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Fitzgerald PB, Pridmore S. Letter to the Editor regarding 'Five facts about rTMS?'. Aust N Z J Psychiatry 2023; 57:303-304. [PMID: 36039921 DOI: 10.1177/00048674221121740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Paul B Fitzgerald
- School of Medicine and Psychology, Australian National University, Canberra, ACT, Australia
| | - Saxby Pridmore
- Saint Helens Private Hospital, Hobart and Discipline of Psychiatry, University of Tasmania, Hobart, Tasmania, TAS, Australia
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Wu C, Yang L, Feng S, Zhu L, Yang L, Liu TCY, Duan R. Therapeutic non-invasive brain treatments in Alzheimer's disease: recent advances and challenges. Inflamm Regen 2022; 42:31. [PMID: 36184623 PMCID: PMC9527145 DOI: 10.1186/s41232-022-00216-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
Alzheimer's disease (AD) is one of the major neurodegenerative diseases and the most common form of dementia. Characterized by the loss of learning, memory, problem-solving, language, and other thinking abilities, AD exerts a detrimental effect on both patients' and families' quality of life. Although there have been significant advances in understanding the mechanism underlying the pathogenesis and progression of AD, there is no cure for AD. The failure of numerous molecular targeted pharmacologic clinical trials leads to an emerging research shift toward non-invasive therapies, especially multiple targeted non-invasive treatments. In this paper, we reviewed the advances of the most widely studied non-invasive therapies, including photobiomodulation (PBM), transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and exercise therapy. Firstly, we reviewed the pathological changes of AD and the challenges for AD studies. We then introduced these non-invasive therapies and discussed the factors that may affect the effects of these therapies. Additionally, we review the effects of these therapies and the possible mechanisms underlying these effects. Finally, we summarized the challenges of the non-invasive treatments in future AD studies and clinical applications. We concluded that it would be critical to understand the exact underlying mechanisms and find the optimal treatment parameters to improve the translational value of these non-invasive therapies. Moreover, the combined use of non-invasive treatments is also a promising research direction for future studies and sheds light on the future treatment or prevention of AD.
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Affiliation(s)
- Chongyun Wu
- Laboratory of Regenerative Medicine in Sports Science, School of Physical Education and Sports Science, South China Normal University, Guangzhou, 510006, China
| | - Luoman Yang
- Department of Anesthesiology, Peking University Third Hospital (PUTH), Beijing, 100083, China
| | - Shu Feng
- Laboratory of Regenerative Medicine in Sports Science, School of Physical Education and Sports Science, South China Normal University, Guangzhou, 510006, China
| | - Ling Zhu
- Laboratory of Regenerative Medicine in Sports Science, School of Physical Education and Sports Science, South China Normal University, Guangzhou, 510006, China
| | - Luodan Yang
- Department of Neurology, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, 71103, USA. .,Department of Neuroscience and Regenerative Medicine, Medical College of Georgia, Augusta University, Augusta, GA, 30912, USA.
| | - Timon Cheng-Yi Liu
- Laboratory of Regenerative Medicine in Sports Science, School of Physical Education and Sports Science, South China Normal University, Guangzhou, 510006, China.
| | - Rui Duan
- Laboratory of Regenerative Medicine in Sports Science, School of Physical Education and Sports Science, South China Normal University, Guangzhou, 510006, China.
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Xu Y, Han L, Wei Y, Mao H, Yu Z. Combined repetitive transcranial magnetic stimulation and medication treatment for depression is associated with serum amyloid a level: Evidence from naturalistic clinical practice. Front Neurosci 2022; 16:1002816. [PMID: 36188478 PMCID: PMC9515661 DOI: 10.3389/fnins.2022.1002816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveRepetitive transcranial magnetic stimulation (rTMS) has a positive effect on patients with depressive disorder, while the underpinning molecular mechanism is unknown. Here, we aimed to investigate the effect of rTMS on serum levels of serum amyloid A (SAA) and testosterone in a real-world setting.Materials and methodsIn total, ninety-seven patients with depressive disorder were treated with medicine and rTMS (the rTMS group) while 122 patients were treated using the medicine only (the control group). Plasma levels of SAA (n = 52) and testosterone (n = 37) were measured before and after 2 weeks of treatment, and the treatment effect was evaluated by Hamilton Rating Scale for Depression (HAMD).ResultsThe treatment effect revealed by the percentage of decrease in HAMD in the second week was significantly greater in the rTMS group compared with the control group. No significant difference was found in SAA or testosterone levels between the two groups. However, the percentage of changes in SAA (r = −0.492, p = 0.017) in the second week was significantly correlated with the percentage of decrease in HAMD score in the rTMS group, but not in the control group.ConclusionPatients with depression benefit more from combined rTMS and medication treatment in this naturalistic study. Changes in SAA level, but not testosterone level, were related to depressive remission after 2 weeks’ combined treatment.
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Fitzgerald PB, Gill S, Breakspear M, Kulkarni J, Chen L, Pridmore S, Purushothaman S, Galletly C, Clarke P, Ng F, Hussain S, Chamoli S, Csizmadia T, Tolan P, Cocchi L, Ibrahim Oam S, Shankar K, Sarma S, Lau M, Loo C, Yadav T, Hoy KE. Revisiting the effectiveness of repetitive transcranial magnetic stimulation treatment in depression, again. Aust N Z J Psychiatry 2022; 56:905-909. [PMID: 34969310 DOI: 10.1177/00048674211068788] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Following on from the publication of the Royal Australian and New Zealand Journal of Psychiatry Mood Disorder Clinical Practice Guidelines (2020) and criticisms of how these aberrantly addressed repetitive transcranial magnetic stimulation treatment of depression, questions have continued to be raised in the journal about this treatment by a small group of authors, whose views we contend do not reflect the broad acceptance of this treatment nationally and internationally. In fact, the evidence supporting the use of repetitive transcranial magnetic stimulation treatment in depression is unambiguous and substantial, consisting of an extensive series of clinical trials supported by multiple meta-analyses, network meta-analysis and umbrella reviews. Importantly, the use of repetitive transcranial magnetic stimulation treatment in depression has also been subject to a series of health economic analyses. These indicate that repetitive transcranial magnetic stimulation is a cost-effective therapy and have been used in some jurisdictions, including Australia, in support of public funding. An argument has been made that offering repetitive transcranial magnetic stimulation treatment may delay potentially effective pharmacotherapy. In fact, there is considerably greater danger of the opposite happening. Repetitive transcranial magnetic stimulation is as, if not more effective, than antidepressant medication after two unsuccessful medication trials and should be a consideration for all patients under these circumstances where available. There is no meaningful ongoing debate about the use of repetitive transcranial magnetic stimulation treatment in depression - it is a safe, effective and cost-effective treatment.
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Affiliation(s)
- Paul B Fitzgerald
- Epworth Centre for Innovation in Mental Health, Epworth HealthCare, Camberwell, VIC, Australia.,Department of Psychiatry, Monash University, Clayton, VIC, Australia
| | - Shane Gill
- The University of Adelaide, Adelaide, SA, Australia.,SAPBTC, Glenside Health Service, Glenside, SA, Australia.,Discipline of Psychiatry, The Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Michael Breakspear
- Discipline of Psychiatry, College of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Jayashri Kulkarni
- Department of Psychiatry, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Leo Chen
- Department of Psychiatry, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Alfred Mental and Addiction Health, Alfred Health, Melbourne, VIC, Australia
| | - Saxby Pridmore
- Saint Helens Private Hospital, Hobart, TAS, Australia.,Discipline of Psychiatry, University of Tasmania, Hobart, TAS, Australia
| | | | - Cherrie Galletly
- Discipline of Psychiatry, The Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.,The Adelaide Clinic, Ramsay Health Care (SA) Mental Health Services, Adelaide, SA, Australia.,Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Patrick Clarke
- The Adelaide Clinic, Ramsay Health Care (SA) Mental Health Services, Adelaide, SA, Australia
| | - Felicity Ng
- Discipline of Psychiatry, The Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.,The Adelaide Clinic, Ramsay Health Care (SA) Mental Health Services, Adelaide, SA, Australia
| | - Salam Hussain
- Section for ECT and Neurostimulation, The Royal Australian and New Zealand College of Psychiatrists, Melbourne, VIC, Australia.,The University of Western Australia, Perth, WA, Australia.,Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | | | | | - Patrick Tolan
- Alfred Health/Peninsula Health, Melbourne, VIC, Australia
| | | | - Samir Ibrahim Oam
- TMS Northpark Private Hospital, Bundoora, VIC, Australia.,Wyndham Private Clinic, Werribee, VIC, Australia
| | - Kavitha Shankar
- TMS Clinics Australia, Sydney, NSW, Australia.,St John of God Pinelodge Clinic, Dandenong, VIC, Australia
| | - Shanthi Sarma
- Bond University, Robina, QLD, Australia.,Gold Coast Health, Southport, QLD, Australia
| | - Michael Lau
- TMS Clinics Australia, Sydney, NSW, Australia.,Monarch Mental Health Group, Sydney, NSW, Australia.,Hornsby Ku-Ring-Gai Adult Mental Health Unit, Hornsby, NSW, Australia
| | - Colleen Loo
- Black Dog Institute, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Tarun Yadav
- Hunter New England Drug and Alcohol Service, Newcastle, NSW, Australia.,Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Kate E Hoy
- Epworth Centre for Innovation in Mental Health, Epworth HealthCare, Camberwell, VIC, Australia.,Department of Psychiatry, Monash University, Clayton, VIC, Australia
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Rapid treatments for depression: Endocannabinoid system as a therapeutic target. Neurosci Biobehav Rev 2022; 137:104635. [PMID: 35351488 DOI: 10.1016/j.neubiorev.2022.104635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 03/19/2022] [Accepted: 03/20/2022] [Indexed: 12/16/2022]
Abstract
Current first-line treatments for major depressive disorder (MDD), i.e., antidepressant drugs and psychotherapy, show delayed onset of therapeutic effect as late as 2-3 weeks or more. In the clinic, the speed of beginning of the actions of antidepressant drugs or other interventions is vital for many reasons. Late-onset means that depression, its related disability, and the potential danger of suicide remain a threat for some patients. There are some rapid-acting antidepressant interventions, such as sleep deprivation, ketamine, acute exercise, which induce a significant response, ranging from a few hours to maximally one week, and most of them share a common characteristic that is the activation of the endocannabinoid (eCB) system. Activation of this system, i.e., augmentation of eCB signaling, appears to have anti-depressant-like actions. This article puts the idea forward that the activation of eCB signaling represents a critical mechanism of rapid-acting therapeutic interventions in MDD, and this system might contribute to the development of novel rapid-acting treatments for MDD.
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Luan D, You D, Wu Y, Wu F, Xu Z, Li L, Jiao J, Zhang A, Feng H, Kong Y, Zhao Y, Zhang Z. Effects of interaction between single nucleotide polymorphisms and psychosocial factors on the response to antidepressant treatment in patients with major depressive disorder. J Genet Genomics 2021; 49:587-589. [PMID: 34920096 DOI: 10.1016/j.jgg.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/21/2021] [Accepted: 11/27/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Di Luan
- Department of Neurology, Affiliated Zhongda Hospital, Research Institution of Neuropsychiatry, School of Medicine, Southeast University, Nanjing 210009, China
| | - Dongfang You
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Department of Environmental Health, Harvard T.H. C(1)han School of Public Health, Harvard University, Boston 02115, USA
| | - Yaqian Wu
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Fangfang Wu
- Department of Immunology and Medical Microbiology, Nanjing University of Chinese Medicine, Nanjing 210046, China
| | - Zhi Xu
- Department of Psychosomatics and Psychiatry, Affiliated Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
| | - Ling Li
- Department of Neurology, Affiliated Zhongda Hospital, Research Institution of Neuropsychiatry, School of Medicine, Southeast University, Nanjing 210009, China
| | - Jiao Jiao
- Department of Neurology, Affiliated Zhongda Hospital, Research Institution of Neuropsychiatry, School of Medicine, Southeast University, Nanjing 210009, China
| | - Aini Zhang
- Department of Neurology, Affiliated Zhongda Hospital, Research Institution of Neuropsychiatry, School of Medicine, Southeast University, Nanjing 210009, China
| | - Haixia Feng
- Department of Nursing, Affiliated Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
| | - Yan Kong
- Department of Biochemistry and Molecular Biology, School of Medicine, Southeast University, Nanjing 210009, China.
| | - Yang Zhao
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston 02115, USA; China International Cooperation Center for Environment and Human Health, Center for Global Health, Nanjing Medical University, Nanjing 211166, China; The Center of Biomedical Big Data and the Laboratory of Biomedical Big Data, Nanjing Medical University, Nanjing 211166, China.
| | - Zhijun Zhang
- Department of Neurology, Affiliated Zhongda Hospital, Research Institution of Neuropsychiatry, School of Medicine, Southeast University, Nanjing 210009, China; Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China.
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Kurimoto N, Inagaki T, Aoki T, Kadotani H, Kurimoto F, Kuriyama K, Yamada N, Ozeki Y. Factors causing a relapse of major depressive disorders following successful electroconvulsive therapy: A retrospective cohort study. World J Psychiatry 2021; 11:841-853. [PMID: 34733646 PMCID: PMC8546764 DOI: 10.5498/wjp.v11.i10.841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/26/2021] [Accepted: 08/30/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is used to treat major depressive disorder (MDD). Relapse is often observed even after successful ECT, followed by adequate pharmaceutical treatment for MDD.
AIM To investigate the diagnostic factors and treatment strategies associated with depression relapse.
METHODS We analyzed the relationships between relapse, the diagnostic change from MDD to bipolar disorder (BP), and treatment after the initial ECT. We performed a 3-year retrospective study of the prognoses of 85 patients of the Shiga University of Medical Science Hospital. The relative risk of relapse of depressive symptoms was calculated based on the diagnostic change from MDD to BP. A receiver operating characteristic (ROC) curve was generated to evaluate the predictive accuracy of diagnostic changes from MDD to BP based on the duration between the first course of ECT and the relapse of depressive symptoms.
RESULTS Eighty-five patients initially diagnosed with MDD and successfully treated with ECT were enrolled in the study. Compared with the MDD participants, more BP patients experienced relapses and required continuation and/or maintenance ECT to maintain remission (65.6% vs 15.1%, P < 0.001; relative risk = 4.35, 95%CI: 2.19-8.63, P < 0.001). Twenty-nine patients experienced relapses during the three-year follow-up. In 21 (72.4%, 21/29) patients with relapse, the diagnosis was changed from MDD to BP. The duration from the first course of ECT to relapse was shorter for the BP patients than for the MDD patients (9.63 ± 10.4 mo vs 3.38 ± 3.77 mo, P = 0.022); for most patients, the interval was less than one month. The relative risk of depressive symptoms based on diagnostic changes was 4.35 (95% confidence interval: 2.19–8.63, P < 0.001), and the area under the ROC curve for detecting diagnostic changes based on relapse duration was 0.756 (95%CI: 0.562-0.895, P = 0.007).
CONCLUSION It may be beneficial to suspect BP and change the treatment strategy from MDD to BP for patients experiencing an early relapse.
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Affiliation(s)
- Naoki Kurimoto
- Department of Psychiatry, Shiga University of Medical Science, Otsu 520-2192, Shiga, Japan
- Department of Psychiatry, Shigasato Hospital, Otsu 520-0006, Shiga, Japan
| | - Takahiko Inagaki
- Department of Psychiatry, Shiga University of Medical Science, Otsu 520-2192, Shiga, Japan
- Department of Psychiatry, Biwako Hospital, Otsu 520-0113, Shiga, Japan
| | - Takashi Aoki
- Department of Psychiatry, Shiga University of Medical Science, Otsu 520-2192, Shiga, Japan
- Department of Psychiatry, Shiga Hachiman Hospital, Omihachiman 523-8503, Shiga, Japan
| | - Hiroshi Kadotani
- Department of Psychiatry, Shiga University of Medical Science, Otsu 520-2192, Shiga, Japan
- Department of Sleep and Behavioral Sciences, Shiga University of Medical Science, Otsu 520-2192, Shiga, Japan
| | - Fujiki Kurimoto
- Department of Psychiatry, Shigasato Hospital, Otsu 520-0006, Shiga, Japan
| | - Kenichi Kuriyama
- Department of Psychiatry, Shiga University of Medical Science, Otsu 520-2192, Shiga, Japan
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira 187-8502, Tokyo, Japan
| | - Naoto Yamada
- Department of Psychiatry, Shiga University of Medical Science, Otsu 520-2192, Shiga, Japan
| | - Yuji Ozeki
- Department of Psychiatry, Shiga University of Medical Science, Otsu 520-2192, Shiga, Japan
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Repetitive Transcranial Magnetic Stimulation: A Potential Treatment for Obesity in Patients with Schizophrenia. Behav Sci (Basel) 2021; 11:bs11060086. [PMID: 34208079 PMCID: PMC8230713 DOI: 10.3390/bs11060086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 05/28/2021] [Accepted: 06/09/2021] [Indexed: 11/21/2022] Open
Abstract
Obesity is highly prevalent in patients with schizophrenia and, in association with metabolic syndrome, contributes to premature deaths of patients due to cardiovascular disease complications. Moreover, pharmacologic, and behavioral interventions have not stemmed the tide of obesity in schizophrenia. Therefore, novel effective interventions are urgently needed. Repetitive transcranial magnetic stimulation (rTMS) has shown efficacy for inducing weight loss in obese non-psychiatric samples but this promising intervention has not been evaluated as a weight loss intervention in patients with schizophrenia. In this narrative review, we describe three brain mechanisms (hypothalamic inflammation, dysregulated mesocorticolimbic reward system, and impaired prefrontal cortex function) implicated in the pathogenesis and pathophysiology of obesity and emphasize how the three mechanisms have also been implicated in the neurobiology of schizophrenia. We then argue that, based on the three overlapping brain mechanisms in obesity and schizophrenia, rTMS would be effective as a weight loss intervention in patients with schizophrenia and comorbid obesity. We end this review by describing how deep TMS, relative to conventional TMS, could potentially result in larger effect size for weight loss. While this review is mainly conceptual and based on an extrapolation of findings from non-schizophrenia samples, our aim is to stimulate research in the use of rTMS for weight loss in patients with schizophrenia.
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