Department of Psychology, The University of British Columbia, Vancouver, BC, Canada.
Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada; Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, BC, Canada.
J Affect Disord. 2023 Jan 15;321:182-190. doi: 10.1016/j.jad.2022.10.041. Epub 2022 Oct 28.
Repetitive transcranial magnetic stimulation (rTMS) can elicit 45-55 % response rates and may alleviate suicidality symptoms in treatment resistant depression (TRD). Blunted anticipatory reward sensitivity and negatively biased self-referential processing may predict trajectories of depressive and suicidality symptoms in rTMS for TRD and be modulated during treatment.
Fifty-five individuals with TRD received four weeks of low-frequency rTMS applied to the right dorsolateral prefrontal cortex (LFR-rTMS) and were followed until 17 weeks post-baseline. Participants completed behavioral measures of anticipatory reward sensitivity and self-referential processing at baseline and five weeks post-baseline (approximately one-week post-treatment). We examined whether baseline anticipatory reward sensitivity and self-referential processing predicted trajectories of depressive and suicidality symptoms from baseline to follow-up and whether these cognitive-affective variables showed change from baseline to week five.
Anticipatory reward sensitivity and negative self-referential encoding at baseline were associated with higher overall depressive symptoms and suicidality from baseline to 17 weeks post-baseline. At week five, participants self-attributed a higher number of positive traits and a lower number of negative traits and had a lesser tendency to remember negative relative to positive traits they had self-attributed, compared to baseline.
The specificity of these results to LFR-rTMS is unknown in the absence of a comparison group, and our relatively small sample size precluded the interpretation of null results.
Baseline blunted anticipatory reward sensitivity and negative biases in self-referential processing may be risk factors for higher depressive symptoms and suicidality during and after LFR-rTMS, and LFR-rTMS may modulate self-referential processing.
重复经颅磁刺激（rTMS）可产生 45-55%的反应率，并可能缓解治疗抵抗性抑郁症（TRD）的自杀意念症状。在 rTMS 治疗 TRD 时，预测抑郁和自杀意念症状轨迹的前瞻性奖励敏感性降低和自我参照加工负偏可能会发生变化，并在治疗过程中得到调节。
55 名 TRD 患者接受了四周的右侧背外侧前额叶皮质低频 rTMS（LFR-rTMS）治疗，并随访至基线后 17 周。参与者在基线和基线后五周（约治疗后一周）完成了前瞻性奖励敏感性和自我参照加工的行为测量。我们检查了基线前瞻性奖励敏感性和自我参照加工是否预测了从基线到随访的抑郁和自杀意念症状轨迹，以及这些认知-情感变量是否从基线到第 5 周发生了变化。
基线时的前瞻性奖励敏感性和负性自我参照编码与基线至 17 周时的总体抑郁症状和自杀意念有关。在第 5 周，与基线相比，参与者自我归因的积极特质数量更多，消极特质数量更少，并且记住自己归因的消极特质的倾向低于积极特质。
由于缺乏对照组，这些结果对 LFR-rTMS 的特异性尚不清楚，而且我们的样本量相对较小，无法解释无效结果。
基线时前瞻性奖励敏感性降低和自我参照加工负偏可能是 LFR-rTMS 期间和之后抑郁症状和自杀意念增加的风险因素，而 LFR-rTMS 可能会调节自我参照加工。
