afeto Negativo e Processos Sociais (SANPS), HCPA, UFRGS, Porto Alegre, RS, Brazil
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium.,Department of Experimental Clinical and Health Psychology, Psychopathology and Affective Neuroscience Lab, Ghent University, Ghent, Belgium
| | - Renerio Fraguas
- Laboratório de Neuroimagem em Psiquiatria (LIM-21), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Hospital Universitário, USP, São Paulo, SP, Brazil
| | - Isabela Benseñor
- Estudo Longitudinal de Saúde do Adulto (ELSA), Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, USP, São Paulo, SP, Brazil
| | - Leandro Valiengo
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Andre R Brunoni
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas,
Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Hospital Universitário, USP, São Paulo, SP, Brazil
| |
Collapse
|
24
|
Spagnolo PA, Montemitro C, Pettorruso M, Martinotti G, Di Giannantonio M. Better Together? Coupling Pharmacotherapies and Cognitive Interventions With Non-invasive Brain Stimulation for the Treatment of Addictive Disorders. Front Neurosci 2020; 13:1385. [PMID: 31998061 PMCID: PMC6967837 DOI: 10.3389/fnins.2019.01385] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/09/2019] [Indexed: 01/11/2023] Open
Affiliation(s)
- Primavera A Spagnolo
- Human Motor Control Section, Medical Neurology Branch, National Institute on Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Chiara Montemitro
- Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University, Chieti, Italy.,Neuroimaging Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, United States
| | - Mauro Pettorruso
- Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University, Chieti, Italy
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University, Chieti, Italy
| | - Massimo Di Giannantonio
- Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University, Chieti, Italy
| |
Collapse
|
25
|
Sathappan AV, Luber BM, Lisanby SH. The Dynamic Duo: Combining noninvasive brain stimulation with cognitive interventions. Prog Neuropsychopharmacol Biol Psychiatry 2019; 89:347-360. [PMID: 30312634 DOI: 10.1016/j.pnpbp.2018.10.006] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 12/21/2022]
Abstract
Pharmacotherapy, psychotherapy, and non-invasive brain stimulation (NIBS)1 each show efficacy in the treatment of psychiatric disorders; however, more efficacious interventions are needed as reflected by an overall unmet need in mental health care. While each modality has typically been studied and developed as a monotherapy, in practice they are typically used in combination. Research has begun to emerge studying the potential synergistic actions of multi-modal, combination therapies. For example, NIBS combined with rehabilitation strategies have demonstrated some success for speech and motor rehabilitation in stroke patients. In this review we present evidence suggesting that combining NIBS with targeted, cognitive interventions offers a potentially powerful new approach to treating neuropsychiatric disorders. Here we focus on NIBS studies using transcranial direct current stimulation (tDCS)2 and transcranial magnetic stimulation (TMS)3 given that these modalities are relatively safe, noninvasive, and can be performed simultaneously with neurocognitive interventions. We review the concept of "state dependent" effects of NIBS and highlight how simultaneous or sequential cognitive interventions could help optimize NIBS therapy by providing further control of ongoing neural activity in targeted neural networks. This review spans a range of neuropsychiatric disorders including major depressive disorder, schizophrenia, generalized anxiety, and autism. For each disorder, we emphasize neuroanatomical circuitry that could be engaged with combination therapy and critically discuss the literature that has begun to emerge. Finally, we present possible underlying mechanisms and propose future research strategies that may further refine the potential of combination therapies.
Collapse
Affiliation(s)
- Aakash V Sathappan
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Bruce M Luber
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
| | - Sarah H Lisanby
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|