Department of Psychiatry and Medical Psychology, Ghent University, Ghent; Ghent Experimental Psychiatry Lab, Ghent University, Ghent; Department of Psychiatry, University Hospital, Brussels, Belgium.
Department of Psychiatry and Medical Psychology, Ghent University, Ghent; Ghent Experimental Psychiatry Lab, Ghent University, Ghent.
Biol Psychiatry Cogn Neurosci Neuroimaging. 2017 Oct;2(7):556-565. doi: 10.1016/j.bpsc.2017.01.001. Epub 2017 Jan 20.
Accelerated repetitive transcranial magnetic stimulation paradigms have been shown to result in fast decreases in depressive symptoms and suicidal ideation. Although the subgenual anterior cingulate cortex (sgACC) region has been put forward as a possible biological marker, so far, no studies evaluated the clinical effects of accelerated intermittent theta burst stimulation (aiTBS) on sgACC functional connectivity (FC).
Fifty patients with treatment-resistant depression were enrolled in this registered randomized double-blind sham-controlled crossover aiTBS treatment study. All received 20 iTBS sessions applied to the left dorsolateral prefrontal cortex (5 daily sessions spread over 4 days). Forty-four complete resting-state functional magnetic resonance imaging scans were collected. Baseline resting-state functional magnetic resonance imaging scans were compared with a matched healthy control group. Besides depression severity, all patients were also assessed with the Scale for Suicide Ideation and the Beck Hopelessness Scale.
Our main resting-state functional magnetic resonance imaging findings indicate that a positive sgACC FC correlation with the medial orbitofrontal cortex could distinguish aiTBS responders from nonresponders at baseline. Beneficial aiTBS treatment strengthened sgACC-medial orbitofrontal cortex FC patterns. Moreover, this increased FC pattern was associated with a decrease in feelings of hopelessness.
Clinical response to aiTBS treatment is not only characterized by stronger FC patterns between the sgACC and the medial orbitofrontal cortex, but it is also associated with decreases in hopelessness. Our observations provide a possible neurobiological explanation why accelerated repetitive transcranial magnetic stimulation paradigms may result in prompt attenuation of negative thinking in depressed patients.
加速重复经颅磁刺激方案已被证明可导致抑郁症状和自杀意念迅速减轻。尽管亚属前扣带皮层（sgACC）区域已被提出作为可能的生物学标志物，但迄今为止，尚无研究评估加速间歇性 theta 爆发刺激（aiTBS）对 sgACC 功能连接（FC）的临床效果。
本注册随机双盲假对照交叉 aiTBS 治疗研究纳入了 50 名治疗抵抗性抑郁症患者。所有患者均接受 20 次 iTBS 治疗，应用于左侧背外侧前额叶皮层（5 次/d，持续 4 天）。共采集 44 次静息态功能磁共振成像扫描。将静息态功能磁共振成像基线扫描与匹配的健康对照组进行比较。除抑郁严重程度外，所有患者还接受自杀意念量表和贝克无望量表评估。
我们的主要静息态功能磁共振成像发现表明，sgACC 与内侧眶额皮质之间存在正相关 FC，可在基线时区分 aiTBS 应答者和非应答者。有益的 aiTBS 治疗增强了 sgACC-内侧眶额皮质 FC 模式。此外，这种增加的 FC 模式与无望感的降低相关。
aiTBS 治疗的临床反应不仅表现为 sgACC 与内侧眶额皮质之间更强的 FC 模式，而且还与无望感降低相关。我们的观察结果提供了一种可能的神经生物学解释，即加速重复经颅磁刺激方案可能会导致抑郁患者的负面思维迅速减弱。
