Ghent University, Department of Psychiatry and Medical Psychology, Ghent, Belgium; Department of Psychiatry, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium; Ghent University, Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium.
Ghent University, Department of Data Analysis, Ghent, Belgium.
Brain Stimul. 2015 Jul-Aug;8(4):808-15. doi: 10.1016/j.brs.2015.01.415. Epub 2015 Feb 7.
Although one of the most frequent diagnosed mental illnesses worldwide, it appears to be challenging to successfully treat major depressive disorder (MDD). Although the phenomenon of treatment-resistant depression (TRD) still remains unclear, the subgenual anterior cingulate cortex (sgACC) has been put forward as a possible neurobiological marker to evaluate clinical effects of a variety of antidepressant treatments, including repetitive transcranial magnetic stimulation (rTMS). Accelerated high-frequency (HF)-rTMS may have the potential to rapidly result in beneficial clinical outcomes in TRD. No studies yet examined the clinical effects of such accelerated stimulation treatment paradigms on sgACC regional glucose metabolism (CMRglc), nor the predictive value of the latter for clinical outcome.
First, we investigated the predictive value of baseline sgACC metabolic activity for clinical outcome. Second, we hypothesized that in clinical responders only accelerated HF-rTMS treatment would result in significant metabolic decreases.
We recruited right-handed antidepressant-free unipolar melancholic TRD patients to participate in a two-week randomized sham-controlled crossover HF-rTMS treatment study. Stimulation was applied to the left dorsolateral prefrontal cortex (DLPFC). Fifteen patients underwent 18FDG PET (CMRglc) at baseline (T0), after the first week (T1) of accelerated HF-rTMS and at the end of the treatment after the second week (T2).
Higher baseline sgACC metabolic activity may indicate beneficial clinical outcome to this kind of accelerated HF-rTMS treatment. Moreover, clinical response resulted in a significant decrease in sgACC CMRglc. Non-response did not affect sgACC CMRglc.
Our results add to the sgACC as a specific neurobiological marker for anti-depressive response in accelerated HF-rTMS treatment paradigms. Such protocols may not only have the ability to result in fast clinical responses but they may also have potential to acutely modulate a dysfunctional sgACC.
尽管抑郁症是全球最常见的精神疾病之一，但成功治疗重度抑郁症（MDD）似乎具有挑战性。尽管治疗抵抗性抑郁症（TRD）的现象仍不清楚，但扣带前皮质（sgACC）亚区已被提出作为评估各种抗抑郁治疗，包括重复经颅磁刺激（rTMS）的临床效果的可能神经生物学标志物。加速高频（HF）-rTMS 可能具有快速产生 TRD 患者临床获益的潜力。目前尚无研究检查这种加速刺激治疗方案对 sgACC 区域葡萄糖代谢（CMRglc）的临床效果，也没有研究检查后者对临床结局的预测价值。
首先，我们调查了基线 sgACC 代谢活性对临床结局的预测价值。其次，我们假设仅在临床反应者中，加速 HF-rTMS 治疗才会导致代谢显著降低。
我们招募了未经抗抑郁药物治疗的右利手单相抑郁性 TRD 患者参加为期两周的随机假对照交叉 HF-rTMS 治疗研究。刺激应用于左侧背外侧前额叶皮质（DLPFC）。15 名患者在基线（T0）、加速 HF-rTMS 治疗第一周后（T1）和第二周治疗结束时（T2）进行 18FDG PET（CMRglc）。
基线 sgACC 代谢活性较高可能预示着对这种加速 HF-rTMS 治疗有益的临床结局。此外，临床反应导致 sgACC CMRglc 显著降低。无反应则不影响 sgACC CMRglc。
我们的结果增加了 sgACC 作为加速 HF-rTMS 治疗中抗抑郁反应的特定神经生物学标志物。这些方案不仅有可能快速产生临床反应，而且有可能急性调节功能失调的 sgACC。
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