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Xia AWL, Jin M, Zhang BBB, Kan RLD, Lin TTZ, Qin PP, Wang X, Chau WMW, Shi NMXY, Kannan P, Lu EY, Yuan T, Jiaqi Zhang J, Kranz GS. Investigating the hemodynamic response to iTBS of the left DLPFC: A concurrent iTBS/fNIRS study. Brain Stimul 2025; 18:235-245. [PMID: 39955026 DOI: 10.1016/j.brs.2025.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Revised: 02/10/2025] [Accepted: 02/12/2025] [Indexed: 02/17/2025] Open
Abstract
BACKGROUND Intermittent theta burst stimulation (iTBS) targeting the left dorsolateral prefrontal cortex (DLPFC) is an established treatment regimen for major depressive disorder, but its instantaneous effects on neural excitability during and immediately after the stimulation remain unclear. This study aimed to investigate the hemodynamic response in the bilateral DLPFC during and immediately after iTBS and explored factors that may modulate iTBS-induced excitability. METHODS We measured the prefrontal hemodynamic response before, during, and after iTBS using concurrent iTBS/functional near-infrared spectroscopy (fNIRS) in healthy participants across multiple sessions (3-11 visits, ≥48 hours apart). We investigated the moderating effect of several inter- and intra-individual variables. To this end, we analyzed the average change of oxygenated (HbO) and deoxygenated hemoglobin (HbR) in the stimulated and contralateral DLPFC and used generalized linear mixed models (GLMMs) to test for potential moderators. RESULTS Twenty participants completed 157 concurrent iTBS/fNIRS sessions in total. HbR increased significantly during iTBS (0.247 ± 0.032, p < 0.001) in the stimulated DLPFC, while the contralateral DLPFC showed significant decreases in HbR during (-0.046 ± 0.017, p = 0.024) and after the stimulation (-0.05 ± 0.018, p = 0.015). No significant change in HbO was observed. GLMM revealed that age (β = 0.033, p = 0.004), sex (β = -0.248, p = 0.004), education years (β = -0.094, p < 0.001), the personality trait agreeableness (β = -0.013, p = 0.005), and positive affect (β = -0.032, p = 0.012) significantly influenced local HbR response during iTBS, and sex (β = 0.305, p = 0.012) significantly influenced local HbO response during iTBS. CONCLUSION This study revealed a pronounced increase in HbR during iTBS in the stimulated DLPFC, alongside decreased HbR contralaterally both during and post-stimulation. Furthermore, our study highlights the importance of individual factors in understanding iTBS effects on cortical excitability.
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Affiliation(s)
- Adam W L Xia
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Minxia Jin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong; Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Bella B B Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Rebecca L D Kan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Tim T Z Lin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Penny P Qin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Xiao Wang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Wanda M W Chau
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Nancy M X Y Shi
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Priya Kannan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Erin Y Lu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Tifei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jack Jiaqi Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Georg S Kranz
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong; Mental Health Research Center (MHRC), The Hong Kong Polytechnic University, Hong Kong.
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Jomha A, Sohn MN, Watson M, Kopala-Sibley DC, McGirr A. Self-criticism predicts antidepressant effects of intermittent theta-burst stimulation in Major Depressive Disorder. J Affect Disord 2025; 372:210-215. [PMID: 39631702 DOI: 10.1016/j.jad.2024.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 10/24/2024] [Accepted: 12/01/2024] [Indexed: 12/07/2024]
Abstract
BACKGROUND Self-criticism is a risk factor for depression and depressive symptom persistence, however higher degrees of self-criticism have been associated with greater antidepressant benefits from repetitive transcranial magnetic stimulation (rTMS), suggesting that self-criticism may act as a proxy for function of the targeted circuit. We test this hypothesis using secondary data from an rTMS treatment trial where an NMDA receptor agonist (D-Cycloserine) was used to enhance TMS synaptic plasticity to improve efficacy. We hypothesized that self-criticism would be more strongly associated with treatment outcome when stimulation was paired with D-Cycloserine than with a placebo. METHODS In a 4-week single-site double-blind randomized placebo-controlled trial, fifty adults with Major Depressive Disorder (MDD) (NCT03937596) were randomized to receive placebo or D-Cycloserine (100 mg) with daily intermittent theta-burst stimulation (iTBS) to the left dorsolateral prefrontal cortex (DLPFC). At baseline and after treatment, self-criticism was assessed using the Depressive Experiences Questionnaire as a secondary trial outcome and depressive symptoms were assessed using the clinician rated Montgomery Asberg Depression Rating scale (MADRS). Clinical response was defined as a ≥50 % decrease on the MADRS. RESULTS Self-criticism differentially predicted antidepressant effects when operationalized as both percent decrease on the MADRS and clinical response (≥50 % decrease), with a statistically significantly stronger association in the iTBS+D-Cycloserine group than the iTBS+Placebo condition. Self-criticism did not significantly change in either condition over the course of treatment. CONCLUSIONS Our data suggests that iTBS to the left DLPFC engages a circuit related to self-criticism. Higher levels of self-criticism predicted better response to iTBS with an adjuvant that enhances synaptic plasticity. This suggests that personality traits may be used to tailor non-invasive neurostimulation treatments.
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Affiliation(s)
- Aliya Jomha
- Department of Psychology, Mount Royal University, Calgary, Alberta, Canada; Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada
| | - Myren N Sohn
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada
| | - Molly Watson
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada
| | - Daniel C Kopala-Sibley
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada
| | - Alexander McGirr
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada.
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Lan XJ, Yang XH, Mo Y, Deng CJ, Huang XB, Cai DB, Zheng W. Deep transcranial magnetic stimulation for treatment-resistant depression: A systematic review and meta-analysis of randomized controlled studies. Asian J Psychiatr 2024; 96:104032. [PMID: 38574492 DOI: 10.1016/j.ajp.2024.104032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/22/2024] [Accepted: 03/24/2024] [Indexed: 04/06/2024]
Abstract
The efficacy and safety of deep transcranial magnetic stimulation (dTMS) in treating treatment-resistant depression (TRD) are unknown. Up to June 21, 2023, we conducted a systematic search for RCTs, and then extracted and synthesized data using random effects models. Five RCTs involving 507 patients with TRD (243 in the active dTMS group and 264 in the control group) were included in the present study. The active dTMS group showed significantly higher study-defined response rate (45.3% versus 24.2%, n = 507, risk ratio [RR] = 1.87, 95% confidence interval [CI]: 1.21-2.91, I2 = 53%; P = 0.005) and study-defined remission rate (38.3% versus 14.4%, n = 507, RR = 2.37, 95%CI: 1.30-4.32, I2 = 58%; P = 0.005) and superiority in improving depressive symptoms (n = 507, standardized mean difference = -0.65, 95%CI: -1.11--0.18, I2 = 82%; P = 0.006) than the control group. In terms of cognitive functions, no significant differences were observed between the two groups. The two groups also showed similar rates of other adverse events and all-cause discontinuations (P > 0.05). dTMS is an effective and safe treatment strategy for the management of patients with TRD.
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Affiliation(s)
- Xian-Jun Lan
- The Brain Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, China
| | - Xin-Hu Yang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Yu Mo
- The Brain Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, China
| | - Can-Jin Deng
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Xing-Bing Huang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Dong-Bin Cai
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China.
| | - Wei Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China.
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Cheng JL, Tan C, Liu HY, Han DM, Liu ZC. Past, present, and future of deep transcranial magnetic stimulation: A review in psychiatric and neurological disorders. World J Psychiatry 2023; 13:607-619. [PMID: 37771645 PMCID: PMC10523198 DOI: 10.5498/wjp.v13.i9.607] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/25/2023] [Accepted: 08/01/2023] [Indexed: 09/15/2023] Open
Abstract
Deep transcranial magnetic stimulation (DTMS) is a new non-invasive neuromodulation technique based on repetitive transcranial magnetic stimulation tech-nology. The new H-coil has significant advantages in the treatment and mechanism research of psychiatric and neurological disorders. This is due to its deep stimulation site and wide range of action. This paper reviews the clinical progress of DTMS in psychiatric and neurological disorders such as Parkinson's disease, Alzheimer's disease, post-stroke motor dysfunction, aphasia, and other neurological disorders, as well as anxiety, depression, and schizophrenia.
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Affiliation(s)
- Jin-Ling Cheng
- Department of Rehabilitation Medicine, Shaoguan First People’s Hospital, Shaoguan 512000, Guangdong Province, China
| | - Cheng Tan
- Department of Rehabilitation Medicine, Shaoguan First People’s Hospital, Shaoguan 512000, Guangdong Province, China
| | - Hui-Yu Liu
- Department of Infectious Diseases, Yuebei Second People’s Hospital, Shaoguan 512026, Guangdong Province, China
| | - Dong-Miao Han
- Department of Rehabilitation Therapy Teaching and Research, Gannan Healthcare Vocational College, Ganzhou 341000, Jiangxi Province, China
| | - Zi-Cai Liu
- Department of Rehabilitation Medicine, Shaoguan First People’s Hospital, Shaoguan 512000, Guangdong Province, China
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Hayden A, Hooley JM, Dougherty DD, Camprodon JA, Chou T. Neuroticism modulates the qualitative effects of inferior parietal tDCS on negatively-valenced memories. J Psychiatr Res 2023; 161:467-475. [PMID: 37060719 DOI: 10.1016/j.jpsychires.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/29/2023] [Accepted: 04/05/2023] [Indexed: 04/17/2023]
Abstract
For individuals with increased levels of neuroticism, experiencing criticism or receiving negative feedback has been associated with worse psychological and cognitive outcomes. Transcranial direct current stimulation (tDCS) can change cognitive processes in clinical populations. We bilaterally stimulated the posterior inferior parietal lobule (pIPL), a critical superficial node of the default model network. We investigated how baseline neuroticism modulates the impact of bilateral tDCS to pIPL on qualitative measures of memory after hearing criticism, hypothesizing that cathodal stimulation of the IPL would offer qualitative memory improvements for individuals with higher levels of neuroticism. Ninety individuals from the community were randomly assigned to receive anodal, cathodal, or sham stimulation while they were exposed to critical comments before and after stimulation. Participants then recalled the critical comments, and their linguistic responses were analyzed using Pennebaker's Linguistic Inquiry and Word Count software, a quantitative analysis software for linguistic data. Results showed that for individuals receiving cathodal tDCS, higher neuroticism scores corresponded with greater proportions of non-personal language (i.e., words such as "us," "they," or "other" instead of "I" or "me") when recalling negative feedback. For individuals with higher neuroticism, cathodal tDCS stimulation, rather than anodal or sham, of the pIPL prompted increased emotional distancing and perspective taking strategies when recalling criticism. These results further highlight the state-dependent nature of tDCS effects and the role of the IPL in interpersonal processing - a clinically meaningful outcome that current tDCS studies solely examining quantitative measures of memory (e.g., task-based accuracy or speed) do not reveal.
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Affiliation(s)
- Ashley Hayden
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA.
| | | | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA
| | - Joan A Camprodon
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA
| | - Tina Chou
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA
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Personality Prediction with Hybrid Genetic Programming using Portable EEG Device. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:4867630. [PMID: 35694595 PMCID: PMC9177303 DOI: 10.1155/2022/4867630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/28/2022] [Indexed: 11/17/2022]
Abstract
This work suggests a method to identify personality traits regarding the targeted film clips in real-time. Such film clips elicit feelings in people while capturing their brain impulses using the electroencephalogram (EEG) devices and examining personality traits. The Myers–Briggs Type Indicator (MBTI) paradigm for determining personality is employed in this study. The fast Fourier transform (FFT) approach is used for feature extraction, and we have used hybrid genetic programming (HGP) for EEG data classification. We used a single-channel NeuroSky MindWave 2 dry electrode unit to obtain the EEG data. In order to collect the data, thirty Hindi and English video clips were placed in a conventional database. Fifty people volunteered to participate in this study and willingly provided brain signals. Using this dataset, we have generated four two-class HGP classifiers (HGP1, HGP2, HGP3, and HGP4), one for each group of MBTI traits overall classification accuracy of the HGP classifier as 82.25% for 10-fold cross-validation partition.
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Ramasubbu R, McAusland L, Chopra S, Clark DL, Bewernick BH, Kiss ZHT. Personality changes with subcallosal cingulate deep brain stimulation in patients with treatment-resistant depression. J Psychiatry Neurosci 2021; 46:E490-E499. [PMID: 34609949 PMCID: PMC8519494 DOI: 10.1503/jpn.210028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/11/2021] [Accepted: 05/27/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) is a promising investigational approach for treatment-resistant depression. However, reports suggesting changes in personality with DBS for movement disorders have raised clinical and ethical concerns. We prospectively examined changes in personality dimensions and antidepressant response to subcallosal cingulate (SCC)-DBS for treatment-resistant depression. METHODS Twenty-two patients with treatment-resistant depression underwent SCC-DBS. We used the NEO Five-Factor Inventory for personality assessment at baseline and every 3 months until 15 months post-DBS. We assessed depression severity monthly using the Hamilton Depression Rating Scale. RESULTS We found a significant decrease in neuroticism (p = 0.002) and an increase in extraversion (p = 0.001) over time, showing a change toward normative data. Improvement on the Hamilton Depression Rating Scale was correlated with decreases in neuroticism at 6 months (p = 0.001) and 12 months (p < 0.001), and with an increase in extraversion at 12 months (p = 0.01). Changes on the Hamilton Depression Rating Scale over time had a significant covariate effect on neuroticism (p < 0.001) and extraversion (p = 0.001). Baseline openness and agreeableness predicted response to DBS at 6 (p = 0.006) and 12 months (p = 0.004), respectively. LIMITATIONS Limitations included a small sample size, a lack of sham control and the use of subjective personality evaluation. CONCLUSION We observed positive personality changes following SCC-DBS, with reduced neuroticism and increased extraversion related to clinical improvement in depression, suggesting a state effect. As well, pretreatment levels of openness and agreeableness may have predicted subsequent response to DBS. The NEO Five-Factor Inventory assessment may have a role in clinical decision-making and prognostic evaluation in patients with treatment-resistant depression who undergo SCC-DBS.
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Affiliation(s)
- Rajamannar Ramasubbu
- From the Department of Psychiatry, University of Calgary, Calgary, Alberta (Ramasubbu, McAusland, Chopra, Clark, Kiss); the Clinical Neurosciences, University of Calgary, Calgary, Alberta (Ramasubbu, McAusland, Clark, Kiss); the Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Alberta (Ramasubbu, McAusland, Chopra, Clark, Kiss); the Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta (Ramasubbu, Chopra, Clark, Kiss); The Department of Geriatric Psychiatry and Section for Medical Psychology of the Department of Psychiatry and Psychotherapy, University Hospital Bonn, Germany (Bewernick)
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Ward HB, Yip A, Siddiqui R, Morales OG, Seiner SJ, Siddiqi SH. Borderline personality traits do not influence response to TMS. J Affect Disord 2021; 281:834-838. [PMID: 33229022 DOI: 10.1016/j.jad.2020.11.054] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/13/2020] [Accepted: 11/08/2020] [Indexed: 12/21/2022]
Abstract
Comorbid personality disorders are common in patients with major depressive disorder (MDD). Individuals with comorbid borderline personality disorder (BPD) may be less responsive to electroconvulsive therapy (ECT), but it remains unclear whether BPD affects responsiveness to transcranial magnetic stimulation (TMS). We sought to investigate the association between BPD and response to TMS. We conducted a retrospective analysis of individuals receiving TMS (n=356) at McLean Hospital. We also included individuals receiving ECT (n=1434) as a control. All individuals completed the McLean Screening Instrument for BPD (MSI-BPD) at baseline. Response to treatment was measured by the Quick Inventory of Depression Symptomatology Self-Report (QIDS-SR). We performed general linear models (GLMs) to assess the effect of BPD on treatment response to TMS and ECT. At baseline, the ECT group had a higher average QIDS-SR score (21.4 vs. 20.3, p<0.05). For both treatment groups, the number of treatments had a significant effect on depression severity. For the TMS group, there was no significant Group x Time interaction on QIDS-SR score (p=0.18). However, for individuals receiving ECT, there was a significant Group x Time interaction on QIDS-SR score (p=0.02), suggesting that BPD significantly impaired response. These results suggest that borderline personality traits did not affect treatment response to TMS for MDD. BPD traits modestly predicted response to ECT, which is consistent with the literature. These results require replication in a clinical trial.
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Affiliation(s)
- Heather Burrell Ward
- Department of Psychiatry, Brigham & Women's Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA.
| | - Agustin Yip
- Department of Psychiatry, Harvard Medical School, Boston, MA; Psychiatric Neurotherapeutics Program, McLean Hospital, Belmont, MA
| | - Rameez Siddiqui
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, MA
| | - Oscar G Morales
- Department of Psychiatry, Harvard Medical School, Boston, MA; Psychiatric Neurotherapeutics Program, McLean Hospital, Belmont, MA
| | - Stephen J Seiner
- Department of Psychiatry, Harvard Medical School, Boston, MA; Psychiatric Neurotherapeutics Program, McLean Hospital, Belmont, MA
| | - Shan H Siddiqi
- Department of Psychiatry, Brigham & Women's Hospital, Boston, MA; Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, MA
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Kopala-Sibley DC, Chartier GB, Bhanot S, Cole J, Chan PY, Berlim MT, McGirr A. Personality Trait Predictive Utility and Stability in Transcranial
Magnetic Stimulation (rTMS) for Major Depression: Dissociation of Neuroticism
and Self-Criticism: Utilité prédictive et stabilité des traits de personnalité
dans la stimulation magnétique transcrânienne répétitive (SMTr) pour la
dépression majeure : dissociation du neuroticisme et de
l’autocritique. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:264-272. [PMID: 31043062 PMCID: PMC7385423 DOI: 10.1177/0706743719839705] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: Cost-efficient and non-invasive predictors of antidepressant response to repetitive transcranial magnetic stimulation (rTMS) are required. The personality vulnerabilities—neuroticism and self-criticism—are associated with antidepressant outcomes in other modalities; however, self-criticism has not been examined in response to rTMS, and the literature on neuroticism and rTMS is inconsistent. Methods: This naturalistic, 4-week study involved daily dorsolateral prefrontal cortex (DLFPC) rTMS for major depression (15 unipolar, 2 bipolar). Participants completed the Big Five Inventory (neuroticism) and the Depressive Experiences Questionnaire (self-criticism) at baseline and at the end of treatment. Changes in depressive symptoms, as rated by the clinician, were quantified using the 21-item Hamilton Depression Rating Scale. Given the inconsistencies in data regarding the stability of neuroticism in patients receiving rTMS, we performed a systematic review and quantitative meta-analysis of trials examining rTMS and neuroticism. Results: rTMS significantly improved depressive symptoms, and this was predicted by higher levels of self-criticism but not neuroticism. Self-criticism was stable over the 4 weeks of rTMS; however, neuroticism decreased, and this was not related to decreases in depressive symptoms. Our quantitative meta-analysis of 4 rTMS trials in major depression (n = 52 patients) revealed decreases in neuroticism, with a moderate effect size. Limitations: Our results are limited by a small sample size, and the absence of a sham-rTMS group. Our meta-analysis included only 4 trials. Conclusion: Highly self-critical patients appear to benefit more from rTMS than less self-critical patients. Neuroticism, a conceptually similar but distinct personality domain, does not appear to predict antidepressant response, yet this vulnerability factor for depression decreases after rTMS.
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Affiliation(s)
- Daniel C. Kopala-Sibley
- Department of Psychiatry, University of Calgary, Calgary, Alberta,
Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta,
Canada
- Mathison Centre for Mental Health Research and Education, Calgary,
Alberta, Canada
- Alberta Children’s Hospital Research Institute, University of
Calgary, Calgary, Alberta, Canada
| | | | - Shiv Bhanot
- Department of Psychiatry, University of Calgary, Calgary, Alberta,
Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta,
Canada
- Mathison Centre for Mental Health Research and Education, Calgary,
Alberta, Canada
- Alberta Children’s Hospital Research Institute, University of
Calgary, Calgary, Alberta, Canada
| | - Jaeden Cole
- Department of Psychiatry, University of Calgary, Calgary, Alberta,
Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta,
Canada
- Mathison Centre for Mental Health Research and Education, Calgary,
Alberta, Canada
| | - Peter Y. Chan
- Department of Psychiatry, University of British Columbia, British
Columbia, Canada
| | - Marcelo T. Berlim
- Neuromodulation Research Clinic, Douglas Institute, Montreal,
Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec,
Canada
| | - Alexander McGirr
- Department of Psychiatry, University of Calgary, Calgary, Alberta,
Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta,
Canada
- Mathison Centre for Mental Health Research and Education, Calgary,
Alberta, Canada
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Krepel N, Rush AJ, Iseger TA, Sack AT, Arns M. Can psychological features predict antidepressant response to rTMS? A Discovery-Replication approach. Psychol Med 2020; 50:264-272. [PMID: 30674359 DOI: 10.1017/s0033291718004191] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Few studies focused on the relationship between psychological measures, major depressive disorder (MDD) and repetitive transcranial magnetic stimulation (rTMS) response. This study investigated several psychological measures as potential predictors for rTMS treatment response. Additionally, this study employed two approaches to evaluate the robustness of our findings by implementing immediate replication and full-sample exploration with strict p-thresholding. METHODS This study is an open-label, multi-site study with a total of 196 MDD patients. The sample was subdivided in a Discovery (60% of total sample, n = 119) and Replication sample (40% of total sample, n = 77). Patients were treated with right low frequency (1 Hz) or left high frequency (10 Hz) rTMS at the dorsolateral prefrontal cortex. Clinical variables [Beck Depression Inventory (BDI), Neuroticism, Extraversion, Openness Five-Factor Inventory, and Depression, Anxiety, and Stress Scale, and BDI subscales] were obtained at baseline, post-treatment, and at follow-up. Predictors were analyzed in terms of statistical association, robustness (independent replication), as well as for their clinical relevance [positive predictive value (PPV) and negative predictive value (NPV)]. RESULTS Univariate analyses revealed that non-responders had higher baseline anhedonia scores. Anhedonia scores at baseline correlated negatively with total BDI percentage change over time. This finding was replicated. However, anhedonia scores showed to be marginally predictive of rTMS response, and neither PPV nor NPV reached the levels of clinical relevance. CONCLUSIONS This study suggests that non-responders to rTMS treatment have higher baseline anhedonia scores. However, anhedonia was only marginally predictive of rTMS response. Since all other psychological measures did not show predictive value, it is concluded that psychological measures cannot be used as clinically relevant predictors to rTMS response in MDD.
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Affiliation(s)
- Noralie Krepel
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Research Institute Brainclinics, Nijmegen, The Netherlands
| | - A John Rush
- Duke-National University of Singapore, Singapore
- Duke Medical School, Durham, NC, USA
- Texas Tech University Health Sciences Center, Permian Basin, TX, USA
| | - Tabitha A Iseger
- Research Institute Brainclinics, Nijmegen, The Netherlands
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands
| | - Alexander T Sack
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Martijn Arns
- Research Institute Brainclinics, Nijmegen, The Netherlands
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands
- neuroCare Group Netherlands, Nijmegen, The Netherlands
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11
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Wigmore EM, Hafferty JD, Hall LS, Howard DM, Clarke TK, Fabbri C, Lewis CM, Uher R, Navrady LB, Adams MJ, Zeng Y, Campbell A, Gibson J, Thomson PA, Hayward C, Smith BH, Hocking LJ, Padmanabhan S, Deary IJ, Porteous DJ, Mors O, Mattheisen M, Nicodemus KK, McIntosh AM. Genome-wide association study of antidepressant treatment resistance in a population-based cohort using health service prescription data and meta-analysis with GENDEP. THE PHARMACOGENOMICS JOURNAL 2020; 20:329-341. [PMID: 30700811 PMCID: PMC7096334 DOI: 10.1038/s41397-019-0067-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/20/2018] [Accepted: 12/20/2018] [Indexed: 02/08/2023]
Abstract
Antidepressants demonstrate modest response rates in the treatment of major depressive disorder (MDD). Despite previous genome-wide association studies (GWAS) of antidepressant treatment response, the underlying genetic factors are unknown. Using prescription data in a population and family-based cohort (Generation Scotland: Scottish Family Health Study; GS:SFHS), we sought to define a measure of (a) antidepressant treatment resistance and (b) stages of antidepressant resistance by inferring antidepressant switching as non-response to treatment. GWAS were conducted separately for antidepressant treatment resistance in GS:SFHS and the Genome-based Therapeutic Drugs for Depression (GENDEP) study and then meta-analysed (meta-analysis n = 4213, cases = 358). For stages of antidepressant resistance, a GWAS on GS:SFHS only was performed (n = 3452). Additionally, we conducted gene-set enrichment, polygenic risk scoring (PRS) and genetic correlation analysis. We did not identify any significant loci, genes or gene sets associated with antidepressant treatment resistance or stages of resistance. Significant positive genetic correlations of antidepressant treatment resistance and stages of resistance with neuroticism, psychological distress, schizotypy and mood disorder traits were identified. These findings suggest that larger sample sizes are needed to identify the genetic architecture of antidepressant treatment response, and that population-based observational studies may provide a tractable approach to achieving the necessary statistical power.
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Affiliation(s)
- Eleanor M. Wigmore
- 0000 0004 1936 7988grid.4305.2Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, EH10 5HF Edinburgh, UK
| | - Jonathan D. Hafferty
- 0000 0004 1936 7988grid.4305.2Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, EH10 5HF Edinburgh, UK
| | - Lynsey S. Hall
- 0000 0004 1936 7988grid.4305.2Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, EH10 5HF Edinburgh, UK
| | - David M. Howard
- 0000 0004 1936 7988grid.4305.2Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, EH10 5HF Edinburgh, UK
| | - Toni-Kim Clarke
- 0000 0004 1936 7988grid.4305.2Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, EH10 5HF Edinburgh, UK
| | - Chiara Fabbri
- 0000 0001 2322 6764grid.13097.3cMRC SGDP Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England ,0000 0004 1757 1758grid.6292.fDepartment of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Cathryn M. Lewis
- 0000 0001 2322 6764grid.13097.3cMRC SGDP Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
| | - Rudolf Uher
- 0000 0001 2322 6764grid.13097.3cMRC SGDP Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England ,0000 0004 1936 8200grid.55602.34Department of Psychiatry, Dalhousie University, Halifax, NS Canada
| | - Lauren B. Navrady
- 0000 0004 1936 7988grid.4305.2Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, EH10 5HF Edinburgh, UK
| | - Mark J. Adams
- 0000 0004 1936 7988grid.4305.2Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, EH10 5HF Edinburgh, UK
| | - Yanni Zeng
- 0000 0004 1936 7988grid.4305.2Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, EH10 5HF Edinburgh, UK
| | - Archie Campbell
- 0000 0004 1936 7988grid.4305.2Centre for Genomic and Experimental Medicine, Institute of Genetics and
Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh, UK
| | - Jude Gibson
- 0000 0004 1936 7988grid.4305.2Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, EH10 5HF Edinburgh, UK
| | - Pippa A. Thomson
- 0000 0004 1936 7988grid.4305.2Centre for Genomic and Experimental Medicine, Institute of Genetics and
Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh, UK ,0000 0004 1936 7988grid.4305.2Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Caroline Hayward
- 0000 0004 1936 7988grid.4305.2MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine,
Western General Hospital, University of Edinburgh, Edinburgh, UK
| | - Blair H. Smith
- 0000 0004 0397 2876grid.8241.fDivision of Population Health Sciences, University of Dundee, Dundee, UK
| | - Lynne J. Hocking
- 0000 0004 1936 7291grid.7107.1Division of Applied Medicine, University of Aberdeen, Aberdeen, UK
| | - Sandosh Padmanabhan
- 0000 0001 2193 314Xgrid.8756.cInstitute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Ian J. Deary
- 0000 0004 1936 7988grid.4305.2Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK ,0000 0004 1936 7988grid.4305.2Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - David J. Porteous
- 0000 0004 1936 7988grid.4305.2Centre for Genomic and Experimental Medicine, Institute of Genetics and
Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh, UK ,0000 0004 1936 7988grid.4305.2Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Ole Mors
- 0000 0004 0512 597Xgrid.154185.cPsychosis Research Unit, Aarhus University Hospital, Risskov, Denmark ,0000 0000 9817 5300grid.452548.aiPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric
Research, Aarhus, Denmark
| | - Manuel Mattheisen
- 0000 0000 9817 5300grid.452548.aiPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric
Research, Aarhus, Denmark ,0000 0001 1956 2722grid.7048.bDepartment of Biomedicine and Centre for Integrative Sequencing
(iSEQ), Aarhus University, Aarhus, Denmark ,0000 0004 1937 0626grid.4714.6Centre for Psychiatry Research, Department of Clinical
Neuroscience, Karolinska Institutet, Stockholm, Sweden ,0000 0001 2326 2191grid.425979.4Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Kristin K. Nicodemus
- 0000 0004 1936 7988grid.4305.2Centre for Genomic and Experimental Medicine, Institute of Genetics and
Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh, UK ,0000 0004 1936 7988grid.4305.2Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Andrew M. McIntosh
- 0000 0004 1936 7988grid.4305.2Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, EH10 5HF Edinburgh, UK ,0000 0004 1936 7988grid.4305.2Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
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12
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The influence of personality on the effect of iTBS after being stressed on cortisol secretion. PLoS One 2019; 14:e0223927. [PMID: 31618272 PMCID: PMC6795454 DOI: 10.1371/journal.pone.0223927] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/01/2019] [Indexed: 11/19/2022] Open
Abstract
Over the last years, individualization of repetitive Transcranial Magnetic Stimulation (rTMS) parameters has been a focus of attention in the field of non-invasive stimulation. It has been proposed that in stress-related disorders personality characteristics may influence the clinical outcome of rTMS. However, the underlying physiological mechanisms as to how personality may affect the rTMS response to stress remains to be clarified. In this sham-controlled crossover study, after being stressed by the Trier Social Stress Test, 38 healthy females received two sessions of intermittent theta burst stimulation (iTBS) applied to the left dorsolateral prefrontal cortex. To take possible personality influences into account, they also completed the Temperament and Character Inventory. Mood and salivary cortisol were assessed throughout the experimental protocol. Overall, two iTBS sessions did not significantly alter mood or influenced cortisol secretion. When taking into account personality features, higher scores on the character dimension Cooperativeness was related to decreased cortisol output, only when active iTBS was administered after the social stressor. In line with other studies, personality features such as the character dimension Cooperativeness may be of particular interest to explain individual neurobiological responses to neurostimulation.
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13
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Bewernick BH, Kilian HM, Schmidt K, Reinfeldt RE, Kayser S, Coenen VA, Markett S, Schlaepfer TE. Deep brain stimulation of the supero-lateral branch of the medial forebrain bundle does not lead to changes in personality in patients suffering from severe depression. Psychol Med 2018; 48:2684-2692. [PMID: 29493478 DOI: 10.1017/s0033291718000296] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Reports of changes in patients' social behavior during deep brain stimulation (DBS) raised the question whether DBS induces changes in personality. This study explored if (1) DBS is associated with changes in personality in patients suffering from treatment-resistant depression (TRD), (2) how personality dimensions and depression are associated, and (3) if TRD patients' self-ratings of personality are valid. METHODS TRD patients were assessed before DBS (n = 30), 6 months (t2, n = 21), 2 (t3, n = 17) and 5 years (t4, n = 11) after the initiation of DBS of the supero-lateral branch of the medial forebrain bundle (slMFB-DBS). Personality was measured with the NEO-Five-Factor Inventory (NEO-FFI), depression severity with Hamilton (HDRS), and Montgomery-Åsberg Depression Rating Scale (MADRS). RESULTS Personality dimensions did not change with slMFB-DBS compared with baseline. Extraversion was negatively correlated with HDRS28 (r = -0.48, p < 0.05) and MADRS (r = -0.45, p < 0.05) at t2. Inter-rater reliability was high for the NEO-FFI at baseline (Cronbach's α = 0.74) and at t4 (α = 0.65). Extraversion [t(29) = -5.20; p < 0.001] and openness to experience [t(29) = -6.96; p < 0.001] differed statistically significant from the normative sample, and did not predict the antidepressant response. CONCLUSIONS slMFB-DBS was not associated with a change in personality. The severity of depression was associated with extraversion. Personality of TRD patients differed from the healthy population and did not change with response, indicating a possible scar effect. Self-ratings of personality seem valid to assess personality during TRD.
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Affiliation(s)
| | - Hannah M Kilian
- Division of Interventional Biological Psychiatry,University Hospital Freiburg,Germany
| | - Klaudius Schmidt
- Department of General Psychology I,University of Cologne,Germany
| | - Ruth E Reinfeldt
- Department of Neurodegenerative Diseases and Geronto Psychiatry,University Hospital Bonn,Germany
| | - Sarah Kayser
- Department of Psychiatry and Psychotherapy,University Hospital Mainz,Germany
| | - Volker A Coenen
- Department of Stereotactic and Functional Neurosurgery,University Hospital Freiburg,Germany
| | | | - Thomas E Schlaepfer
- Division of Interventional Biological Psychiatry,University Hospital Freiburg,Germany
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14
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Wei X, Li Y, Lu M, Wang J, Yi G. Comprehensive Survey on Improved Focality and Penetration Depth of Transcranial Magnetic Stimulation Employing Multi-Coil Arrays. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14111388. [PMID: 29135963 PMCID: PMC5708027 DOI: 10.3390/ijerph14111388] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 11/10/2017] [Accepted: 11/10/2017] [Indexed: 11/16/2022]
Abstract
Multi-coil arrays applied in transcranial magnetic stimulation (TMS) are proposed to accurately stimulate brain tissues and modulate neural activities by an induced electric field (EF). Composed of numerous independently driven coils, a multi-coil array has alternative energizing strategies to evoke EFs targeting at different cerebral regions. To improve the locating resolution and the stimulating focality, we need to fully understand the variation properties of induced EFs and the quantitative control method of the spatial arrangement of activating coils, both of which unfortunately are still unclear. In this paper, a comprehensive analysis of EF properties was performed based on multi-coil arrays. Four types of planar multi-coil arrays were used to study the relationship between the spatial distribution of EFs and the structure of stimuli coils. By changing coil-driven strategies in a basic 16-coil array, we find that an EF induced by compactly distributed coils decays faster than that induced by dispersedly distributed coils, but the former has an advantage over the latter in terms of the activated brain volume. Simulation results also indicate that the attenuation rate of an EF induced by the 36-coil dense array is 3 times and 1.5 times greater than those induced by the 9-coil array and the 16-coil array, respectively. The EF evoked by the 36-coil dispense array has the slowest decay rate. This result demonstrates that larger multi-coil arrays, compared to smaller ones, activate deeper brain tissues at the expense of decreased focality. A further study on activating a specific field of a prescribed shape and size was conducted based on EF variation. Accurate target location was achieved with a 64-coil array 18 mm in diameter. A comparison between the figure-8 coil, the planar array, and the cap-formed array was made and demonstrates an improvement of multi-coil configurations in the penetration depth and the focality. These findings suggest that there is a tradeoff between attenuation rate and focality in the application of multi-coil arrays. Coil-energizing strategies and array dimensions should be based on an adequate evaluation of these two important demands and the topological structure of target tissues.
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Affiliation(s)
- Xile Wei
- Tianjin Key Laboratory of Process Measurement and Control, School of Electrical and Information Engineering, Tianjin University, Tianjin 300072, China.
| | - Yao Li
- Tianjin Key Laboratory of Process Measurement and Control, School of Electrical and Information Engineering, Tianjin University, Tianjin 300072, China.
| | - Meili Lu
- School of Information Technology Engineering, Tianjin University of Technology and Education, Tianjin 300222, China.
| | - Jiang Wang
- Tianjin Key Laboratory of Process Measurement and Control, School of Electrical and Information Engineering, Tianjin University, Tianjin 300072, China.
| | - Guosheng Yi
- Tianjin Key Laboratory of Process Measurement and Control, School of Electrical and Information Engineering, Tianjin University, Tianjin 300072, China.
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15
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Beuzon G, Timour Q, Saoud M. Predictors of response to repetitive transcranial magnetic stimulation (rTMS) in the treatment of major depressive disorder. Encephale 2016; 43:3-9. [PMID: 28034451 DOI: 10.1016/j.encep.2016.11.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 06/28/2016] [Accepted: 11/16/2016] [Indexed: 01/01/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS), based on the principle of electromagnetic induction, consists of applying series of magnetic impulses to the cerebral cortex so as to modulate neurone activity in a target zone. This technique, still experimental, could prove promising in the field of psychiatry, in particular for the treatment of major depressive disorder. It is important for the clinician to be able to assess the response potential of a given patient to rTMS, and this among other things requires relevant predictive factors to be available. This review of the literature aims to determine and analyse reported predictive factors for therapeutic response to rTMS treatment in major depressive disorder. Different parameters are studied, in particular age, the severity of the depressive episode, psychological dimensions, genetic factors, cerebral blood flows via cerebral imagery, and neuronavigation. The factors found to be associated with better therapeutic response were young age, low level of severity of the depressive episode, motor threshold intensity over 100%, more than 1000 stimulations per session, more than 10 days treatment, L/L genotype on the 5-HTTLPR transporter gene, C/C homozygosity on the promotor regions of the 5-HT1A receptor gene, Val/Val homozygosity on the BDNF gene, cordance analyses by EEG, and finally the accurate localisation provided by neuronavigation. The authors conclude that investigations in larger patient samples are required in the future, and that the work already achieved should provide lines of approach for the coming experimental studies.
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Affiliation(s)
- G Beuzon
- Pharmacologie médicale, EA 4312 neurocardiologie, physiopathologie des troubles du rythme cardiaque, hôpital Louis-Pradel, unité 50, 28, avenue du Doyen-Lépine, 69677 Bron, France.
| | - Q Timour
- Pharmacologie médicale, EA 4612 neurocardiologie, physiopathologie des troubles du rythme cardiaque hôpital Louis-Pradel, unité 50, 28, avenue du Doyen-Lépine, 69677 Bron, France.
| | - M Saoud
- Unité de recherche EA4615, PsyR, université Claude-Bernard-Lyon 1, 27-29, boulevard du 11-Novembre-1918, 69622 Lyon, France; Service de psychiatrie adultes liaison consultation, hospices civils de Lyon, 59, boulevard Pinel, 69500 Bron, France.
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16
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de Sousa RT, Zanetti MV, Brunoni AR, Machado-Vieira R. Challenging Treatment-Resistant Major Depressive Disorder: A Roadmap for Improved Therapeutics. Curr Neuropharmacol 2016; 13:616-35. [PMID: 26467411 PMCID: PMC4761633 DOI: 10.2174/1570159x13666150630173522] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/15/2014] [Accepted: 12/17/2014] [Indexed: 02/06/2023] Open
Abstract
Major
depressive disorder (MDD) is associated with a significant burden and costs to
the society. As remission of depressive symptoms is achieved in only one-third
of the MDD patients after the first antidepressant trial, unsuccessful
treatments contribute largely to the observed suffering and social costs of MDD.
The present article provides a summary of the therapeutic strategies that have
been tested for treatment-resistant depression (TRD). A computerized search on
MedLine/PubMed database from 1975 to September 2014 was performed, using the
keywords “treatment-resistant depression”, “major depressive disorder”,
“adjunctive”, “refractory” and “augmentation”. From the 581 articles retrieved,
two authors selected 79 papers. A manual searching further considered relevant
articles of the reference lists. The evidence found supports adding or switching
to another antidepressant from a different class is an effective strategy in
more severe MDD after failure to an initial antidepressant trial. Also, in
subjects resistant to two or more classes of antidepressants, some augmentation
strategies and antidepressant combinations should be considered, although the
overall response and remission rates are relatively low, except for fast acting
glutamatergic modulators. The wide range of available treatments for TRD
reflects the complexity of MDD, which does not underlie diverse key features of
the disorder. Larger and well-designed studies applying dimensional approaches
to measure efficacy and effectiveness are warranted.
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Affiliation(s)
| | | | | | - Rodrigo Machado-Vieira
- Laboratory of Neuroscience (LIM27), Department and Institute of Psychiatry, University of Sao Paulo, Brazil, Address: Instituto de Psiquiatria do HC-FMUSP, 3o andar, LIM-27, Rua Dr. Ovidio Pires de Campos, 785, Postal code 05403- 010, Sao Paulo, SP, Brazil
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17
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Use of the Temperament and Character Inventory to Predict Response to Repetitive Transcranial Magnetic Stimulation for Major Depression. J Psychiatr Pract 2016; 22:193-202. [PMID: 27123799 PMCID: PMC4852279 DOI: 10.1097/pra.0000000000000150] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The goal of this study was to investigate the utility of the Temperament and Character Inventory (TCI) in predicting antidepressant response to repetitive transcranial magnetic stimulation (rTMS). BACKGROUND Although rTMS of the dorsolateral prefrontal cortex is an established antidepressant treatment, little is known about predictors of response. The TCI measures multiple personality dimensions (harm avoidance, novelty seeking, reward dependence, persistence, self-directedness, self-transcendence, and cooperativeness), some of which have predicted response to pharmacotherapy and cognitive-behavioral therapy. A previous study suggested a possible association between self-directedness and response to rTMS in melancholic depression, although this was limited by the fact that melancholic depression is associated with a limited range of TCI profiles. METHODS Nineteen patients with a major depressive episode completed the TCI before a clinical course of rTMS over the dorsolateral prefrontal cortex. Treatment response was defined as ≥50% decrease in scores on the Hamilton Rating Scale for Depression (Ham-D). Baseline scores on each TCI dimension were compared between responders and nonresponders through analysis of variance. Pearson correlations were also calculated for temperament/character scores in comparison with percentage improvement in Ham-D scores. RESULTS Eleven of the 19 patients responded to rTMS. T-scores for persistence were significantly higher in responders than in nonresponders (P=0.022). Linear regression revealed a correlation between persistence scores and percentage improvement in Ham-D scores. CONCLUSIONS Higher persistence scores predicted antidepressant response to rTMS. This may be explained by rTMS-induced enhancement of cortical excitability, which has been found to be decreased in patients with high persistence. Personality assessment that includes measurement of TCI persistence may be a useful component of precision medicine initiatives in rTMS for depression.
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18
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Kedzior KK, Gellersen HM, Brachetti AK, Berlim MT. Deep transcranial magnetic stimulation (DTMS) in the treatment of major depression: An exploratory systematic review and meta-analysis. J Affect Disord 2015; 187:73-83. [PMID: 26321258 DOI: 10.1016/j.jad.2015.08.033] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 07/30/2015] [Accepted: 08/12/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND Deep transcranial magnetic stimulation (DTMS) is a relatively new, non-invasive method of stimulating larger and, presumably, deeper brain regions. The current study investigated if DTMS delivered with H-coils has acute antidepressant effects in major depression using a systematic literature review and a quantitative meta-analysis. METHODS Seventeen studies on 'DTMS or H-coil' and 'depression' were identified on Medline, PsycInfo, and Google Scholar (until November 2014). Data from nine open-label studies were meta-analysed using a random-effects model with inverse-variance weights. The outcome measures were the standardised paired mean difference (Cohen's d) in depression scores on Hamilton Depression Rating Scale (HDRS), response, remission, and dropout rates after acute DTMS treatment compared to baseline. RESULTS There was a large antidepressant effect after 20 acute, high-frequency DTMS sessions compared to baseline according to HDRS change scores (overall mean weighted d=2.04, 95% confidence interval: 1.53-2.55; nine studies; 150 patients). Overall weighted response, remission, and dropout rates were 60%, 29%, and 18% respectively. HDRS change scores and response rates tended to be higher in four studies with 68 patients on concurrent antidepressants compared to two studies with 26 patients who received DTMS as a monotherapy. LIMITATIONS These results are based on data from a low number of open-label studies. CONCLUSION High-frequency DTMS appears to have acute antidepressant effects after 20 sessions in mostly unipolar and treatment-resistant patients. Concurrent treatment with antidepressants might enhance the efficacy of DTMS.
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Affiliation(s)
- Karina Karolina Kedzior
- Institute of Psychology and Transfer, University of Bremen, Grazer Straße 2c, 28359 Bremen, Germany.
| | | | | | - Marcelo T Berlim
- Department of Psychiatry, McGill University, and Neuromodulation Research Clinic, Douglas Institute, Montreal, Canada
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19
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Baeken C, Desmyter S, Duprat R, De Raedt R, Van Denabbeele D, Tandt H, Lemmens GMD, Vervaet M, van Heeringen K. Self-directedness: an indicator for clinical response to the HF-rTMS treatment in refractory melancholic depression. Psychiatry Res 2014; 220:269-74. [PMID: 25175912 DOI: 10.1016/j.psychres.2014.07.084] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 07/27/2014] [Accepted: 07/31/2014] [Indexed: 12/26/2022]
Abstract
Although well-defined predictors of response are still unclear, clinicians refer a variety of depressed patients for a repetitive Transcranial Magnetic Stimulation (rTMS) treatment. It has been suggested that personality features such as Harm Avoidance (HA) and self-directedness (SD) might provide some guidance for a classical antidepressant treatment outcome. However, to date no such research has been performed in rTMS treatment paradigms. In this open study, we wanted to examine whether these temperament and character scores in particular would predict clinical outcome in refractory unipolar depressed patients when a typical high-frequency (HF)-rTMS treatment protocol is applied. Thirty six unipolar right-handed antidepressant-free treatment resistant depressed (TRD) patients, all of the melancholic subtype, received 10 HF-rTMS sessions applied to the left dorsolateral prefrontal cortex (DLPFC). All patients were classified as at least stage III TRD and were assessed with the Temperament and Character Inventory (TCI) before a HF-rTMS treatment. Only the individual scores on SD predicted clinical outcome. No other personality scales were found to be a predictor of this kind of application. Our results suggest that refractory MDD patients who score higher on the character scale SD may be more responsive to the HF-rTMS treatment.
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Affiliation(s)
- Chris Baeken
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Department of Psychiatry University Hospital (UZBrussel), Brussels, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium.
| | - Stefanie Desmyter
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium
| | - Romain Duprat
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium
| | - Rudi De Raedt
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Dirk Van Denabbeele
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Hannelore Tandt
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Gilbert M D Lemmens
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Myriam Vervaet
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Kees van Heeringen
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium
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