Impact of Repetitive Transcranial Magnetic Stimulation (rTMS) on Theory of Mind and Executive Function in Major Depressive Disorder and Its Correlation with Brain-Derived Neurotrophic Factor (BDNF): A Randomized, Double-Blind, Sham-Controlled Trial

Abstract

Background: Studies have implicated hypofrontality in the pathogenesis of impaired theory of mind (ToM) and executive function (EF) in major depressive disorder (MDD). These symptoms are usually resistant to treatment. Repetitive transcranial magnetic stimulation (rTMS) has been shown to reverse hypofrontality. Moreover, BDNF is an effective biomarker of antidepressant effects, but there have been very few studies on the correlation between BDNF and rTMS. We aimed to evaluate the efficacy of 20 sessions of a 10 Hz unilateral rTMS intervention over the left dorsolateral prefrontal cortex (DLPFC) in improving ToM and EF in patients with MDD and its correlation with BDNF. Methods: A total of 120 MDD patients were enrolled in this randomized, sham-controlled, double-blind trial. Each participant received 20 sessions of rTMS at 10 Hz frequency through the active or the sham coil over 4 weeks. ToM was assessed with the facial emotion identification test (FEIT) and hinting task (HT). EF was assessed with the Wisconsin card sorting test (WCST). BDNF assessments were carried out at baseline and 2-, 4-, 12-, and 24-week follow-ups. Results: The improvement in the ToM (FEIT, HT) in the active rTMS group was significantly different from that in the sham rTMS group (F = 18.09, p < 0.001; F = 5.02, p = 0.026). There were significant differences in the WCST (categories completed, response errors, response perseverative errors, non-response perseverative errors) after logarithmic transformation at different time points in the active rTMS group (F = 14.71, p < 0.001; F = 5.99, p = 0.046; F = 8.90, p = 0.031; F = 2.31, p = 0.048). However, there was no significant difference in log transformed BDNF concentration between the two groups (t = 0.07 to t = 1.29, p > 0.05). BDNF was negatively correlated with WCST categories completed at the 24th week (r = −0.258, p = 0.046). Conclusions: The results show that rTMS may improve the ToM and EF of patients with MDD and there was no significant correlation with serum BDNF concentration. RTMS can not only be used for treatment of patients with MDD but also has a positive effect on ToM and EF.

Tilapia Skin Peptides Ameliorate Cyclophosphamide-Induced Anxiety- and Depression-Like Behavior via Improving Oxidative Stress, Neuroinflammation, Neuron Apoptosis, and Neurogenesis in Mice

“…TSP can restore CP-induced phosphorylate CREB in mice. The results suggest that the BDNF/TRKB/CREB pathway may be involved in the protective effect of TSP to ameliorate CP-induced neuronal apoptosis and neurogenesis, which is consistent with previous papers that the recovery of BDNF function may be the basis of antidepressant therapy ( 53 ). Further exploration is needed to expound whether TSP crosses the BBB and the mechanism of its CP-induced anxiety- and depression-like behavior effects.…”

Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation Across Mental Disorders

“…We included 110 studies, encompassing a total of 4820 participants . The majority of participants were male (2959 [61.4%] compared with 1861 females [38.6%]), and the mean (SD) age was 43 (8.8) years.…”

“…The details of all retained studies and the overall results for dose equivalents are reported in eTable 1 in Supplement 1 and the Table, respectively. Overall, considering the important heterogeneity found for borderline disorder and autism spectrum disorder, we included 33 studies on schizophrenia, 43 on mood disorders, 18 on OCD, 4 on posttraumatic stress disorder (PTSD), and 11 on substance use disorder (SUD) . We also included 32 studies on treatment-resistant depression .…”

“…Five studies delivered HF-LDLPFC TMS for 209 participants with depression 42 , 57 , 70 , 110 , 113 over a mean (SD) duration of 2.5 (0.5) weeks. A bell-shaped curve was obtained, with coherent results.…”

Is the Therapeutic Mechanism of Repetitive Transcranial Magnetic Stimulation in Cognitive Dysfunctions of Depression Related to the Neuroinflammatory Processes in Depression?

“…A systematic review and meta-analysis have shown that rTMS treatment targeting the prefrontal cortex in patients with MDD may moderately enhance cognitive function in set-shifting ability, visual scanning, and psychomotor speed ( 21 ). Tong et al showed that rTMS might improve executive function in patients with MDD ( 22 ). Repetitive transcranial magnetic stimulation is considered promising and valuable for improving cognitive dysfunction in TRD ( 23 ).…”