title: rTMS treatment for depression in Parkinson's disease increases BOLD responses in the left prefrontal cortex.
abstract: The mechanisms underlying the effects of antidepressant treatment in patients with Parkinson's disease (PD) are unclear. The neural changes after successful therapy investigated by neuroimaging methods can give insights into the mechanisms of action related to a specific treatment choice. To study the mechanisms of neural modulation of repetitive transcranial magnetic stimulation (rTMS) and fluoxetine, 21 PD depressed patients were randomized into only two active treatment groups for 4 wk: active rTMS over left dorsolateral prefrontal cortex (DLPFC) (5 Hz rTMS; 120% motor threshold) with placebo pill and sham rTMS with fluoxetine 20 mg/d. Event-related functional magnetic resonance imaging (fMRI) with emotional stimuli was performed before and after treatment - in two sessions (test and re-test) at each time-point. The two groups of treatment had a significant, similar mood improvement. After rTMS treatment, there were brain activity decreases in left fusiform gyrus, cerebellum and right DLPFC and brain activity increases in left DLPFC and anterior cingulate gyrus compared to baseline. In contrast, after fluoxetine treatment, there were brain activity increases in right premotor and right medial prefrontal cortex. There was a significant interaction effect between groups vs. time in the left medial prefrontal cortex, suggesting that the activity in this area changed differently in the two treatment groups. Our findings show that antidepressant effects of rTMS and fluoxetine in PD are associated with changes in different areas of the depression-related neural network.
authors: NIF, LIM-44, Department of Radiology, University of São Paulo, São Paulo, Brazil. lim@usp.br
authors: Ellison Fernando
authors: EF
authors: Cardoso
authors: Felipe
authors: F
authors: Fregni
authors: Fernanda
authors: F
authors: Martins Maia
authors: Paulo S
authors: PS
authors: Boggio
authors: Martin
authors: M
authors: Luis Myczkowski
authors: Karen
authors: K
authors: Coracini
authors: Adriana
authors: A
authors: Lopes Vieira
authors: Luciano M
authors: LM
authors: Melo
authors: João R
authors: JR
authors: Sato
authors: Marco
authors: M
authors: Antonio Marcolin
authors: Sergio P
authors: SP
authors: Rigonatti
authors: Antonio Cesário
authors: AC
authors: Cruz
authors: Egberto
authors: E
authors: Reis Barbosa
authors: Edson
authors: E
authors: Amaro
mesh_terms: D000339:Affect / Q000187:drug effects; D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D001931:Brain Mapping / Q000379:methods*; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D004644:Emotions / Q000187:drug effects; D005071:Evoked Potentials; D005473:Fluoxetine / Q000627:therapeutic use*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy; D017397:Prefrontal Cortex / Q000187:drug effects* / Q000503:physiopathology; D011569:Psychiatric Status Rating Scales; D013997:Time Factors; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome
chemical_list: D018687:Antidepressive Agents, Second-Generation; D005473:Fluoxetine