Pregenual or subgenual anterior cingulate cortex as potential effective region for brain stimulation of depression

Abstract

Background:The dorsolateral prefrontal cortex (DLPFC) is the standard stimulation target for the repetitive transcranial magnetic stimulation (rTMS) treatment of major depression disorder (MDD). A retrospective study by Fox and colleagues found that a more negative resting-state functional magnetic resonance imaging (RS-fMRI) functional connectivity (FC) between left DLPFC and the subgenual anterior cingulate cortex (sgACC) in a large group of healthy participants is associated with a better curative effects of rTMS in MDD, suggesting that the sgACC may be an effective region.However, a recent meta-analysis on RS-fMRI studies found that the pregenual ACC (pgACC), rather than the sgACC, of MDD patients showed increased local activity. Methods: We used the stimulation coordinates in the left DLPFC analyzed by Fox et al. to perform RS-fMRI FC between the stimulation targets obtained from previous rTMS MDD studies and the potential effective regions (sgACC and pgACC, respectively) on the RS-fMRI data from 88 heathy participants. Results: (a) Both the pgACC and the sgACC were negatively connected to the left DLPFC; (b) both FCs of sgACC-DLPFC and pgACC-DLPFC were more negative in responders than in nonresponders; and (c) the associations between DLPFC-sgACC functional connectivity and clinical efficacy were clustered around the midline sgACC. Conclusions: Both the pgACC and the sgACC may be potential effective regions for rTMS on the left DLPFC for treatment of MDD. However, individualized ACC-DLPFC FC-based rTMS on depression should be performed in the future to test the pgACC or the sgACC as effective regions. K E Y W O R D S depression, functional connectivity, pregenual anterior cingulate cortex, repetitive transcranial magnetic stimulation, subgenual anterior cingulate cortex S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. How to cite this article: Jing Y, Zhao N, Deng X-P, et al.Pregenual or subgenual anterior cingulate cortex as potential effective region for brain stimulation of depression. Brain

Functional MRI in Depression—Multivariate Analysis of Emotional Task

“…The effective connectivity of the fronto-limbic circuit has been suggested as a predictor of response to antidepressants [46]. Most recent study suggests that stimulation of pre-or subgenual ACC might be an effective treatment for depression [47]. Our results of less activation of the abovementioned regions in depressed patients are in line with the cited literature.…”

Sequential multi-locus transcranial magnetic stimulation for treatment of obsessive-compulsive disorder with comorbid major depression: A case series

“…DLPFC is a part of the Default Mode Network (DMN), which has been reported to have aberrant function in both OCD and MDD [7,8]. The therapeutic benefit of DLPFC stimulation may be mediated through connections to the subgenual [9] and pregenual [10] anterior cingulate cortex. Interestingly, in Tadayonnejad et al (2018) study, pregenual anterior cingulate cortex was shown to mediate the abnormal interaction between cortico-striatal-thalamo-cortical OCD and frontolimbic MDD circuits.…”

Baseline functional connectivity in resting state networks associated with depression and remission status after 16 weeks of pharmacotherapy: A CAN-BIND Report

“…The ACC has been proposed to play a central role in MDD pathology [49–51]. While the subgenual part of the ACC is most often highlighted, the pregenual ACC, where our seed was located, has also been found to be part of the altered DMN in MDD and associated with treatment effects [52, 53]. Our finding that ACC connectivity with regions from both other networks differentiates patients with different treatment outcomes further supports this idea and highlights the potential of this feature for predicting early remission in response to pharmacotherapy.…”