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Thai M, Nair AU, Klimes-Dougan B, Albott CS, Silamongkol T, Corkrum M, Hill D, Roemer JW, Lewis CP, Croarkin PE, Lim KO, Widge AS, Nahas Z, Eberly LE, Cullen KR. Deep transcranial magnetic stimulation for adolescents with treatment-resistant depression: A preliminary dose-finding study exploring safety and clinical effectiveness. J Affect Disord 2024; 354:589-600. [PMID: 38484878 DOI: 10.1016/j.jad.2024.03.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 02/20/2024] [Accepted: 03/09/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) is an intervention for treatment-resistant depression (TRD) that modulates neural activity. Deep TMS (dTMS) can target not only cortical but also deeper limbic structures implicated in depression. Although TMS has demonstrated safety in adolescents, dTMS has yet to be applied to adolescent TRD. OBJECTIVE/HYPOTHESIS This pilot study evaluated the safety, tolerability, and clinical effects of dTMS in adolescents with TRD. We hypothesized dTMS would be safe, tolerable, and efficacious for adolescent TRD. METHODS 15 adolescents with TRD (Age, years: M = 16.4, SD = 1.42) completed a six-week daily dTMS protocol targeting the left dorsolateral prefrontal cortex (BrainsWay H1 coil, 30 sessions, 10 Hz, 3.6 s train duration, 20s inter-train interval, 55 trains; 1980 total pulses per session, 80 % to 120 % of motor threshold). Participants completed clinical, safety, and neurocognitive assessments before and after treatment. The primary outcome was depression symptom severity measured by the Children's Depression Rating Scale-Revised (CDRS-R). RESULTS 14 out of 15 participants completed the dTMS treatments. One participant experienced a convulsive syncope; the other participants only experienced mild side effects (e.g., headaches). There were no serious adverse events and minimal to no change in cognitive performance. Depression symptom severity significantly improved pre- to post-treatment and decreased to a clinically significant degree after 10 treatment sessions. Six participants met criteria for treatment response. LIMITATIONS Main limitations include a small sample size and open-label design. CONCLUSIONS These findings provide preliminary evidence that dTMS may be tolerable and associated with clinical improvement in adolescent TRD.
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Affiliation(s)
- Michelle Thai
- Department of Psychology, University of Minnesota, Twin Cities, MN, United States of America; Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA, United States of America; Department of Psychiatry, Harvard Medical School, United States of America.
| | - Aparna U Nair
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Bonnie Klimes-Dougan
- Department of Psychology, University of Minnesota, Twin Cities, MN, United States of America
| | - C Sophia Albott
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Thanharat Silamongkol
- Graduate School of Applied and Professional Psychology, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States of America
| | - Michelle Corkrum
- Columbia University Medical Center, New York, NY, United States of America
| | - Dawson Hill
- University of Michigan Medical School, Ann Arbor, MI, United States of America
| | - Justin W Roemer
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Charles P Lewis
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States of America
| | - Kelvin O Lim
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Alik S Widge
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Ziad Nahas
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Lynn E Eberly
- Division of Biostatistics, School of Public Health, University of Minnesota, United States of America
| | - Kathryn R Cullen
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
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2
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Zhou XY, Thai M, Roediger D, Mueller BA, Cullen KR, Klimes-Dougan B, Andreazza AC. Mitochondrial health, NLRP3 inflammasome activation, and white matter integrity in adolescent mood disorders: A pilot study. J Affect Disord 2023; 340:149-159. [PMID: 37549811 DOI: 10.1016/j.jad.2023.08.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/24/2023] [Accepted: 08/04/2023] [Indexed: 08/09/2023]
Abstract
Adolescence is a particularly important period for brain development and is also when mood disorders typically emerge. Several psychiatric illnesses exhibit mitochondrial dysfunction, elevated inflammation, and impaired white matter integrity. This study explored the intersection of mitochondrial health, NLRP3 inflammasome activation, and white matter integrity in a small cohort of 29 adolescent patients with mood disorders (bipolar disorder (BD): n = 11, major depressive disorder (MDD): n = 19) and 19 healthy controls. In this sample, adolescents with mood disorders showed lower fractional anisotropy of the ventral cingulum bundle than healthy controls. Across all adolescents, we demonstrated a significant relationship between mitochondrial electron transport chain gene expression, and NLRP3 inflammasome gene expression and activation. Furthermore, circulating cell free mitochondrial DNA was associated with lower white matter integrity in the anterior thalamic radiation. Exploratory subgroup analyses revealed that adolescents with bipolar disorder exhibited lower levels of mitochondrial gene expression and volume, along with increased sensitivity to NLRP3 inflammasome activation compared to adolescents with unipolar depression. Overall, our results reveal relationships between peripherally-measured endpoints of mitochondrial health and NLRP3 inflammasome activation, and centrally measured endpoints of white matter integrity in adolescents. Together with subtle patterns of aberrant neural and biological structure and function in association with mood disorder diagnoses, these results may shed light on the pathophysiology of disease in this early phase of illness.
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Affiliation(s)
- Xinyang Y Zhou
- Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada
| | - Michelle Thai
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Donovan Roediger
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Bryon A Mueller
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Kathryn R Cullen
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | | | - Ana C Andreazza
- Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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3
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Başgöze Z, Demers L, Thai M, Falke CA, Mueller BA, Fiecas MB, Roediger DJ, Thomas KM, Klimes-Dougan B, Cullen KR. A Multilevel Examination of Cognitive Control in Adolescents With Nonsuicidal Self-injury. Biol Psychiatry Glob Open Sci 2023; 3:855-866. [PMID: 37881532 PMCID: PMC10593942 DOI: 10.1016/j.bpsgos.2023.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 10/27/2023] Open
Abstract
Background Nonsuicidal self-injury (NSSI), a transdiagnostic behavior, often emerges during adolescence. This study used the Research Domain Criteria approach to examine cognitive control (CC) with a focus on response inhibition and urgency relative to NSSI severity in adolescents. Methods One hundred thirty-eight adolescents, assigned female sex at birth, with a continuum of NSSI severity completed negative and positive urgency measurements (self-report), an emotional Go/NoGo task within negative and positive contexts (behavioral), and structural and functional imaging during resting state and task (brain metrics). Cortical thickness, subcortical volume, resting-state functional connectivity, and task activation focused on an a priori-defined CC network. Eighty-four participants had all these main measures. Correlations and stepwise model selection followed by multiple regression were used to examine the association between NSSI severity and multiunit CC measurements. Results Higher NSSI severity correlated with higher negative urgency and lower accuracy during positive no-inhibition (Go). Brain NSSI severity correlates varied across modalities and valence. For right medial prefrontal cortex and right caudate, higher NSSI severity correlated with greater negative but lower positive inhibition (NoGo) activation. The opposite pattern was observed for the right dorsolateral prefrontal cortex. Higher NSSI severity correlated with lower left dorsal anterior cingulate cortex (ACC) negative inhibition activation and thicker left dorsal ACC, yet it was correlated with higher right rostral ACC positive inhibition activation and thinner right rostral ACC, as well as lower CC network resting-state functional connectivity. Conclusions Findings revealed multifaceted signatures of NSSI severity across CC units of analysis, confirming the relevance of this domain in adolescent NSSI and illustrating how multimodal approaches can shed light on psychopathology.
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Affiliation(s)
- Zeynep Başgöze
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Lauren Demers
- Child Development & Rehabilitation Center, Oregon Health & Science University, Portland, Oregon
| | - Michelle Thai
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota
| | - Chloe A. Falke
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Bryon A. Mueller
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Mark B. Fiecas
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Donovan J. Roediger
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Kathleen M. Thomas
- Institute of Child Development, University of Minnesota, Minneapolis, Minnesota
| | | | - Kathryn R. Cullen
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota
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4
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Reinke M, Longenecker JM, Chowdhury L, Thai M, Begnel E, Horek N, Olman C, Cullen KR, Klimes-Dougan B. Behavioral Apophenia and Dimensions of Psychoticism in Adolescents with and without Mood Disorders. Psychopathology 2023; 56:473-477. [PMID: 36889291 DOI: 10.1159/000529796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 02/14/2023] [Indexed: 03/10/2023]
Abstract
Apophenia is the tendency to falsely detect meaningful relationships and may indicate susceptibility to more extreme expressions on the psychotic spectrum. This pilot investigated the fragmented ambiguous object task (FAOT), a new measure designed to assess apophenia behaviorally in a sample of adolescents with and without mood disorders using an image recognition task. Our primary hypothesis was that increased image recognition would be associated with PID-5 psychoticism. Participants were 33 (79% female) adolescents with (n = 18) and without (n = 15) mood disorders. Consistent with predictions, increased recognition of ambiguous images correlated positively with psychoticism. There was also moderate evidence for long-term stability of FAOT apophenia scores over time (mean interval of approximately 10 months). These findings offer preliminary evidence that the FAOT may be reflective of underlying psychoticism in our target population.
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Affiliation(s)
- Michael Reinke
- Medical School, University of Minnesota, Minneapolis, Minnesota, USA,
| | - Julia M Longenecker
- VISN 4 Mental Illness Research Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Lamisa Chowdhury
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michelle Thai
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Erin Begnel
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Nathan Horek
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Cheryl Olman
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kathryn R Cullen
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
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5
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Wagner AC, Ozturk S, Thai M, Westervelt A, Reigstad K, Cullen KR, Gunlicks-Stoessel M, Klimes-Dougan B. Executive functioning as a predictor of response to interpersonal psychotherapy in adolescents with depression: A pilot study. Journal of Affective Disorders Reports 2022. [DOI: 10.1016/j.jadr.2022.100376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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6
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Bendezú JJ, Thai M, Wiglesworth A, Cullen KR, Klimes-Dougan B. Adolescent stress experience-expression-physiology correspondence: Links to depression, self-injurious thoughts and behaviors, and frontolimbic neural circuity. J Affect Disord 2022; 300:269-279. [PMID: 34954334 PMCID: PMC9062769 DOI: 10.1016/j.jad.2021.12.098] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 12/10/2021] [Accepted: 12/20/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Dysregulated stress responsivity is implicated in adolescent risk for depression and self-injurious thoughts and behaviors (STBs). However, studies often examine levels of the stress response in isolation, precluding understanding of how coordinated disturbance across systems confers risk. The current study utilized a novel person-centered approach to identify stress correspondence profiles and linked them to depressive symptoms, STBs, and neural indices of self-regulatory capacity. METHOD Adolescents with and without a major depressive disorder diagnosis (N = 162, Mage = 16.54, SD = 1.96, 72.8% White, 66.5% female) completed the Trier Social Stress Test (TSST), questionnaires, and clinical interviews. Stress experience (self-report), expression (observed), and physiology (salivary cortisol) were assessed during the experimental protocol. Adolescents also underwent a magnetic resonance imaging scan. RESULTS Multitrajectory modeling revealed four profiles. High Experience-High Expression-Low Physiology (i.e., lower stress correspondence) adolescents were more likely to report depressive symptoms, lifetime nonsuicidal self-injury, and suicidal ideation relative to all other subgroups reflecting higher stress correspondence: Low Experience-Low Expression-Low Physiology, Moderate Experience-Moderate Expression-Moderate Physiology, High Experience-High Expression-High Physiology. High Experience-High Expression-Low Physiology adolescents also exhibited less positive amygdala-ventromedial prefrontal cortex resting state functional connectivity relative to Moderate Experience-Moderate Expression-Moderate Physiology. LIMITATIONS Data were cross-sectional, precluding inference about our profiles as etiological risk factors or mechanisms of risk. CONCLUSIONS Findings illustrate meaningful heterogeneity in adolescent stress correspondence with implications for multimodal, multilevel assessment and outcome monitoring in depression prevention and intervention efforts.
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Affiliation(s)
- Jason José Bendezú
- The Institute of Child Development, University of Minnesota, Minneapolis, MN 55455, United States; Department of Psychology, University of Minnesota, Minneapolis, MN 55455, United States.
| | | | | | - Kathryn R. Cullen
- Department of Psychiatry and Behavioral Sciences, University of Minnesota
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7
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Bendezú JJ, Howland M, Thai M, Marceau K, Shirtcliff EA, Hastings PD, Zahn-Waxler C, Klimes-Dougan B. Adolescent cortisol and DHEA responses to stress as prospective predictors of emotional and behavioral difficulties: A person-centered approach. Psychoneuroendocrinology 2021; 132:105365. [PMID: 34399100 PMCID: PMC8932361 DOI: 10.1016/j.psyneuen.2021.105365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 07/19/2021] [Accepted: 07/22/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Well-orchestrated cortisol and DHEA stress responsivity is thought to support efficacious stressor management (i.e., coping) and reduce risk for psychopathology during adolescence. Evidence of these relations, however, is lacking empirically. This longitudinal investigation had three aims: 1) to identify within-adolescent profiles of joint cortisol-DHEA responsivity, 2) examine profiles as prospective predictors of adolescents' later emotional and behavioral difficulties, and 3) examine whether distraction coping helped buffer such prospective risk in each profile. METHOD At Time 1, boys (n = 110) and girls (n = 105) between 11 and 16 years of age with varied levels of risk for psychopathology completed a lab-based socio-evaluative stressor and questionnaires (e.g., coping, internalizing and externalizing problems). Emotional and behavioral adjustment was assessed again at Time 2 (2 years later). RESULTS Multi-trajectory modeling of adolescents' cortisol and DHEA within the context of the stressor revealed three groups: Normative (n = 107; 49.8%), Hyperresponsive (n = 64; 29.8%), Hyporesponsive (n = 44; 20.5%). Relative to Normative, Hyperresponsive and Hyporesponsive adolescents were more and less advanced in pubertal status, respectively. Hyperresponsive adolescents, but not Hyporesponsive, reported greater emotional and behavioral problems at Time 2, relative to Normative adolescents. Links between distraction coping and Time 2 adjustment varied across the groups. Specifically, distraction coping was associated with fewer Time 2 emotional and behavioral problems for Normative adolescents. However, the converse was true for Hyporesponsive adolescents, with distraction associated with greater Time 2 emotional and behavioral problems. Distraction was not associated with Time 2 emotional and behavioral problems for Hyperresponsive adolescents (i.e., elevated levels irrespective of distraction coping utilization). CONCLUSION Our results strengthen inference about the role neuroendocrine coordination plays in risk for psychopathology. Findings also help to clarify inconsistent distraction coping-psychopathology linkages, illustrating different patterns of cortisol-DHEA responsivity that support as well as thwart the use of this potentially efficacious strategy.
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Affiliation(s)
- Jason José Bendezú
- The Institute of Child Development, University of Minnesota, United States.
| | - Mariann Howland
- The Institute of Child Development, University of Minnesota,Department of Psychology, University of Minnesota
| | | | - Kristine Marceau
- Department of Human Development and Family Studies, Purdue University
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8
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Koenig J, Abler B, Agartz I, Åkerstedt T, Andreassen OA, Anthony M, Bär KJ, Bertsch K, Brown RC, Brunner R, Carnevali L, Critchley HD, Cullen KR, de Geus EJC, de la Cruz F, Dziobek I, Ferger MD, Fischer H, Flor H, Gaebler M, Gianaros PJ, Giummarra MJ, Greening SG, Guendelman S, Heathers JAJ, Herpertz SC, Hu MX, Jentschke S, Kaess M, Kaufmann T, Klimes-Dougan B, Koelsch S, Krauch M, Kumral D, Lamers F, Lee TH, Lekander M, Lin F, Lotze M, Makovac E, Mancini M, Mancke F, Månsson KNT, Manuck SB, Mather M, Meeten F, Min J, Mueller B, Muench V, Nees F, Nga L, Nilsonne G, Ordonez Acuna D, Osnes B, Ottaviani C, Penninx BWJH, Ponzio A, Poudel GR, Reinelt J, Ren P, Sakaki M, Schumann A, Sørensen L, Specht K, Straub J, Tamm S, Thai M, Thayer JF, Ubani B, van der Mee DJ, van Velzen LS, Ventura-Bort C, Villringer A, Watson DR, Wei L, Wendt J, Schreiner MW, Westlye LT, Weymar M, Winkelmann T, Wu GR, Yoo HJ, Quintana DS. Cortical thickness and resting-state cardiac function across the lifespan: A cross-sectional pooled mega-analysis. Psychophysiology 2021; 58:e13688. [PMID: 33037836 DOI: 10.1111/psyp.13688] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 12/27/2022]
Abstract
Understanding the association between autonomic nervous system [ANS] function and brain morphology across the lifespan provides important insights into neurovisceral mechanisms underlying health and disease. Resting-state ANS activity, indexed by measures of heart rate [HR] and its variability [HRV] has been associated with brain morphology, particularly cortical thickness [CT]. While findings have been mixed regarding the anatomical distribution and direction of the associations, these inconsistencies may be due to sex and age differences in HR/HRV and CT. Previous studies have been limited by small sample sizes, which impede the assessment of sex differences and aging effects on the association between ANS function and CT. To overcome these limitations, 20 groups worldwide contributed data collected under similar protocols of CT assessment and HR/HRV recording to be pooled in a mega-analysis (N = 1,218 (50.5% female), mean age 36.7 years (range: 12-87)). Findings suggest a decline in HRV as well as CT with increasing age. CT, particularly in the orbitofrontal cortex, explained additional variance in HRV, beyond the effects of aging. This pattern of results may suggest that the decline in HRV with increasing age is related to a decline in orbitofrontal CT. These effects were independent of sex and specific to HRV; with no significant association between CT and HR. Greater CT across the adult lifespan may be vital for the maintenance of healthy cardiac regulation via the ANS-or greater cardiac vagal activity as indirectly reflected in HRV may slow brain atrophy. Findings reveal an important association between CT and cardiac parasympathetic activity with implications for healthy aging and longevity that should be studied further in longitudinal research.
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Affiliation(s)
- Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Section for Experimental Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Birgit Abler
- Department of Psychiatry and Psychotherapy III, Ulm University, Ulm, Germany
| | - Ingrid Agartz
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
- Department of Clinical Neuroscience, Centre for Psychiatric Research, Karolinska Institutet, Stockholm, Sweden
| | - Torbjörn Åkerstedt
- Stress Research Institute, Stockholm University, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Mia Anthony
- University of Rochester Medical Center, Rochester, NY, USA
| | - Karl-Jürgen Bär
- Department of Psychosomatic Medicine, University Hospital Jena, Jena, Germany
| | - Katja Bertsch
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Rebecca C Brown
- Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Romuald Brunner
- Clinic and Polyclinic for Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Luca Carnevali
- Stress Physiology Lab, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Hugo D Critchley
- Psychiatry, BSMS Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK
| | - Kathryn R Cullen
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Medical School, Minneapolis, MN, USA
| | - Eco J C de Geus
- Department of Biological Psychology, Amsterdam Public Health Research Institute, VU University, Amsterdam, The Netherlands
| | | | - Isabel Dziobek
- Department of Psychology, Berlin School of Mind and Brain, Humboldt Universität, Berlin, Germany
| | - Marc D Ferger
- Department of Psychiatry and Psychotherapy III, Ulm University, Ulm, Germany
| | - Håkan Fischer
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Herta Flor
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Michael Gaebler
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- MindBrainBody Institute, Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Peter J Gianaros
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Melita J Giummarra
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Caulfield Pain Management and Research Centre, Caulfield, VIC, Australia
| | - Steven G Greening
- Department of Psychology, Cognitive and Brain Sciences, Louisiana State University, Baton Rouge, LA, USA
| | - Simon Guendelman
- Berlin School of Mind and Brain, Humboldt Universität, Berlin, Germany
| | | | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Mandy X Hu
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sebastian Jentschke
- Cluster "Languages of Emotion", Freie Universität Berlin, Berlin, Germany
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Tobias Kaufmann
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Bonnie Klimes-Dougan
- Department of Psychology, University of Minnesota, College of Liberal Arts, Minneapolis, MN, USA
| | - Stefan Koelsch
- Cluster "Languages of Emotion", Freie Universität Berlin, Berlin, Germany
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Marlene Krauch
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Deniz Kumral
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- MindBrainBody Institute, Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Femke Lamers
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Tae-Ho Lee
- Department of Psychology, Virginia Tech, Blacksburg, VA, USA
| | - Mats Lekander
- Stress Research Institute, Stockholm University, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Feng Lin
- University of Rochester Medical Center, Rochester, NY, USA
| | - Martin Lotze
- Functional Imaging Unit, Center of Diagnostic Radiology and Neuroradiology, University of Greifswald, Greifswald, Germany
| | - Elena Makovac
- Centre for Neuroimaging Science, King's College London, London, UK
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Matteo Mancini
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, Brighton, UK
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Falk Mancke
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Kristoffer N T Månsson
- Department of Psychology, Stockholm University, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Stephen B Manuck
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mara Mather
- Leonard Davis School of Gerontology, Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Frances Meeten
- School of Psychology, University of Sussex, Brighton, UK
| | - Jungwon Min
- Emotion and Cognition Lab, University of Southern California, Los Angeles, CA, USA
| | - Bryon Mueller
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Medical School, Minneapolis, MN, USA
| | - Vera Muench
- Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Frauke Nees
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Lin Nga
- Emotion and Cognition Lab, University of Southern California, Los Angeles, CA, USA
| | - Gustav Nilsonne
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | | | - Berge Osnes
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Bjorgvin District Psychiatric Centre, Haukeland University Hospital, Bergen, Norway
| | - Cristina Ottaviani
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Allison Ponzio
- Emotion and Cognition Lab, University of Southern California, Los Angeles, CA, USA
| | - Govinda R Poudel
- Behaviour Environment and Cognition Research Program, Mary MacKillop Institute for Health Research, Melbourne, VIC, Australia
| | - Janis Reinelt
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Ping Ren
- University of Rochester Medical Center, Rochester, NY, USA
| | - Michiko Sakaki
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
- Research Institute, Kochi University of Technology, Kami, Japan
| | - Andy Schumann
- Department of Psychosomatic Medicine, University Hospital Jena, Jena, Germany
| | - Lin Sørensen
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Karsten Specht
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Department of Education, UiT/The Arctic University of Norway, Tromsø, Norway
| | - Joana Straub
- Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Sandra Tamm
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Stockholm University, Stockholm, Sweden
- Department of Psychiatry, Oxford University, Oxford, UK
| | - Michelle Thai
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Medical School, Minneapolis, MN, USA
| | - Julian F Thayer
- Department of Psychological Science, The University of California, Irvine, CA, USA
| | - Benjamin Ubani
- Boston University, School of Public Health, Boston, MA, USA
| | - Denise J van der Mee
- Department of Biological Psychology, Amsterdam Public Health Research Institute, VU University, Amsterdam, The Netherlands
| | - Laura S van Velzen
- Department of Psychiatry, Neuroscience Campus Amsterdam, VU University, Medical Center and GGZ inGeest, Amsterdam, the Netherlands
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Carlos Ventura-Bort
- Department of Biological Psychology and Affective Science, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany
| | - Arno Villringer
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- MindBrainBody Institute, Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - David R Watson
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of Sussex, Falmer, UK
| | - Luqing Wei
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Southwest University, Chongqing, China
| | - Julia Wendt
- Department of Biological Psychology and Affective Science, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany
| | | | - Lars T Westlye
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Mathias Weymar
- Department of Biological Psychology and Affective Science, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany
- Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany
| | - Tobias Winkelmann
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Guo-Rong Wu
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Southwest University, Chongqing, China
| | - Hyun Joo Yoo
- Emotion and Cognition Lab, University of Southern California, Los Angeles, CA, USA
| | - Daniel S Quintana
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Farmer AD, Strzelczyk A, Finisguerra A, Gourine AV, Gharabaghi A, Hasan A, Burger AM, Jaramillo AM, Mertens A, Majid A, Verkuil B, Badran BW, Ventura-Bort C, Gaul C, Beste C, Warren CM, Quintana DS, Hämmerer D, Freri E, Frangos E, Tobaldini E, Kaniusas E, Rosenow F, Capone F, Panetsos F, Ackland GL, Kaithwas G, O'Leary GH, Genheimer H, Jacobs HIL, Van Diest I, Schoenen J, Redgrave J, Fang J, Deuchars J, Széles JC, Thayer JF, More K, Vonck K, Steenbergen L, Vianna LC, McTeague LM, Ludwig M, Veldhuizen MG, De Couck M, Casazza M, Keute M, Bikson M, Andreatta M, D'Agostini M, Weymar M, Betts M, Prigge M, Kaess M, Roden M, Thai M, Schuster NM, Montano N, Hansen N, Kroemer NB, Rong P, Fischer R, Howland RH, Sclocco R, Sellaro R, Garcia RG, Bauer S, Gancheva S, Stavrakis S, Kampusch S, Deuchars SA, Wehner S, Laborde S, Usichenko T, Polak T, Zaehle T, Borges U, Teckentrup V, Jandackova VK, Napadow V, Koenig J. International Consensus Based Review and Recommendations for Minimum Reporting Standards in Research on Transcutaneous Vagus Nerve Stimulation (Version 2020). Front Hum Neurosci 2021; 14:568051. [PMID: 33854421 PMCID: PMC8040977 DOI: 10.3389/fnhum.2020.568051] [Citation(s) in RCA: 108] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 09/01/2020] [Indexed: 12/18/2022] Open
Abstract
Given its non-invasive nature, there is increasing interest in the use of transcutaneous vagus nerve stimulation (tVNS) across basic, translational and clinical research. Contemporaneously, tVNS can be achieved by stimulating either the auricular branch or the cervical bundle of the vagus nerve, referred to as transcutaneous auricular vagus nerve stimulation(VNS) and transcutaneous cervical VNS, respectively. In order to advance the field in a systematic manner, studies using these technologies need to adequately report sufficient methodological detail to enable comparison of results between studies, replication of studies, as well as enhancing study participant safety. We systematically reviewed the existing tVNS literature to evaluate current reporting practices. Based on this review, and consensus among participating authors, we propose a set of minimal reporting items to guide future tVNS studies. The suggested items address specific technical aspects of the device and stimulation parameters. We also cover general recommendations including inclusion and exclusion criteria for participants, outcome parameters and the detailed reporting of side effects. Furthermore, we review strategies used to identify the optimal stimulation parameters for a given research setting and summarize ongoing developments in animal research with potential implications for the application of tVNS in humans. Finally, we discuss the potential of tVNS in future research as well as the associated challenges across several disciplines in research and clinical practice.
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Affiliation(s)
- Adam D. Farmer
- Department of Gastroenterology, University Hospitals of North Midlands NHS Trust, Stoke on Trent, United Kingdom
| | - Adam Strzelczyk
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | | | - Alexander V. Gourine
- Department of Neuroscience, Physiology and Pharmacology, Centre for Cardiovascular and Metabolic Neuroscience, University College London, London, United Kingdom
| | - Alireza Gharabaghi
- Institute for Neuromodulation and Neurotechnology, University Hospital and University of Tuebingen, Tuebingen, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, Augsburg, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Andreas M. Burger
- Laboratory for Biological Psychology, Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | | | - Ann Mertens
- Department of Neurology, Institute for Neuroscience, 4Brain, Ghent University Hospital, Gent, Belgium
| | - Arshad Majid
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Bart Verkuil
- Clinical Psychology and the Leiden Institute of Brain and Cognition, Leiden University, Leiden, Netherlands
| | - Bashar W. Badran
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United States
| | - Carlos Ventura-Bort
- Department of Biological Psychology and Affective Science, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany
| | - Charly Gaul
- Migraine and Headache Clinic Koenigstein, Königstein im Taunus, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | | | - Daniel S. Quintana
- NORMENT, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| | - Dorothea Hämmerer
- Medical Faculty, Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University, Magdeburg, Germany
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
- Center for Behavioral Brain Sciences Magdeburg (CBBS), Otto-von-Guericke University, Magdeburg, Germany
| | - Elena Freri
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Eleni Frangos
- Pain and Integrative Neuroscience Branch, National Center for Complementary and Integrative Health, NIH, Bethesda, MD, United States
| | - Eleonora Tobaldini
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Eugenijus Kaniusas
- Institute of Electrodynamics, Microwave and Circuit Engineering, TU Wien, Vienna, Austria
- SzeleSTIM GmbH, Vienna, Austria
| | - Felix Rosenow
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Fioravante Capone
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Fivos Panetsos
- Faculty of Biology and Faculty of Optics, Complutense University of Madrid and Institute for Health Research, San Carlos Clinical Hospital (IdISSC), Madrid, Spain
| | - Gareth L. Ackland
- Translational Medicine and Therapeutics, Barts and The London School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Gaurav Kaithwas
- Department of Pharmaceutical Sciences, School of Biosciences and Biotechnology, Babasaheb Bhimrao Ambedkar University (A Central University), Lucknow, India
| | - Georgia H. O'Leary
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United States
| | - Hannah Genheimer
- Department of Biological Psychology, Clinical Psychology and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Heidi I. L. Jacobs
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, Netherlands
| | - Ilse Van Diest
- Research Group Health Psychology, Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Jean Schoenen
- Headache Research Unit, Department of Neurology-Citadelle Hospital, University of Liège, Liège, Belgium
| | - Jessica Redgrave
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Jiliang Fang
- Functional Imaging Lab, Department of Radiology, Guang An Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jim Deuchars
- School of Biomedical Science, Faculty of Biological Science, University of Leeds, Leeds, United Kingdom
| | - Jozsef C. Széles
- Division for Vascular Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Julian F. Thayer
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - Kaushik More
- Institute for Cognitive Neurology and Dementia Research, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
- Neuromodulatory Networks, Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Kristl Vonck
- Department of Neurology, Institute for Neuroscience, 4Brain, Ghent University Hospital, Gent, Belgium
| | - Laura Steenbergen
- Clinical and Cognitive Psychology and the Leiden Institute of Brain and Cognition, Leiden University, Leiden, Netherlands
| | - Lauro C. Vianna
- NeuroV̇ASQ̇ - Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasilia, Brasilia, Brazil
| | - Lisa M. McTeague
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United States
| | - Mareike Ludwig
- Department of Anatomy, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Maria G. Veldhuizen
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Marijke De Couck
- Faculty of Health Care, University College Odisee, Aalst, Belgium
- Division of Epileptology, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Marina Casazza
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| | - Marius Keute
- Institute for Neuromodulation and Neurotechnology, University Hospital and University of Tuebingen, Tuebingen, Germany
| | - Marom Bikson
- Department of Biomedical Engineering, City College of New York, New York, NY, United States
| | - Marta Andreatta
- Department of Biological Psychology, Clinical Psychology and Psychotherapy, University of Würzburg, Würzburg, Germany
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Martina D'Agostini
- Research Group Health Psychology, Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Mathias Weymar
- Department of Biological Psychology and Affective Science, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany
- Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany
| | - Matthew Betts
- Department of Anatomy, Faculty of Medicine, Mersin University, Mersin, Turkey
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Magdeburg, Germany
- Center for Behavioral Brain Sciences, Otto-von-Guericke University, Magdeburg, Germany
| | - Matthias Prigge
- Neuromodulatory Networks, Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Michael Roden
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research, Munich, Germany
| | - Michelle Thai
- Department of Psychology, College of Liberal Arts, University of Minnesota, Minneapolis, MN, United States
| | - Nathaniel M. Schuster
- Department of Anesthesiology, Center for Pain Medicine, University of California, San Diego Health System, La Jolla, CA, United States
| | - Nicola Montano
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Niels Hansen
- Department of Psychiatry and Psychotherapy, University of Göttingen, Göttingen, Germany
- Laboratory of Systems Neuroscience and Imaging in Psychiatry (SNIPLab), University of Göttingen, Göttingen, Germany
| | - Nils B. Kroemer
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Peijing Rong
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Rico Fischer
- Department of Psychology, University of Greifswald, Greifswald, Germany
| | - Robert H. Howland
- Department of Psychiatry, University of Pittsburgh School of Medicine, UPMC Western Psychiatric Hospital, Pittsburgh, PA, United States
| | - Roberta Sclocco
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States
- Department of Radiology, Logan University, Chesterfield, MO, United States
| | - Roberta Sellaro
- Cognitive Psychology Unit, Institute of Psychology, Leiden University, Leiden, Netherlands
- Leiden Institute for Brain and Cognition, Leiden, Netherlands
- Department of Developmental Psychology and Socialisation, University of Padova, Padova, Italy
| | - Ronald G. Garcia
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Sebastian Bauer
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Sofiya Gancheva
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Stavros Stavrakis
- Faculty of Biological Science, School of Biomedical Science, University of Leeds, Leeds, United Kingdom
| | - Stefan Kampusch
- Institute of Electrodynamics, Microwave and Circuit Engineering, TU Wien, Vienna, Austria
- SzeleSTIM GmbH, Vienna, Austria
| | - Susan A. Deuchars
- School of Biomedical Science, Faculty of Biological Science, University of Leeds, Leeds, United Kingdom
| | - Sven Wehner
- Department of Surgery, University Hospital Bonn, Bonn, Germany
| | - Sylvain Laborde
- Department of Performance Psychology, Institute of Psychology, Deutsche Sporthochschule, Köln, Germany
| | - Taras Usichenko
- Department of Anesthesiology, University Medicine Greifswald, Greifswald, Germany
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Thomas Polak
- Laboratory of Functional Neurovascular Diagnostics, AG Early Diagnosis of Dementia, Department of Psychiatry, Psychosomatics and Psychotherapy, University Clinic Würzburg, Würzburg, Germany
| | - Tino Zaehle
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Uirassu Borges
- Department of Performance Psychology, Institute of Psychology, Deutsche Sporthochschule, Köln, Germany
- Department of Social and Health Psychology, Institute of Psychology, Deutsche Sporthochschule, Köln, Germany
| | - Vanessa Teckentrup
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Vera K. Jandackova
- Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
- Department of Human Movement Studies, Faculty of Education, University of Ostrava, Ostrava, Czechia
| | - Vitaly Napadow
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States
- Department of Radiology, Logan University, Chesterfield, MO, United States
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Section for Experimental Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
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Thai M, Klimes-Dougan B, Cullen K. Editorial: The Ups and Downs of Mind-Wandering in Adolescents. J Am Acad Child Adolesc Psychiatry 2021; 60:340-342. [PMID: 32561405 DOI: 10.1016/j.jaac.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/08/2020] [Indexed: 11/16/2022]
Abstract
The human brain is always active; it wanders freely during rest as well as when we lose focus during tasks. Mind-wandering encompasses spontaneous thinking, such as processing recent experiences, problem solving, and achieving insights. Understanding this unconstrained brain activity may lead to clues about the neural mechanisms of mental health problems. Brain networks implicated in mind-wandering include the default mode network (DMN), the salience network, and task-positive networks including the frontoparietal control network and dorsal attention network.1 Given that these networks mature during adolescence, coinciding with a time notable for the emergence of mental health problems, quantifying and examining the neural correlates of mind-wandering in adolescents with psychopathology may shed light on how the healthy and pathological brain functions and point to possible methods of intervening.
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Affiliation(s)
- Michelle Thai
- College of Liberal Arts, University of Minnesota, Twin Cities
| | | | - Kathryn Cullen
- School of Medicine, University of Minnesota, Twin Cities.
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11
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Thai M, Schreiner MW, Mueller BA, Cullen KR, Klimes-Dougan B. Coordination between frontolimbic resting state connectivity and hypothalamic-pituitary-adrenal axis functioning in adolescents with and without depression. Psychoneuroendocrinology 2021; 125:105123. [PMID: 33465581 PMCID: PMC8443322 DOI: 10.1016/j.psyneuen.2020.105123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 12/23/2020] [Accepted: 12/27/2020] [Indexed: 10/22/2022]
Abstract
Depression is associated with abnormalities in Hypothalamic-Pituitary-Adrenal (HPA) axis functioning and neural circuitry that underlie the stress response. Resting-state functional connectivity (RSFC) between frontolimbic brain regions captures intrinsic connections that may set the stage for the rallying and regulating of the HPA axis system. This study examined the association between cortisol stress response and frontolimbic (amygdala and ventral and dorsal medial prefrontal cortex [vmPFC and dmPFC respectively]) RSFC in 88 (Age: M = 15.95, SD = 2.04; 71.60% female) adolescents with (N = 55) and without (N = 33) major depressive disorder (MDD). We collected salivary cortisol in the context of a modified Trier Social Stress Test (TSST) paradigm. Key findings were that adolescents with depression and healthy controls showed different patterns of association between amygdala and vmPFC RSFC and HPA functioning: while healthy controls showed a positive relationship between frontolimbic connectivity and cortisol levels that may indicate coordination across neural and neuroendocrine systems, adolescents with depression showed a minimal or inverse relationship, suggesting poor coordination of these systems. Results were similar when examining non-suicidal self-injury subgroups within the MDD sample. These findings suggest that the intrinsic quality of this frontolimbic connection may be related to HPA axis functioning. In MDD, inverse associations may represent a compensatory response in one system in response to dysfunction in the other. Longitudinal multilevel research, however, is needed to disentangle how stress system coordination develops in normal and pathological contexts and how these systems recover with treatment.
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Affiliation(s)
- Michelle Thai
- Psychology Department, College of Liberal Arts, University of Minnesota, Twin Cities, United States.
| | | | - Bryon A. Mueller
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Minnesota, Twin Cities
| | - Kathryn R. Cullen
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Minnesota, Twin Cities
| | - Bonnie Klimes-Dougan
- Psychology Department, College of Liberal Arts, University of Minnesota, Twin Cities, United States.
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Roy AV, Thai M, Klimes-Dougan B, Schreiner MW, Mueller BA, Albott CS, Lim KO, Fiecas M, Tye SJ, Cullen KR. Brain entropy and neurotrophic molecular markers accompanying clinical improvement after ketamine: Preliminary evidence in adolescents with treatment-resistant depression. J Psychopharmacol 2021; 35:168-177. [PMID: 32643995 PMCID: PMC8569740 DOI: 10.1177/0269881120928203] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Current theory suggests that treatment-resistant depression (TRD) involves impaired neuroplasticity resulting in cognitive and neural rigidity, and that clinical improvement may require increasing brain flexibility and adaptability. AIMS In this hypothesis-generating study, we sought to identify preliminary evidence of brain flexibility correlates of clinical change within the context of an open-label ketamine trial in adolescents with TRD, focusing on two promising candidate markers of neural flexibility: (a) entropy of resting-state functional magnetic resonance imaging (fMRI) signals; and (b) insulin-stimulated phosphorylation of mammalian target of rapamycin (mTOR) and glycogen synthase-3-beta (GSK3β) in peripheral blood mononuclear cells. METHODS We collected resting-state functional magnetic resonance imaging data and blood samples from 13 adolescents with TRD before and after a series of six ketamine infusions over 2 weeks. Usable pre/post ketamine data were available from 11 adolescents for imaging and from 10 adolescents for molecular signaling. We examined correlations between treatment response and changes in the central and peripheral flexibility markers. RESULTS Depression reduction correlated with increased nucleus accumbens entropy. Follow-up analyses suggested that physiological changes were associated with treatment response. In contrast to treatment non-responders (n=6), responders (n=5) showed greater increase in nucleus accumbens entropy after ketamine, together with greater post-treatment insulin/mTOR/GSK3β signaling. CONCLUSIONS These data provide preliminary evidence that changes in neural flexibility may underlie symptom relief in adolescents with TRD following ketamine. Future research with adequately powered samples is needed to confirm resting-state entropy and insulin-stimulated mTOR and GSK3β as brain flexibility markers and candidate targets for future clinical trials. CLINICAL TRIAL NAME Ketamine in adolescents with treatment-resistant depressionURL: https://clinicaltrials.gov/ct2/show/NCT02078817Registration number: NCT02078817.
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Affiliation(s)
- Abhrajeet V Roy
- Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis, USA
| | - Michelle Thai
- Department of Psychology, College of Liberal Arts, University of Minnesota, Minneapolis, USA
| | - Bonnie Klimes-Dougan
- Department of Psychology, College of Liberal Arts, University of Minnesota, Minneapolis, USA
| | | | - Bryon A Mueller
- Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis, USA
| | - Christina Sophia Albott
- Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis, USA
| | - Kelvin O Lim
- Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis, USA
| | - Mark Fiecas
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, USA
| | - Susannah J Tye
- Queensland Brain Institute, The University of Queensland, Brisbane, Australia
| | - Kathryn R Cullen
- Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis, USA
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Klimes-Dougan B, Chong LS, Samikoglu A, Thai M, Amatya P, Cullen KR, Lim KO. Transcendental meditation and hypothalamic-pituitary-adrenal axis functioning: a pilot, randomized controlled trial with young adults. Stress 2020; 23:105-115. [PMID: 31418329 DOI: 10.1080/10253890.2019.1656714] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Transcendental meditation (TM) is effective in alleviating stress and anxiety and promoting well-being. While the underlying biological mechanisms of TM are not yet fully explored, the hypothalamic-pituitary-adrenal (HPA) axis represents an index providing important clues embodying the stress system cascade. In this pilot study, young adults were randomly assigned to TM training followed by 8 weeks of meditation practice or a wait-list control condition. TM was conducted over 8 weeks. Thirty-four young adult participants were randomized; 27 participants completed the HPA outcome assessments (41% male). To assess HPA axis functioning, salivary samples to assess cortisol awakening response (CAR) that were collected in the morning, both at baseline and at week-4. Salivary cortisol in the context of a social stressor using the Trier Social Stress Test (TSST) was collected at week-8. The results indicate that participants who were randomly assigned to TM had lower awakening salivary cortisol levels and a greater drop in CAR from baseline to week-4 than the control group. There were no significant differences in HPA axis functioning in the context of the TSST. Primary limitations of this randomized controlled trial were the small sample size, the use of a wait-list as opposed to an active control, and the limited scope of HPA axis assessments. The results of this pilot study provide tentative evidence that TM may impact biological stress system functioning and suggests that this may be a worthwhile avenue to continue to examine. It will also be useful to extend these findings to a broader array of meditative and mindful practices, particularly for those who are experiencing more distress.
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Affiliation(s)
| | - Li Shen Chong
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Ali Samikoglu
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Michelle Thai
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Palistha Amatya
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Kathryn R Cullen
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Kelvin O Lim
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
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Thai M, Başgöze Z, Klimes-Dougan B, Mueller BA, Fiecas M, Lim KO, Albott CS, Cullen KR. Neural and Behavioral Correlates of Clinical Improvement to Ketamine in Adolescents With Treatment Resistant Depression. Front Psychiatry 2020; 11:820. [PMID: 33013493 PMCID: PMC7461781 DOI: 10.3389/fpsyt.2020.00820] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/29/2020] [Indexed: 12/27/2022] Open
Abstract
Treatment-resistant depression (TRD) is a serious problem in adolescents. Development and optimization of novel interventions for these youth will require a deeper knowledge of the neurobiology of depression. A well-established phenomenon of depression is an attention bias toward negativity and away from positivity that is evidenced behaviorally and neurally, but it is unclear how symptom reduction is related to changes to this bias. Neurobiological research using a treatment probe has promise to help discover the neural changes that accompany symptom improvement. Ketamine has utility for such research because of its known rapid and strong antidepressant effects in the context of TRD. Our previous study of six open-label ketamine infusions in 11 adolescents with TRD showed variable response, ranging from full remission, partial response, non-response, or clinical worsening. In this study, we examined the performance of these participants on Word Face Stroop (WFS) fMRI task where they indicated the valence of affective words superimposed onto either congruent or incongruent emotional faces before and after the ketamine infusions. Participants also completed a clinical assessment (including measurement of depression symptomology and anhedonia/pleasure) before and after the ketamine infusions. Following ketamine treatment, better WFS performance correlated with self-reported decreased depressive symptoms and increased pleasure. Analyses of corticolimbic, corticostriatal and default mode (DMN) networks showed that across networks, decreased activation during all conditions (congruent negative, congruent positive, incongruent negative, and incongruent positive) correlated with decreases in depressive symptoms and with increases in pleasure. These findings suggest that in adolescents with TRD, clinical improvement may require an attenuation of the negativity bias and re-tuning of these three critical neural networks to attenuate DMN and limbic regions activation and allow more efficient recruitment of the reward network. Lower activation across conditions may facilitate shifting across different salient emotional stimuli rather than getting trapped in downward negative spirals.
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Affiliation(s)
- Michelle Thai
- Psychology Department, College of Liberal Arts, University of Minnesota, Twin Cities, MN, United States
| | - Zeynep Başgöze
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Minnesota, Twin Cities, MN, United States
| | - Bonnie Klimes-Dougan
- Psychology Department, College of Liberal Arts, University of Minnesota, Twin Cities, MN, United States
| | - Bryon A Mueller
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Minnesota, Twin Cities, MN, United States
| | - Mark Fiecas
- Biostatistics Department, School of Public Health, University of Minnesota, Twin Cities, MN, United States
| | - Kelvin O Lim
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Minnesota, Twin Cities, MN, United States
| | - C Sophia Albott
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Minnesota, Twin Cities, MN, United States
| | - Kathryn R Cullen
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Minnesota, Twin Cities, MN, United States
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15
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Klimes-Dougan B, Begnel E, Almy B, Thai M, Schreiner MW, Cullen KR. Hypothalamic-pituitary-adrenal axis dysregulation in depressed adolescents with non-suicidal self-injury. Psychoneuroendocrinology 2019; 102:216-224. [PMID: 30590339 DOI: 10.1016/j.psyneuen.2018.11.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 10/30/2018] [Accepted: 11/01/2018] [Indexed: 11/22/2022]
Abstract
Non-suicidal self-injury (NSSI) is characterized by causing harm to one's own body without the intent of suicide. While major depressive disorder (MDD) has been associated with elevated cortisol (at least in some subgroups), prior studies in NSSI have suggested that NSSI is associated with blunted reactivity to stress of the hypothalamic-pituitary-adrenal (HPA) axis, possibly consistent with an allostatic load model. The present study used a multi-level approach to examine salivary cortisol in the context of a social stressor in 162 adolescents (ages 12 to 19 years old) with MDD with a history of repeated engagement in NSSI (MDD/NSSI) versus MDD without repeated NSSI (MDD), and healthy controls (HC). Observed (expressed) and self-reported (experienced) ratings of stress were also obtained during the social stress paradigm. The results showed that MDD/NSSI exhibited lower salivary cortisol levels and differed in cortisol trajectories in the context of a social stressor compared to HC and MDD. Observed stress, but not self-reported stress, during the social stress paradigm was greater for the MDD/NSSI than HC. Follow-up analyses suggested the possibility that this pattern of lower cortisol for those who engage in NSSI was present in females and males, and was more pronounced in those with repeated NSSI (but not subthreshold NSSI) and those with a history of NSSI and suicide attempts. Overall, these findings add to the prior literature and begin to show a consistent pattern for how stress is processed in atypical ways for those who engage in repeated NSSI. Importantly, these results suggest that some of the heterogeneity across adolescent depression may be better represented by these underlying biological processes, perhaps even representing subgroups that will benefit from different types of intervention. Hypothalamic-Pituitary-Adrenal Axis Dysregulation in Depressed Adolescents with Non-Suicidal Self-Injury.
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Affiliation(s)
- Bonnie Klimes-Dougan
- Psychology Department, College of Liberal Arts, University of Minnesota, Twin Cities, United States.
| | - Erin Begnel
- Psychology Department, College of Liberal Arts, University of Minnesota, Twin Cities, United States.
| | - Brandon Almy
- Institute of Child Development, College of Education and Human Development, University of Minnesota, Twin Cities, United States.
| | - Michelle Thai
- Psychology Department, College of Liberal Arts, University of Minnesota, Twin Cities, United States.
| | | | - Kathryn R Cullen
- Psychiatry Department, School of Medicine, University of Minnesota, Twin Cities, United States.
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Cullen K, Thai M, Lim K, Klimes-Dougan B. Targeting rumination with combined mindful breathing and tDCS in adolescents with suicidal thoughts. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Klimes-Dougan B, Westlund Schreiner M, Thai M, Gunlicks-Stoessel M, Reigstad K, Cullen KR. Neural and neuroendocrine predictors of pharmacological treatment response in adolescents with depression: A preliminary study. Prog Neuropsychopharmacol Biol Psychiatry 2018; 81:194-202. [PMID: 29100972 DOI: 10.1016/j.pnpbp.2017.10.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/09/2017] [Accepted: 10/24/2017] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Typically, about 30 to 50% of adolescents with depression fail to respond to evidence-based treatments, including antidepressant medications such as selective serotonin reuptake inhibitors (SSRIs). Efforts for identifying predictors and moderators of treatment response are needed to begin to address critical questions relevant to personalized care in adolescent depression. In this pilot study, we aim to identify biological predictors of response to antidepressant treatment. METHOD We used a multiple levels of analysis approach to evaluate threat system functioning (fronto-limbic system and the associated hormonal cascade) to determine if key biological indexes at baseline could predict improvement in depressive symptoms after eight weeks of antidepressant treatment in adolescents with depression. RESULTS Neural predictors of favorable treatment response included lower amygdala connectivity with left supplementary motor area and with right precentral gyrus, and greater amygdala connectivity with right central opercular cortex and Heschl's gyrus connectivity during rest. During an emotion task, neural predictors of treatment response were greater activation of the bilateral anterior cingulate cortex and left medial frontal gyrus. Additionally, different patterns of salivary cortisol obtained in the context of a modified Trier Social Stress Test were associated with those whose depressive symptoms remitted as compared to those whose symptoms persisted. CONCLUSIONS This approach shows significant promise for identifying predictors of treatment response in adolescents with depression. Future work is needed that incorporates sufficiently powered, randomized control trials to provide the basis by which both predictors and moderators of treatment response are identified. The hope is that this work will inform the development of methods that can guide clinician decision-making in assigning beneficial treatments for adolescents who are suffering from depression.
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Affiliation(s)
- Bonnie Klimes-Dougan
- Department of Psychology, University of Minnesota, Minneapolis, MN, United States.
| | - Melinda Westlund Schreiner
- Department of Psychology, University of Minnesota, Minneapolis, MN, United States; Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
| | - Michelle Thai
- Department of Psychology, University of Minnesota, Minneapolis, MN, United States
| | | | - Kristina Reigstad
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
| | - Kathryn R Cullen
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, United States
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DeGutis J, Chiu C, Thai M, Esterman M, Milberg W, McGlinchey R. Trauma Sequelae are Uniquely Associated with Components of Self-Reported Sleep Dysfunction in OEF/OIF/OND Veterans. Behav Sleep Med 2018; 16:38-63. [PMID: 27183394 DOI: 10.1080/15402002.2016.1173550] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
While the associations between psychological distress (e.g., posttraumatic stress disorder [PTSD], depression) and sleep dysfunction have been demonstrated in trauma-exposed populations, studies have not fully explored the associations between sleep dysfunction and the wide range of common physical and physiological changes that can occur after trauma exposure (e.g., pain, cardiometabolic risk factors). We aimed to clarify the unique associations of psychological and physical trauma sequelae with different aspects of self-reported sleep dysfunction. A comprehensive psychological and physical examination was administered to 283 combat-deployed trauma-exposed Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) veterans. The Pittsburgh Sleep Quality Index (PSQI) and PSQI Addendum for PSTD (PSQI-A) were administered along with measures of PTSD, depression, anxiety, pain, traumatic brain injury, alcohol use, nicotine dependence, and cardiometabolic symptoms. We first performed a confirmatory factor analysis of the PSQI and then conducted regressions with the separate PSQI factors as well as the PSQI-A to identify unique associations between trauma-related measures and the separate aspects of sleep. We found that the PSQI global score was composed of three factors: Sleep Efficiency (sleep efficiency/sleep duration), Perceived Sleep Quality (sleep quality/sleep latency/sleep medication) and Daily Disturbances (sleep disturbances/daytime dysfunction). Linear regressions demonstrated that PTSD symptoms were uniquely associated with the PSQI global score and all three factors, as well as the PSQI-A. For the other psychological distress variables, anxiety was independently associated with PSQI global as well as Sleep Efficiency, Perceived Sleep Quality, and PSQI-A, whereas depression was uniquely associated with Daily Disturbances and PSQI-A. Notably, cardiometabolic symptoms explained independent variance in PSQI global and Sleep Efficiency. These findings help lay the groundwork for further investigations of the mechanisms of sleep dysfunction in trauma-exposed individuals and may help in the development of more effective, individualized treatments.
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Affiliation(s)
- Joseph DeGutis
- a Boston Attention and Learning Laboratory , Boston Division VA Healthcare System , Boston , Massachusetts , USA.,b Geriatric Research Education and Clinical Center , Boston Division VA Healthcare System , Boston , Massachusetts , USA.,c Department of Medicine , Harvard Medical School , Boston , Massachusetts , USA
| | - Christopher Chiu
- a Boston Attention and Learning Laboratory , Boston Division VA Healthcare System , Boston , Massachusetts , USA.,b Geriatric Research Education and Clinical Center , Boston Division VA Healthcare System , Boston , Massachusetts , USA
| | - Michelle Thai
- a Boston Attention and Learning Laboratory , Boston Division VA Healthcare System , Boston , Massachusetts , USA.,b Geriatric Research Education and Clinical Center , Boston Division VA Healthcare System , Boston , Massachusetts , USA
| | - Michael Esterman
- a Boston Attention and Learning Laboratory , Boston Division VA Healthcare System , Boston , Massachusetts , USA.,b Geriatric Research Education and Clinical Center , Boston Division VA Healthcare System , Boston , Massachusetts , USA.,d Department of Psychiatry , Boston University School of Medicine , Boston , Massachusetts , USA
| | - William Milberg
- b Geriatric Research Education and Clinical Center , Boston Division VA Healthcare System , Boston , Massachusetts , USA.,e Translational Research Center for TBI and Stress Disorders (TRACTS) , VA RR&D TBI Center of Excellence, VA Boston Healthcare System , Boston , Massachusetts , USA
| | - Regina McGlinchey
- b Geriatric Research Education and Clinical Center , Boston Division VA Healthcare System , Boston , Massachusetts , USA.,e Translational Research Center for TBI and Stress Disorders (TRACTS) , VA RR&D TBI Center of Excellence, VA Boston Healthcare System , Boston , Massachusetts , USA
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Esterman M, Thai M, Okabe H, DeGutis J, Saad E, Laganiere SE, Halko MA. Network-targeted cerebellar transcranial magnetic stimulation improves attentional control. Neuroimage 2017; 156:190-198. [PMID: 28495634 PMCID: PMC5973536 DOI: 10.1016/j.neuroimage.2017.05.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/04/2017] [Accepted: 05/07/2017] [Indexed: 11/22/2022] Open
Abstract
Developing non-invasive brain stimulation interventions to improve attentional control is extremely relevant to a variety of neurological and psychiatric populations, yet few studies have identified reliable biomarkers that can be readily modified to improve attentional control. One potential biomarker of attention is functional connectivity in the core cortical network supporting attention - the dorsal attention network (DAN). We used a network-targeted cerebellar transcranial magnetic stimulation (TMS) procedure, intended to enhance cortical functional connectivity in the DAN. Specifically, in healthy young adults we administered intermittent theta burst TMS (iTBS) to the midline cerebellar node of the DAN and, as a control, the right cerebellar node of the default mode network (DMN). These cerebellar targets were localized using individual resting-state fMRI scans. Participants completed assessments of both sustained (gradual onset continuous performance task, gradCPT) and transient attentional control (attentional blink) immediately before and after stimulation, in two sessions (cerebellar DAN and DMN). Following cerebellar DAN stimulation, participants had significantly fewer attentional lapses (lower commission error rates) on the gradCPT. In contrast, stimulation to the cerebellar DMN did not affect gradCPT performance. Further, in the DAN condition, individuals with worse baseline gradCPT performance showed the greatest enhancement in gradCPT performance. These results suggest that temporarily increasing functional connectivity in the DAN via network-targeted cerebellar stimulation can enhance sustained attention, particularly in those with poor baseline performance. With regard to transient attention, TMS stimulation improved attentional blink performance across both stimulation sites, suggesting increasing functional connectivity in both networks can enhance this aspect of attention. These findings have important implications for intervention applications of TMS and theoretical models of functional connectivity.
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Affiliation(s)
- Michael Esterman
- Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, United States; Boston Attention and Learning Laboratory, VA Boston Healthcare System, United States; Geriatric Research Education and Clinical Center (GRECC), Boston Division VA Healthcare System, United States; Department of Psychiatry, Boston University School of Medicine, United States.
| | - Michelle Thai
- Boston Attention and Learning Laboratory, VA Boston Healthcare System, United States
| | - Hidefusa Okabe
- Boston Attention and Learning Laboratory, VA Boston Healthcare System, United States
| | - Joseph DeGutis
- Boston Attention and Learning Laboratory, VA Boston Healthcare System, United States; Department of Psychiatry, Harvard Medical School, United States
| | - Elyana Saad
- Boston Attention and Learning Laboratory, VA Boston Healthcare System, United States; Department of Psychiatry, Harvard Medical School, United States
| | - Simon E Laganiere
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, United States
| | - Mark A Halko
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, United States
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Bauerfeind A, Barnett C, Thai M, Heinemann K. The effect of BMI on unintended pregnancy rates among users of combined oral contraceptives. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Barnett C, Bauerfeind A, Thai M, Heinemann K. Influence of age and BMI on risk of venous thromboembolism: a meta-analysis of 246,513 women using combined oral contraceptives based on 521,516 women–years. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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22
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Kletzel SL, Cary MP, Ciro C, Berbrayer D, Dawson D, Hoffecker L, Machtinger J, Pham P, Thai M, Heyn PC. Brain Gaming: A User's Product Guide for the Clinician. Arch Phys Med Rehabil 2016; 97:1399-400. [PMID: 27470173 DOI: 10.1016/j.apmr.2016.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/01/2016] [Indexed: 11/30/2022]
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23
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Benoit A, Thai M, Medart L, Desiron Q, Fraipont V. [AORTOENTERIC FISTULA, A POOR PROGNOSIS FINDING]. Rev Med Liege 2016; 71:233-235. [PMID: 27337841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We report the case of a patient admitted with upper gastrointestinal bleeding. The CT scan revealed an aorto-duodenal fistula. This case highlights the progression of radiological imaging in parallel with the clinical course. We take this opportunity to write a brief literature review mainly focused on the description and diagnostic modalities of aortoenteric fistulas.
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Esterman M, Liu G, Okabe H, Reagan A, Thai M, DeGutis J. Frontal eye field involvement in sustaining visual attention: evidence from transcranial magnetic stimulation. Neuroimage 2015; 111:542-8. [PMID: 25655445 DOI: 10.1016/j.neuroimage.2015.01.044] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 12/15/2014] [Accepted: 01/23/2015] [Indexed: 11/18/2022] Open
Abstract
The frontal eye field (FEF), particularly the right FEF, is broadly implicated in top-down control of transient acts of attention, but less is known about its involvement in sustained attention. Although neuroimaging studies of sustained attention tasks commonly find FEF activation, it is unclear how this region contributes to moment-to-moment fluctuations in sustained performance. We sought to determine if the FEF plays a critical role in sustained attention, and if that role differs between periods of worse performance (out-of-the-zone) and periods of better performance (in-the-zone). We used offline 1 Hz repetitive transcranial magnetic stimulation (TMS) to temporarily attenuate either right or left FEF excitability while participants performed a go/no-go sustained attention task (the gradual onset continuous performance task). The results demonstrate that following TMS to the right FEF, sustained attention during in-the-zone periods significantly worsened both in terms of lower accuracy and increased reaction time variability. In contrast, applying TMS to the left FEF did not significantly affect accuracy or variability. These results demonstrate that the right FEF plays a crucial role in supporting optimal sustained attention.
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Affiliation(s)
- Michael Esterman
- Boston Attention and Learning Laboratory & Neuroimaging Research for Veterans Center (NeRVe), Veterans Administration, Boston Healthcare System, Boston, MA 02130, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA.
| | - Guanyu Liu
- Boston Attention and Learning Laboratory & Neuroimaging Research for Veterans Center (NeRVe), Veterans Administration, Boston Healthcare System, Boston, MA 02130, USA
| | - Hidefusa Okabe
- Boston Attention and Learning Laboratory & Neuroimaging Research for Veterans Center (NeRVe), Veterans Administration, Boston Healthcare System, Boston, MA 02130, USA
| | - Andrew Reagan
- Boston Attention and Learning Laboratory & Neuroimaging Research for Veterans Center (NeRVe), Veterans Administration, Boston Healthcare System, Boston, MA 02130, USA
| | - Michelle Thai
- Boston Attention and Learning Laboratory & Neuroimaging Research for Veterans Center (NeRVe), Veterans Administration, Boston Healthcare System, Boston, MA 02130, USA
| | - Joe DeGutis
- Boston Attention and Learning Laboratory & Neuroimaging Research for Veterans Center (NeRVe), Veterans Administration, Boston Healthcare System, Boston, MA 02130, USA; Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
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Ravari BH, Mirpuri R, Lee S, Thai M. Poster 328 A Variant of Acute Disseminated Encephalomyelitis with Predominant Spinal Presentation and Optic Neuritis. A Case Report. PM R 2014. [DOI: 10.1016/j.pmrj.2014.08.707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Ravi Mirpuri
- University California of Irvine, Orange , CA, United States
| | - Sujin Lee
- University California of Irvine, Orange , CA, United States
| | - Michelle Thai
- University California of Irvine, Orange , CA, United States
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Ravari BH, Mirpuri R, Natanzi NM, Lee S, Thai M, Huang J. Poster 327 Two Cases of West Nile Virus with Either Secondary Poliomyelitis or Encephalitis. Case Report. PM R 2014. [DOI: 10.1016/j.pmrj.2014.08.706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Ravi Mirpuri
- University California of Irvine, Orange , CA, United States
| | | | - Sujin Lee
- University California of Irvine, Orange , CA, United States
| | - Michelle Thai
- University California of Irvine, Orange , CA, United States
| | - James Huang
- University California of Irvine, Orange , CA, United States
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Ravari BH, Mirpuri R, Lee S, Natanzi N, Thai M. Poster 326 Giant Cell Arteritis with Acute Hemiparesis: A Case Report. PM R 2014. [DOI: 10.1016/j.pmrj.2014.08.705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Ravi Mirpuri
- University of California Irvine, Orange, CA, United States
| | - Sujin Lee
- University of California Irvine, Orange, CA, United States
| | - Naveed Natanzi
- University of California Irvine, Orange, CA, United States
| | - Michelle Thai
- University of California Irvine, Orange, CA, United States
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