Global connectivity and local excitability changes underlie antidepressant effects of repetitive transcranial magnetic stimulation

Repetitive transcranial magnetic stimulation (rTMS) is a commonly- used treatment for major depressive disorder (MDD). However, our understanding of the mechanism by which TMS exerts its antidepressant effect is minimal. Furthermore, we lack brain signals that can be used to predict and track clinic...

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Veröffentlicht in:Neuropsychopharmacology (New York, N.Y.) Jg. 45; H. 6; S. 1018 - 1025
Hauptverfasser: Eshel, Neir, Keller, Corey J, Wu, Wei, Jiang, Jing, Mills-Finnerty, Colleen, Huemer, Julia, Wright, Rachael, Fonzo, Gregory A, Ichikawa, Naho, Carreon, David, Wong, Melinda, Yee, Andrew, Shpigel, Emmanuel, Guo, Yi, McTeague, Lisa, Maron-Katz, Adi, Etkin, Amit
Format: Journal Article
Sprache:Englisch
Veröffentlicht: England Nature Publishing Group 01.05.2020
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ISSN:0893-133X, 1740-634X, 1740-634X
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Abstract Repetitive transcranial magnetic stimulation (rTMS) is a commonly- used treatment for major depressive disorder (MDD). However, our understanding of the mechanism by which TMS exerts its antidepressant effect is minimal. Furthermore, we lack brain signals that can be used to predict and track clinical outcome. Such signals would allow for treatment stratification and optimization. Here, we performed a randomized, sham-controlled clinical trial and measured electrophysiological, neuroimaging, and clinical changes before and after rTMS. Patients (N = 36) were randomized to receive either active or sham rTMS to the left dorsolateral prefrontal cortex (dlPFC) for 20 consecutive weekdays. To capture the rTMS-driven changes in connectivity and causal excitability, resting fMRI and TMS/EEG were performed before and after the treatment. Baseline causal connectivity differences between depressed patients and healthy controls were also evaluated with concurrent TMS/fMRI. We found that active, but not sham rTMS elicited (1) an increase in dlPFC global connectivity, (2) induction of negative dlPFC-amygdala connectivity, and (3) local and distributed changes in TMS/EEG potentials. Global connectivity changes predicted clinical outcome, while both global connectivity and TMS/EEG changes tracked clinical outcome. In patients but not healthy participants, we observed a perturbed inhibitory effect of the dlPFC on the amygdala. Taken together, rTMS induced lasting connectivity and excitability changes from the site of stimulation, such that after active treatment, the dlPFC appeared better able to engage in top-down control of the amygdala. These measures of network functioning both predicted and tracked clinical outcome, potentially opening the door to treatment optimization.
AbstractList Repetitive transcranial magnetic stimulation (rTMS) is a commonly- used treatment for major depressive disorder (MDD). However, our understanding of the mechanism by which TMS exerts its antidepressant effect is minimal. Furthermore, we lack brain signals that can be used to predict and track clinical outcome. Such signals would allow for treatment stratification and optimization. Here, we performed a randomized, sham-controlled clinical trial and measured electrophysiological, neuroimaging, and clinical changes before and after rTMS. Patients (N = 36) were randomized to receive either active or sham rTMS to the left dorsolateral prefrontal cortex (dlPFC) for 20 consecutive weekdays. To capture the rTMS-driven changes in connectivity and causal excitability, resting fMRI and TMS/EEG were performed before and after the treatment. Baseline causal connectivity differences between depressed patients and healthy controls were also evaluated with concurrent TMS/fMRI. We found that active, but not sham rTMS elicited (1) an increase in dlPFC global connectivity, (2) induction of negative dlPFC-amygdala connectivity, and (3) local and distributed changes in TMS/EEG potentials. Global connectivity changes predicted clinical outcome, while both global connectivity and TMS/EEG changes tracked clinical outcome. In patients but not healthy participants, we observed a perturbed inhibitory effect of the dlPFC on the amygdala. Taken together, rTMS induced lasting connectivity and excitability changes from the site of stimulation, such that after active treatment, the dlPFC appeared better able to engage in top-down control of the amygdala. These measures of network functioning both predicted and tracked clinical outcome, potentially opening the door to treatment optimization.Repetitive transcranial magnetic stimulation (rTMS) is a commonly- used treatment for major depressive disorder (MDD). However, our understanding of the mechanism by which TMS exerts its antidepressant effect is minimal. Furthermore, we lack brain signals that can be used to predict and track clinical outcome. Such signals would allow for treatment stratification and optimization. Here, we performed a randomized, sham-controlled clinical trial and measured electrophysiological, neuroimaging, and clinical changes before and after rTMS. Patients (N = 36) were randomized to receive either active or sham rTMS to the left dorsolateral prefrontal cortex (dlPFC) for 20 consecutive weekdays. To capture the rTMS-driven changes in connectivity and causal excitability, resting fMRI and TMS/EEG were performed before and after the treatment. Baseline causal connectivity differences between depressed patients and healthy controls were also evaluated with concurrent TMS/fMRI. We found that active, but not sham rTMS elicited (1) an increase in dlPFC global connectivity, (2) induction of negative dlPFC-amygdala connectivity, and (3) local and distributed changes in TMS/EEG potentials. Global connectivity changes predicted clinical outcome, while both global connectivity and TMS/EEG changes tracked clinical outcome. In patients but not healthy participants, we observed a perturbed inhibitory effect of the dlPFC on the amygdala. Taken together, rTMS induced lasting connectivity and excitability changes from the site of stimulation, such that after active treatment, the dlPFC appeared better able to engage in top-down control of the amygdala. These measures of network functioning both predicted and tracked clinical outcome, potentially opening the door to treatment optimization.
Repetitive transcranial magnetic stimulation (rTMS) is a commonly- used treatment for major depressive disorder (MDD). However, our understanding of the mechanism by which TMS exerts its antidepressant effect is minimal. Furthermore, we lack brain signals that can be used to predict and track clinical outcome. Such signals would allow for treatment stratification and optimization. Here, we performed a randomized, sham-controlled clinical trial and measured electrophysiological, neuroimaging, and clinical changes before and after rTMS. Patients (N = 36) were randomized to receive either active or sham rTMS to the left dorsolateral prefrontal cortex (dlPFC) for 20 consecutive weekdays. To capture the rTMS-driven changes in connectivity and causal excitability, resting fMRI and TMS/EEG were performed before and after the treatment. Baseline causal connectivity differences between depressed patients and healthy controls were also evaluated with concurrent TMS/fMRI. We found that active, but not sham rTMS elicited (1) an increase in dlPFC global connectivity, (2) induction of negative dlPFC-amygdala connectivity, and (3) local and distributed changes in TMS/EEG potentials. Global connectivity changes predicted clinical outcome, while both global connectivity and TMS/EEG changes tracked clinical outcome. In patients but not healthy participants, we observed a perturbed inhibitory effect of the dlPFC on the amygdala. Taken together, rTMS induced lasting connectivity and excitability changes from the site of stimulation, such that after active treatment, the dlPFC appeared better able to engage in top-down control of the amygdala. These measures of network functioning both predicted and tracked clinical outcome, potentially opening the door to treatment optimization.
Author Jiang, Jing
Ichikawa, Naho
McTeague, Lisa
Yee, Andrew
Huemer, Julia
Wu, Wei
Etkin, Amit
Fonzo, Gregory A
Keller, Corey J
Wong, Melinda
Eshel, Neir
Wright, Rachael
Guo, Yi
Maron-Katz, Adi
Mills-Finnerty, Colleen
Shpigel, Emmanuel
Carreon, David
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  organization: Alto Neuroscience, Los Altos, CA, USA
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  organization: School of Automation Science and Engineering, South China University of Technology, 510640, Guangzhou, Guangdong, China
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  organization: Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin, TX, USA
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  surname: Ichikawa
  fullname: Ichikawa, Naho
  organization: Department of Psychiatry and Neurosciences, Hiroshima University, Hiroshima, Japan
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  orcidid: 0000-0002-3260-4111
  surname: Carreon
  fullname: Carreon, David
  organization: Veterans Affairs Palo Alto Healthcare System and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94394, USA
– sequence: 11
  givenname: Melinda
  surname: Wong
  fullname: Wong, Melinda
  organization: Veterans Affairs Palo Alto Healthcare System and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94394, USA
– sequence: 12
  givenname: Andrew
  surname: Yee
  fullname: Yee, Andrew
  organization: Veterans Affairs Palo Alto Healthcare System and the Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, CA, 94394, USA
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  givenname: Emmanuel
  surname: Shpigel
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  surname: Maron-Katz
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  givenname: Amit
  orcidid: 0000-0001-8259-3521
  surname: Etkin
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  email: amitetkin@stanford.edu, amitetkin@stanford.edu, amitetkin@stanford.edu
  organization: Alto Neuroscience, Los Altos, CA, USA. amitetkin@stanford.edu
BackLink https://www.ncbi.nlm.nih.gov/pubmed/32053828$$D View this record in MEDLINE/PubMed
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PublicationTitle Neuropsychopharmacology (New York, N.Y.)
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Snippet Repetitive transcranial magnetic stimulation (rTMS) is a commonly- used treatment for major depressive disorder (MDD). However, our understanding of the...
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SubjectTerms Amygdala
Antidepressants
Brain mapping
Clinical outcomes
EEG
Excitability
Functional magnetic resonance imaging
Magnetic fields
Neural networks
Neuroimaging
Patients
Prefrontal cortex
Transcranial magnetic stimulation
Title Global connectivity and local excitability changes underlie antidepressant effects of repetitive transcranial magnetic stimulation
URI https://www.ncbi.nlm.nih.gov/pubmed/32053828
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