Department of Psychiatry, Ningbo Kangning Hospital, Ningbo 315201, China; Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200030, China.
Department of Psychiatry, Ningbo Kangning Hospital, Ningbo 315201, China.
Cell Rep Med. 2023 Jun 20;4(6):101060. doi: 10.1016/j.xcrm.2023.101060. Epub 2023 May 31.
It has been 15 years since repetitive transcranial magnetic stimulation (rTMS) targeting the dorsolateral prefrontal cortex (DLPFC) was approved by the FDA for clinical depression treatment. Yet, the underlying mechanisms for rTMS-induced depression relief are not fully elucidated. This study analyzes TMS-electroencephalogram (EEG) data from 64 healthy control (HC) subjects and 53 patients with major depressive disorder (MDD) before and after rTMS treatment. Prior to treatment, patients with MDD have lower activity in the DLPFC, the hippocampus (HPC), the orbitofrontal cortex (OFC), and DLPFC-OFC connectivity compared with HCs. Following active rTMS treatment, patients with MDD show a significant increase in the DLPFC, HPC, and OFC. Notably, the increase in HPC activity is specifically associated with amelioration of depressive symptoms but not anxiety or sleep quality. The orbitofrontal-hippocampal pathway plays a crucial role in mediating depression relief following rTMS treatment. These findings suggest potential alternative targets for brain stimulation therapy against depression (chictr.org.cn: ChiCTR2100052007).
经 FDA 批准，采用重复经颅磁刺激（rTMS）技术靶向治疗外侧前额叶皮层（DLPFC）治疗抑郁症已有 15 年。然而，rTMS 诱导抑郁缓解的潜在机制尚未完全阐明。本研究分析了 rTMS 治疗前后 64 名健康对照（HC）受试者和 53 名重度抑郁症（MDD）患者的 TMS-脑电图（EEG）数据。治疗前，与 HC 相比，MDD 患者的 DLPFC、海马（HPC）、眶额皮层（OFC）以及 DLPFC-OFC 连接的活性较低。经过积极的 rTMS 治疗后，MDD 患者的 DLPFC、HPC 和 OFC 活性显著增加。值得注意的是，HPC 活性的增加与抑郁症状的改善，而不是焦虑或睡眠质量的改善有明确关联。眶额-海马通路在 rTMS 治疗后缓解抑郁中起着关键作用。这些发现为针对抑郁症的脑刺激治疗提供了潜在的替代靶点（临床试验注册中心：ChiCTR2100052007）。
