Association of Repetitive Transcranial Magnetic Stimulation Treatment With Subgenual Cingulate Hyperactivity in Patients With Major Depressive Disorder

Abstract

Key Points Question Is repetitive transcranial magnetic stimulation associated with changes in subgenual cingulate cortex (SGC) activity in patients with major depressive disorder (MDD)? Findings This diagnostic study, which compared 30 patients with MDD and 30 healthy controls, found that using transcranial magnetic stimulation combined with electroencephalography, SGC activity in patients with MDD was significantly higher compared with healthy controls. After active repetitive transcranial magnetic stimulation, SGC hyperactivity in patients with MDD was attenuated toward the levels of healthy controls. Meaning These SGC-localized findings support SGC hyperactivity as a central construct in the pathophysiology of MDD, which future work might develop into a clinically significant biological target.

Encoding, Consolidation, and Renormalization in Depression: Synaptic Homeostasis, Plasticity, and Sleep Integrate Rapid Antidepressant Effects

“…Several studies have also reported functional connectivity changes in response to repetitive TMS (rTMS) in depressed patients (Ge et al, 2017;Kito et al, 2017;Richieri et al, 2017;Du et al, 2018;Iwabuchi et al, 2019). Positive responses to rTMS have been associated with reduced connectivity of the SCC to the DMN (Philip et al, 2018), along with reduced activity of the SCC and connectivity with the DLPFC (Hadas et al, 2019), supporting the hypothesis of altered connectivity in these areas underlying depressive symptoms (Hamilton et al, 2015). Moreover, sleep-deprived healthy participants and depressed patients demonstrate alterations in functional connectivity patterns (Bosch et al, 2013;Chen et al, 2018;Kong et al, 2018).…”

Transcranial Magnetic and Electrical Stimulation in Alzheimer's Disease and Mild Cognitive Impairment: A Review of Randomized Controlled Trials

“…Two recent studies illustrate the potential of this approach. In one study, the activity of the subgenual cingulate cortex and its effective connectivity with the DLPFC was calculated using TMS‐EEG before and after a course or rTMS to treat adult major depression . Subgenual cingulate activity is increased in major depression and is anticorrelated with DLPFC activity.…”

“…In one study, the activity of the subgenual cingulate cortex and its effective connectivity with the DLPFC was calculated using TMS-EEG before and after a course or rTMS to treat adult major depression. 28 Subgenual cingulate activity is increased in major depression and is anticorrelated with DLPFC activity. The study found that subgenual cingulate excitability and connectivity were increased in major depression and that changes in these measures were specific to receiving active rTMS vs. sham rTMS.…”

Subgenual cingulate connectivity and hippocampal activation are related to MST therapeutic and adverse effects

“…PET studies also demonstrated increased blood flow of the SGC co-occurring with instances of sadness and depression, and recovery from depression showed the SGC hyperactivity being normalized 7 . SGC hyperactivity normalization was also demonstrated after different lines of treatments for MDD, such as antidepressant drugs [15][16][17][18] , repetitive transcranial magnetic stimulation (rTMS) 13,19,20 and ECT 21 . These findings led to efforts to treat MDD by implanting deep-brain stimulation electrodes at the SGC white matter 22 .…”

“…The subgenual cingulate cortex (SGC) is extensively implicated in the pathophysiology of MDD. There are evidence from studies utilizing positron emission tomography (PET) [5][6][7] , functional magnetic resonance imaging (fMRI) [8][9][10][11][12] , electroencephalography (EEG) 13 , and postmortem assessments 14 which closely tie the SGC with the pathophysiology of MDD. The SGC grey matter volume, PET cerebral blood flow and glucose metabolism have been found to be abnormal in MDD patients 6 .…”