Simultaneous rTMS and psychotherapy in major depressive disorder: Clinical outcomes and predictors from a large naturalistic study

Donse, Lana; Padberg, Frank; Sack, Alexander T.; Rush, A. John; Arns, Martijn

doi:10.1016/j.brs.2017.11.004

Cited by 134 publications

(94 citation statements)

References 54 publications

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“…First, we tested for any effect of stimulation‐group (1 Hz rTMS, sham TMS, 20 Hz rTMS) or/and session (Pre‐TMS, Post‐1‐TMS, Post‐2‐TMS) on mFP‐amygdala‐FC using a 3 × 3 factorial mixed design ANOVA (MD‐ANOVA; see also Donse et al, ). Second, we tested our main hypothesis, that is, that the three stimulation‐groups (1 Hz rTMS, sham TMS, 20 Hz rTMS) would differ in mFP‐amygdala‐FC at the Post‐1‐TMS session compared to the Pre‐TMS session using a 3 × 2 factorial MD‐ANOVA.…”

Section: Methodsmentioning

confidence: 99%

“…First, we tested for any effect of stimulation-group (1 Hz rTMS, sham TMS, 20 Hz rTMS) or/and session (Pre-TMS, Post-1-TMS, Post-2-TMS) on mFP-amygdala-FC using a 3 × 3 factorial mixed design ANOVA (MD-ANOVA; see also Donse et al, 2018). Second, we tested our main hypothesis, that is, that the three stimulation-groups Because the mFP is implicated in a variety of neuronal processes and shows FC with several brain regions, we also conducted an explorative whole brain analysis using a 3 × 2 factorial MD-ANOVA in SPM8 testing for the interaction between stimulation-group (1 Hz rTMS, sham TMS, 20 Hz rTMS) and session (Pre-TMS, Post-1-TMS; see Section 3.4).…”

Section: Subsequent Analyses Focused On Right-mfp-right-amygdala-fcmentioning

confidence: 99%

“…We followed this approach given that we were more confident to observe a disruptive effect (rather than an amplifying effect via 20 Hz rTMS to the left mFP). A recent study also showed no difference in anti‐depressive treatment effects when comparing high‐frequency left PFC rTMS to low‐frequency right PFC rTMS (Donse, Padberg, Sack, Rush, & Arns, ).…”

Section: Introductionmentioning

confidence: 97%

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Modulating functional connectivity between medial frontopolar cortex and amygdala by inhibitory and excitatory transcranial magnetic stimulation

Riedel

Heil

Bender

et al. 2019

Human Brain Mapping

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The prefrontal‐limbic network in the human brain plays a major role in social cognition, especially cognitive control of emotion. The medial frontopolar cortex (mFP; Brodmann Area 10) and the amygdala are part of this network and display correlated neuronal activity in time, as measured by functional magnetic resonance imaging (fMRI). This functional connectivity is dynamic, sensitive to training, and affected in mental disorders. However, the effects of neurostimulation on functional connectivity within this network have not yet been systematically investigated. Here, we investigate the effects of both low‐ and high‐frequency repetitive transcranial magnetic stimulation (rTMS) to the right mFP on functional connectivity between mFP and amygdala, as measured with resting state fMRI (rsfMRI). Three groups of healthy participants received either low‐frequency rTMS (1 Hz; N = 18), sham TMS (1 Hz, subthreshold; N = 18) or high‐frequency rTMS (20 Hz; N = 19). rsfMRI was acquired before and after (separate days). We hypothesized a modulation of functional connectivity in opposite directions compared to sham TMS through adjustment of the stimulation frequency. Groups differed in functional connectivity between mFP and amygdala after stimulation compared to before stimulation (low‐frequency: decrease, high‐frequency: increase). Motion or induced changes in neuronal activity were excluded as confounders. Results show that rTMS is effective for increasing and decreasing functional coherence between prefrontal and limbic regions. This finding is relevant for social and affective neuroscience as well as novel treatment approaches in psychiatry.

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Section: Methodsmentioning

confidence: 99%

Section: Subsequent Analyses Focused On Right-mfp-right-amygdala-fcmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

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Modulating functional connectivity between medial frontopolar cortex and amygdala by inhibitory and excitatory transcranial magnetic stimulation

Riedel

Heil

Bender

et al. 2019

Human Brain Mapping

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“…Response rates reached 66%, with no difference between rTMS modalities. 101 Regarding tDCS, a study in a rodent slice model showed that excitatory direct-current stimulation can strengthen cellular mechanisms thought to underlie learning and memory formation (long-term potentiation, LTP 102 ). Critically, this enhancement occurred only when stimulation was applied ''online,'' i.e., during LTP -there was no effect when the identical stimulation was applied ''offline,'' i.e., prior to LTP.…”

Section: Convulsive Modalitiesmentioning

confidence: 99%

Precision non-implantable neuromodulation therapies: a perspective for the depressed brain

Borrione

Bellini

Razza

et al. 2020

Braz. J. Psychiatry

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Current first-line treatments for major depressive disorder (MDD) include pharmacotherapy and cognitive-behavioral therapy. However, one-third of depressed patients do not achieve remission after multiple medication trials, and psychotherapy can be costly and time-consuming. Although nonimplantable neuromodulation (NIN) techniques such as transcranial magnetic stimulation, transcranial direct current stimulation, electroconvulsive therapy, and magnetic seizure therapy are gaining momentum for treating MDD, the efficacy of non-convulsive techniques is still modest, whereas use of convulsive modalities is limited by their cognitive side effects. In this context, we propose that NIN techniques could benefit from a precision-oriented approach. In this review, we discuss the challenges and opportunities in implementing such a framework, focusing on enhancing NIN effects via a combination of individualized cognitive interventions, using closed-loop approaches, identifying multimodal biomarkers, using computer electric field modeling to guide targeting and quantify dosage, and using machine learning algorithms to integrate data collected at multiple biological levels and identify clinical responders. Though promising, this framework is currently limited, as previous studies have employed small samples and did not sufficiently explore pathophysiological mechanisms Brazilian Psychiatric Association 0 0 0 0 0 0 0 0 -0 0 0 2 -7 3 1 6 -1 1 8 5 associated with NIN response and side effects. Moreover, cost-effectiveness analyses have not been performed. Nevertheless, further advancements in clinical trials of NIN could shift the field toward a more ''precision-oriented'' practice. DisclosureZ-DD is listed as inventor on patents/patent applications related to brain stimulation technology, assigned to Columbia University and NEVA Electromagnetics, not licensed, and with no remuneration. Although he is an employee of the U.S. government, the views expressed Braz J Psychiatry. 2020;00 (00) Precision NIN for depression

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“…Non-invasive brain stimulation (NIBS) strategies such as tDCS have exhibited promising effects in decreasing different psychiatric symptoms, either as a stand-alone or combined with pharmacotherapy and psychological interventions (10).…”

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confidence: 99%

Offline tDCS modulates prefrontal-cortical-subcortical-cerebellar fear pathways in delayed fear extinction

Ganho-Ávila

Guiomar

Valério

et al. 2019

Preprint

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Transcranial direct current stimulation (tDCS) has been studied as an add-on enhancer of extinction-based treatments for anxiety disorders. However, previous studies have failed to address one issue of translational significance: the to-be extinguished fear memory must be consolidated. Additionally, extant literature shows conflicting results about the anxiolytic effect of tDCS delivered to the right dorsolateral prefrontal cortex. To address these issues, we recruited thirty-four female participants to participate in a two-day fear conditioning procedure. On Day 1, laboratory fear acquisition was confirmed by self-reported contingency ratings. On Day 2, participants were randomly assigned to either the control group (n=18; completed the extinction session) or the tDCS group (n=16; whom received 20min tDCS session of 1mA [cathode -F4; anode -contralateral deltoid immediately before extinction).Functional magnetic resonance imagining data showed that tDCS modulates the late phase of the delayed extinction process. In particular, neural activity of the frontal middle cortex, the left frontal superior cortex, and the left and right paracentral and postcentral cortices is increased during the processing of the CS-, supporting the processing of uncertainty. Furthermore, during the processing of threat, tDCS leads to an increased information flow from the contralateral prefrontal cortex along the cortical-amygdalo-hippocampalcerebellar pathways. Thus, the boosted processing of uncertainty and the stronger coupling during threat processing might well be the mechanisms by which tDCS boosts stimuli discrimination, leading to decreased symptoms and enhanced clinical gains.Running head: Using tDCS to interfere with fear extinction Running head: Using tDCS to interfere with fear extinction of anxiety symptoms. According to this model, the fear response is elicited by environmental threats through an associative learning whereby the neutral stimulus (conditioned stimulus, CS+) is paired with an aversive stimulus (unconditioned stimulus, US) and a danger predicting value is assigned to it, eliciting the conditioned fear response (CR; 14). A deregulated fear response may lead to incorrect detection of danger and sustained anxiety-related symptoms (e.g. hyper-vigilance and excessive worrying). Thus, to eliminate the consolidated CR, extinction (the translational equivalent to exposure-based therapies) is implemented, consisting of consecutive presentations of the CS+ alone, leading to a new learning that inhibits the CS+/US association (18).By delivering tDCS to the right or left DLPFC to enhance fear extinction, researchers aimed to artificially modulate brain activity and decrease the fear response (19)(20)(21)(22). Counterintuitively, whereas previous studies have shown that tDCS using the anode electrode over the DLPFC leads to decreased fear, this gain was also associated with the adverse effect of decreasing stimuli discrimination (21,23). Differently, using the cathodal electrode over the DLPFC led to no effect in decreas...

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Simultaneous rTMS and psychotherapy in major depressive disorder: Clinical outcomes and predictors from a large naturalistic study

Cited by 134 publications

References 54 publications

Modulating functional connectivity between medial frontopolar cortex and amygdala by inhibitory and excitatory transcranial magnetic stimulation

Modulating functional connectivity between medial frontopolar cortex and amygdala by inhibitory and excitatory transcranial magnetic stimulation

Precision non-implantable neuromodulation therapies: a perspective for the depressed brain

Offline tDCS modulates prefrontal-cortical-subcortical-cerebellar fear pathways in delayed fear extinction

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