Prefrontal cortical blood flow predicts response of depression to rTMS

Weiduschat, Nora; Dubin, Marc G.

doi:10.1016/j.jad.2013.04.049

Cited by 27 publications

(23 citation statements)

References 19 publications

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“…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.…”

Section: Discussionsupporting

confidence: 62%

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

Daou

Boyd

Donahue

et al. 2017

Journal of Affective Disorders

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Background Vascular pathology is common in late-life depression (LLD) and may contribute to alterations in cerebral blood flow (CBF) and cerebrovascular reactivity (CVR). In turn, such hemodynamic deficits may adversely affect brain function and clinical course. The goal of this study was to examine whether altered cerebral hemodynamics in depressed elders predicted antidepressant response. Methods 21 depressed elders completed cranial 3T MRI, including a pseudo-continuous Arterial Spin Labeling (pcASL) acquisition on both room air and during a hypercapnia challenge. Participants then completed 12 weeks of open-label sertraline. Statistical analyses examined the relationship between regional normalized CBF and CVR values and change in Montgomery-Asberg Depression Rating Scale (MADRS) and tested for differences based on remission status. Results 10 participants remitted and 11 did not. After controlling for age and baseline MADRS, greater change in MADRS with treatment was associated with lower pre-treatment normalized CBF in the caudal anterior cingulate cortex (cACC) and lateral orbitofrontal cortex (OFC), as well as lower CVR with hypercapnia in the caudal medial frontal gyrus (cMFG). After controlling for age and baseline MADRS score, remitters exhibited lower CBF in the cACC and lower CVR in the cMFG. Limitations Our sample was small, did not include a placebo arm, and we examined only specific regions of interest. Conclusions Our findings suggest that increased perfusion of the OFC and the ACC is associated with a poor antidepressant response. They do not support that vascular pathology as measured by CBF and CVR negatively affects acute treatment outcomes.

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Section: Discussionsupporting

confidence: 62%

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

Daou

Boyd

Donahue

et al. 2017

Journal of Affective Disorders

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“…In turn, TMS treatment modulated the abnormal frontal lobe perfusion often observed in depressed patients [14-17]. As neuroimaging technology, acquisition, and analytic techniques have advanced, studies of the antidepressant mechanisms of TMS increasingly focus on network-based mechanisms associated with the clinical expression of the depressive illness (e.g.…”

Section: Introductionmentioning

confidence: 99%

Network-Guided Transcranial Magnetic Stimulation for Depression

Dubin

Liston

Avissar

et al. 2017

Curr Behav Neurosci Rep

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Purpose of Review First, we will identify candidate predictive biomarkers of antidepressant response of TMS based on the neuroimaging literature. Next, we will review the effects of TMS on networks involved in depression. Finally, we will discuss ways in which our current understanding of network engagement by TMS may be used to optimize its antidepressant effect. Recent findings The past few years has seen significant interest in the antidepressant mechanisms of TMS. Studies using functional neuroimaging and neurochemical imaging have demonstrated engagement of networks known to be important in depression. Current evidence supports a model whereby TMS normalizes network function gradually over the course of several treatments. This may, in turn, mediate its antidepressant effect. Summary One strategy to optimize the antidepressant effect of TMS is to more precisely target networks relevant in depression. We propose methods to achieve this using functional and neurochemical imaging.

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“…TMS induces an electrical current in brain tissue that is strongest immediately beneath the surface of the skull where an inducer coil is placed. Stimulation at the left dorsolateral prefrontal cortex (DLPFC) is the FDA-approved antidepressant intervention, and is based on the observation that, in depression, this structure has lower resting metabolism [10–12] and impaired functional connectivity [13–15] and that left prefrontal cortical strokes increase the risk of depression [16]. The mechanism of action of TMS is largely unknown but it is hypothesized that it alters the functional connectivity and morphology of neural structures that process emotion.…”

Section: Introductionmentioning

confidence: 99%

Transcranial Magnetic Stimulation of Left Dorsolateral Prefrontal Cortex Induces Brain Morphological Changes in Regions Associated with a Treatment Resistant Major Depressive Episode: An Exploratory Analysis

et al. 2016

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Background Repetitive transcranial magnetic stimulation (TMS) is an FDA-approved antidepressant treatment but little is known of its mechanism of action. Specifically, downstream effects of TMS remain to be elucidated. Objective/Hypothesis To identify brain structural changes from TMS treatment of a treatment resistant depressive episode through an exploratory analysis Methods 27 subjects in a DSM-IV current major depressive episode and on a stable medication regimen, had a 3T magnetic resonance T1 structural scan before and after five weeks of standard TMS treatment to the left dorsolateral prefrontal cortex. 27 healthy volunteer (HVs) subjects had the same brain MRI acquisition. Voxel-based morphometry was performed using high dimensional non-linear diffusomorphic anatomical registration (DARTEL). Results Six clusters of grey matter volume (GMV) that were lower in pre-treatment MRI’s of depressed subjects than in HV’s. GMV in four of these regions increased in MDD after TMS treatment by 3.5% to 11.2%. The four brain regions that changed with treatment were centered in the left anterior cingulate cortex, the left insula, the left superior temporal gyrus and the right angular gyrus. Increases in the anterior cingulate GMV with TMS correlated with improvement in depression severity. Conclusions To our knowledge, this is the first study of brain structural changes during TMS treatment of depression. The affected brain areas are involved in cognitive appraisal, decision-making and subjective experience of emotion. These effects may have potential relevance for the antidepressant action of TMS.

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Prefrontal cortical blood flow predicts response of depression to rTMS

Cited by 27 publications

References 19 publications

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

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

Network-Guided Transcranial Magnetic Stimulation for Depression

Transcranial Magnetic Stimulation of Left Dorsolateral Prefrontal Cortex Induces Brain Morphological Changes in Regions Associated with a Treatment Resistant Major Depressive Episode: An Exploratory Analysis

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