Global connectivity and local excitability changes underlie antidepressant effects of repetitive transcranial magnetic stimulation.
Journal
Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology
ISSN: 1740-634X
Titre abrégé: Neuropsychopharmacology
Pays: England
ID NLM: 8904907
Informations de publication
Date de publication:
05 2020
05 2020
Historique:
received:
30
04
2019
accepted:
30
01
2020
revised:
23
01
2020
pubmed:
14
2
2020
medline:
24
6
2021
entrez:
14
2
2020
Statut:
ppublish
Résumé
Repetitive transcranial magnetic stimulation (rTMS) is a commonly- used treatment for major depressive disorder (MDD). However, our understanding of the mechanism by which TMS exerts its antidepressant effect is minimal. Furthermore, we lack brain signals that can be used to predict and track clinical outcome. Such signals would allow for treatment stratification and optimization. Here, we performed a randomized, sham-controlled clinical trial and measured electrophysiological, neuroimaging, and clinical changes before and after rTMS. Patients (N = 36) were randomized to receive either active or sham rTMS to the left dorsolateral prefrontal cortex (dlPFC) for 20 consecutive weekdays. To capture the rTMS-driven changes in connectivity and causal excitability, resting fMRI and TMS/EEG were performed before and after the treatment. Baseline causal connectivity differences between depressed patients and healthy controls were also evaluated with concurrent TMS/fMRI. We found that active, but not sham rTMS elicited (1) an increase in dlPFC global connectivity, (2) induction of negative dlPFC-amygdala connectivity, and (3) local and distributed changes in TMS/EEG potentials. Global connectivity changes predicted clinical outcome, while both global connectivity and TMS/EEG changes tracked clinical outcome. In patients but not healthy participants, we observed a perturbed inhibitory effect of the dlPFC on the amygdala. Taken together, rTMS induced lasting connectivity and excitability changes from the site of stimulation, such that after active treatment, the dlPFC appeared better able to engage in top-down control of the amygdala. These measures of network functioning both predicted and tracked clinical outcome, potentially opening the door to treatment optimization.
Identifiants
pubmed: 32053828
doi: 10.1038/s41386-020-0633-z
pii: 10.1038/s41386-020-0633-z
pmc: PMC7162876
doi:
Substances chimiques
Antidepressive Agents
0
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
1018-1025Subventions
Organisme : NIMH NIH HHS
ID : T32 MH019938
Pays : United States
Organisme : NIMH NIH HHS
ID : K23 MH118466
Pays : United States
Organisme : NIMH NIH HHS
ID : T32 MH019908
Pays : United States
Organisme : NIH HHS
ID : DP5 OD028128
Pays : United States
Organisme : NIMH NIH HHS
ID : DP1 MH116506
Pays : United States
Organisme : NIMH NIH HHS
ID : R01 MH126639
Pays : United States
Organisme : NIMH NIH HHS
ID : K23 MH104849
Pays : United States
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