Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Austria.
Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Austria.
J Affect Disord. 2023 Mar 1;324:660-669. doi: 10.1016/j.jad.2022.12.088. Epub 2023 Jan 2.
Previous studies suggest that transcranial magnetic stimulation exerts antidepressant effects by altering functional connectivity (FC). However, knowledge about this mechanism is still limited. Here, we aimed to investigate the effect of bilateral sequential theta-burst stimulation (TBS) on FC in treatment-resistant depression (TRD) in a sham-controlled longitudinal study.
TRD patients (n = 20) underwent a three-week treatment of intermittent TBS of the left and continuous TBS of the right dorsolateral prefrontal cortex (DLPFC). Upon this trial's premature termination, 15 patients had received active TBS and five patients sham stimulation. Resting-state functional magnetic resonance imaging was performed at baseline and after treatment. FC (left and right DLPFC) was estimated for each participant, followed by group statistics (t-tests). Furthermore, depression scores were analyzed (linear mixed models analysis) and tested for correlation with FC.
Both groups exhibited reductions of depression scores, however, there was no significant main effect of group, or group and time. Anticorrelations between DLPFC and the subgenual cingulate cortex (sgACC) were observed for baseline FC, corresponding to changes in depression severity. Treatment did not significantly change DLPFC-sgACC connectivity, but significantly reduced FC between the left stimulation target and bilateral anterior insula.
Our data is compatible with previous reports on the relevance of anticorrelation between DLPFC and sgACC for treatment success. Furthermore, FC changes between left DLPFC and bilateral anterior insula highlight the effect of TBS on the salience network.
Due to the limited sample size, results should be interpreted with caution and are of exploratory nature.
先前的研究表明，经颅磁刺激通过改变功能连接（FC）发挥抗抑郁作用。然而，人们对这一机制的了解仍然有限。在此，我们旨在一项假对照的纵向研究中，探究双侧序贯经颅磁刺激（TBS）对难治性抑郁症（TRD）的 FC 的影响。
TRD 患者（n=20）接受了为期三周的左侧间歇性 TBS 和右侧连续 TBS 的治疗。在该试验提前终止后，15 名患者接受了活性 TBS 治疗，5 名患者接受了假刺激。在基线和治疗后进行了静息状态功能磁共振成像。为每位参与者估计了 FC（左、右背外侧前额叶皮质），随后进行了组统计（t 检验）。此外，还分析了抑郁评分（线性混合模型分析）并测试了与 FC 的相关性。
两组患者的抑郁评分均有所降低，但组间无显著差异，也无组和时间的交互作用。基线 FC 时观察到背外侧前额叶皮质与扣带回下前部（sgACC）之间的负相关，与抑郁严重程度的变化相对应。治疗并未显著改变 DLPFC-sgACC 连接，但显著降低了左侧刺激靶点与双侧前岛叶之间的 FC。
我们的数据与先前关于 DLPFC 与 sgACC 之间负相关与治疗成功相关的报告一致。此外，左背外侧前额叶皮质与双侧前岛叶之间的 FC 变化强调了 TBS 对突显网络的影响。
由于样本量有限，结果应谨慎解释，且具有探索性。
