Tang Nailong, Sun Chuanzhu, Wang Yangtao, Li Xiang, Liu Junchang, Chen Yihuan, Sun Liang, Rao Yang, Li Sanzhong, Qi Shun, Wang Huaning
Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
Department of Psychiatry, 907 Hospital of Joint Logistics Team, Nanping, China.
Front Psychiatry. 2021 Nov 5;12:768819. doi: 10.3389/fpsyt.2021.768819. eCollection 2021.
Suicidal ideation increases precipitously in patients with depression, contributing to the risk of suicidal attempts. Despite the recent advancement in transcranial magnetic stimulation, its effectiveness in depression disorder and its wide acceptance, the network mechanisms of the clinical response to suicidal ideation in major depressive disorder remain unclear. Independent component analysis for neuroimaging data allows the identification of functional network connectivity which may help to explore the neural basis of suicidal ideation in major depressive disorder. Resting-state functional magnetic resonance imaging data and clinical scales were collected from 30 participants (15 major depressive patients with suicidal ideation and 15 healthy subjects). Individual target-transcranial magnetic stimulation (IT-TMS) was then used to decrease the subgenual anterior cingulate cortex activity through the left dorsolateral prefrontal cortex. Thirty days post IT-TMS therapy, seven of 15 patients (46.67%) met suicidal remission criteria, and 12 patients (80.00%) met depression remission criteria. We found that IT-TMS could restore the abnormal functional network connectivity between default mode network and precuneus network, left executive control network and sensory-motor network. Furthermore, the changes in functional network connectivity between the default mode network and precuneus network were associated with suicidal ideation, and depressive symptoms were related to connectivity between left executive control network and sensory-motor network. These findings illustrate that IT-TMS is an effective protocol for the accurate restoration of impaired brain networks, which is consistent with clinical symptoms.
抑郁症患者的自杀意念会急剧增加，这增加了自杀未遂的风险。尽管经颅磁刺激技术最近取得了进展，其在抑郁症治疗中的有效性以及广泛的接受度，但重度抑郁症患者对自杀意念的临床反应的网络机制仍不清楚。对神经影像数据进行独立成分分析可以识别功能网络连接性，这可能有助于探索重度抑郁症患者自杀意念的神经基础。我们收集了30名参与者（15名有自杀意念的重度抑郁症患者和15名健康受试者）的静息态功能磁共振成像数据和临床量表。然后使用个体靶向经颅磁刺激（IT-TMS）通过左侧背外侧前额叶皮层来降低膝下前扣带回皮层的活动。在IT-TMS治疗30天后，15名患者中有7名（46.67%）达到自杀缓解标准，12名患者（80.00%）达到抑郁缓解标准。我们发现，IT-TMS可以恢复默认模式网络与楔前叶网络、左侧执行控制网络与感觉运动网络之间异常的功能网络连接性。此外，默认模式网络与楔前叶网络之间功能网络连接性的变化与自杀意念相关，抑郁症状与左侧执行控制网络与感觉运动网络之间的连接性相关。这些发现表明，IT-TMS是一种有效恢复受损脑网络且与临床症状相符的方案。
