Prefrontal cortical blood flow predicts response of depression to rTMS

Cerebral Blood Perfusion Predicts Response to Sertraline versus Placebo for Major Depressive Disorder in the EMBARC Trial

“…Perfusion in the posterior insula, midbrain, hippocampus, orbital frontal gyrus, dorsolateral prefrontal cortex, precentral gyrus, caudate, and middle temporal gyrus contributed to assignment to placebo as the preferred treatment, showing a faster rate of improvement and increasing remission status from 33% for all those who received placebo to 49% for the lucky group. These results are in line with prior perfusion work (albeit not placebo-controlled) but are the first to identify moderators of treatment response (differential outcome for sertraline vs placebo) [14], [15], [21].…”

Cerebral Blood Perfusion Predicts Response to Sertraline versus Placebo for Major Depressive Disorder in the EMBARC Trial

“…Perfusion in the posterior insula, midbrain, hippocampus, orbital frontal gyrus, dorsolateral prefrontal cortex, precentral gyrus, caudate, and middle temporal gyrus contributed to assignment to placebo as the preferred treatment, showing a faster rate of improvement and increasing remission status from 33% for all those who received placebo to 49% for the lucky group. These results are in line with prior perfusion work (albeit not placebo-controlled) but are the first to identify moderators of treatment response (differential outcome for sertraline vs placebo) [14], [15], [21].…”

Frontocingulate cerebral blood flow and cerebrovascular reactivity associated with antidepressant response in late-life depression

“…These findings thus do not appear to support our Hypoperfusion Hypothesis (Taylor et al 2013) that posits that reductions in CBF would be associated with the persistence of depressive symptoms. However, our association of increased CBF with poor antidepressant response is supported by studies associating higher perfusion in frontocingulate regions with either diagnoses of depression or poor response to treatment, including temporal structures such as the amygdala and hippocampus and frontal areas such as the inferior frontal gyrus and OFC (Chen et al 2011; Duhameau et al 2010; Weiduschat et al 2013). The ACC has been similarly implicated in depression, with increased perfusion and metabolic activity identified in the subgenual ACC (Duhameau et al 2010, Su et al 2014) or subcallosal ACC (Ho et al 2013) although these regions are not the same as observed in our study.…”

Stimulated left DLPFC-nucleus accumbens functional connectivity predicts the anti-depression and anti-anxiety effects of rTMS for depression

“…All of the above studies emphasize the importance of the left DLPFC and NAcc in MDD, particularly the left NAcc 51 . A previous rTMS study with only 13 subjects found that responders had greater baseline resting-state blood flow in the left DLPFC than did the non-responders, but the ROI-based analyses did not reveal any differences in the estimated stimulated area 52 . In this study 52 , the ROIs were defined by placing a 5 mm diameter sphere on published MNI coordinates of a dorsolateral prefrontal region corresponding to the EEG F3 position 52 , which does not represent the stimulated site of rTMS.…”

“…A previous rTMS study with only 13 subjects found that responders had greater baseline resting-state blood flow in the left DLPFC than did the non-responders, but the ROI-based analyses did not reveal any differences in the estimated stimulated area 52 . In this study 52 , the ROIs were defined by placing a 5 mm diameter sphere on published MNI coordinates of a dorsolateral prefrontal region corresponding to the EEG F3 position 52 , which does not represent the stimulated site of rTMS. Thus, we analyzed the regional cerebral activity and local synchronization of the stimulated site in the left DLPFC by labeling the site with a Vitamin E capsule, as well as the left NAcc.…”

Cerebral Blood Perfusion Predicts Response to Sertraline versus Placebo for Major Depressive Disorder in the EMBARC Trial

“…Perfusion in the posterior insula, midbrain, hippocampus, orbital frontal gyrus, dorsolateral prefrontal cortex, precentral gyrus, caudate, and middle temporal gyrus contributed to assignment to placebo as the preferred treatment, showing a faster rate of improvement and increasing remission status from 33% for all those who received placebo to 49% for the lucky group. These results are in line with prior perfusion work (albeit not placebo-controlled) but are the first to identify moderators of treatment response (differential outcome for sertraline vs placebo) [14], [15], [21].…”

Frontocingulate cerebral blood flow and cerebrovascular reactivity associated with antidepressant response in late-life depression

“…These findings thus do not appear to support our Hypoperfusion Hypothesis (Taylor et al 2013) that posits that reductions in CBF would be associated with the persistence of depressive symptoms. However, our association of increased CBF with poor antidepressant response is supported by studies associating higher perfusion in frontocingulate regions with either diagnoses of depression or poor response to treatment, including temporal structures such as the amygdala and hippocampus and frontal areas such as the inferior frontal gyrus and OFC (Chen et al 2011; Duhameau et al 2010; Weiduschat et al 2013). The ACC has been similarly implicated in depression, with increased perfusion and metabolic activity identified in the subgenual ACC (Duhameau et al 2010, Su et al 2014) or subcallosal ACC (Ho et al 2013) although these regions are not the same as observed in our study.…”

Stimulated left DLPFC-nucleus accumbens functional connectivity predicts the anti-depression and anti-anxiety effects of rTMS for depression

“…All of the above studies emphasize the importance of the left DLPFC and NAcc in MDD, particularly the left NAcc 51 . A previous rTMS study with only 13 subjects found that responders had greater baseline resting-state blood flow in the left DLPFC than did the non-responders, but the ROI-based analyses did not reveal any differences in the estimated stimulated area 52 . In this study 52 , the ROIs were defined by placing a 5 mm diameter sphere on published MNI coordinates of a dorsolateral prefrontal region corresponding to the EEG F3 position 52 , which does not represent the stimulated site of rTMS.…”

“…A previous rTMS study with only 13 subjects found that responders had greater baseline resting-state blood flow in the left DLPFC than did the non-responders, but the ROI-based analyses did not reveal any differences in the estimated stimulated area 52 . In this study 52 , the ROIs were defined by placing a 5 mm diameter sphere on published MNI coordinates of a dorsolateral prefrontal region corresponding to the EEG F3 position 52 , which does not represent the stimulated site of rTMS. Thus, we analyzed the regional cerebral activity and local synchronization of the stimulated site in the left DLPFC by labeling the site with a Vitamin E capsule, as well as the left NAcc.…”

Cerebral Blood Perfusion Predicts Response to Sertraline versus Placebo for Major Depressive Disorder in the EMBARC Trial

“…Perfusion in the posterior insula, midbrain, hippocampus, orbital frontal gyrus, dorsolateral prefrontal cortex, precentral gyrus, caudate, and middle temporal gyrus contributed to assignment to placebo as the preferred treatment, showing a faster rate of improvement and increasing remission status from 33% for all those who received placebo to 49% for the lucky group. These results are in line with prior perfusion work (albeit not placebo-controlled) but are the first to identify moderators of treatment response (differential outcome for sertraline vs placebo) [14], [15], [21].…”

Frontocingulate cerebral blood flow and cerebrovascular reactivity associated with antidepressant response in late-life depression

“…These findings thus do not appear to support our Hypoperfusion Hypothesis (Taylor et al 2013) that posits that reductions in CBF would be associated with the persistence of depressive symptoms. However, our association of increased CBF with poor antidepressant response is supported by studies associating higher perfusion in frontocingulate regions with either diagnoses of depression or poor response to treatment, including temporal structures such as the amygdala and hippocampus and frontal areas such as the inferior frontal gyrus and OFC (Chen et al 2011; Duhameau et al 2010; Weiduschat et al 2013). The ACC has been similarly implicated in depression, with increased perfusion and metabolic activity identified in the subgenual ACC (Duhameau et al 2010, Su et al 2014) or subcallosal ACC (Ho et al 2013) although these regions are not the same as observed in our study.…”

Stimulated left DLPFC-nucleus accumbens functional connectivity predicts the anti-depression and anti-anxiety effects of rTMS for depression

“…All of the above studies emphasize the importance of the left DLPFC and NAcc in MDD, particularly the left NAcc 51 . A previous rTMS study with only 13 subjects found that responders had greater baseline resting-state blood flow in the left DLPFC than did the non-responders, but the ROI-based analyses did not reveal any differences in the estimated stimulated area 52 . In this study 52 , the ROIs were defined by placing a 5 mm diameter sphere on published MNI coordinates of a dorsolateral prefrontal region corresponding to the EEG F3 position 52 , which does not represent the stimulated site of rTMS.…”

“…A previous rTMS study with only 13 subjects found that responders had greater baseline resting-state blood flow in the left DLPFC than did the non-responders, but the ROI-based analyses did not reveal any differences in the estimated stimulated area 52 . In this study 52 , the ROIs were defined by placing a 5 mm diameter sphere on published MNI coordinates of a dorsolateral prefrontal region corresponding to the EEG F3 position 52 , which does not represent the stimulated site of rTMS. Thus, we analyzed the regional cerebral activity and local synchronization of the stimulated site in the left DLPFC by labeling the site with a Vitamin E capsule, as well as the left NAcc.…”