Pre-treatment anterior cingulate activity as a predictor of antidepressant response to repetitive transcranial magnetic stimulation (rTMS).
OBJECTIVE
Repetitive transcranial magnetic stimulation (rTMS) is a brain stimulation technique which has received increasing attention as an antidepressant treatment. However available studies are characterized by a substantial variability in response. We hypothesized that individual patients' characteristics might contribute to such heterogeneity. Therefore we investigated whether either alterations of regional cerebral blood flow (rCBF) or clinical characteristics may predict antidepressant response to rTMS.


METHODS
24 patients with major depression and stable medication received high frequency (10 Hz) rTMS over the left dorsolateral prefrontal cortex (DLPFC) for two weeks as add-on treatment. ECD-Single photon emission computed tomographay (SPECT) imaging was performed 1 to 2 days before rTMS.


METHODS
Tertial referral center


RESULTS
After two weeks of rTMS a mean reduction of 30% of the initial Hamilton Depression Rating Score (HAMD) was observed. Using a multivariate regression model with simultaneous evaluation of the relative impact of a-priori chosen potential factors influencing treatment outcome, two variables, the pretreatment anterior cingulate rCBF and the former response to antidepressant agents proved significant. High pretreatment anterior cingulate activity and low treatment resistance to pharmacologic therapy were positive predictors for treatment response to rTMS.


CONCLUSIONS
Pretreatment anterior cingulate activity seems to be a useful prognostic marker of rTMS treatment response, which is in line with other treatment strategies, like sleep deprivation, electroconvulsive therapy or antidepressant medication.
Langguth
Berthold
B
Department of Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Germany. Berthold.Langguth@medbo.de
Wiegand
Rainer
R
Kharraz
Alexander
A
Landgrebe
Michael
M
Marienhagen
Jorg
J
Frick
Ulrich
U
Hajak
Goran
G
Eichhammer
Peter
P
D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D002560:Cerebrovascular Circulation / Q000187:drug effects / Q000528:radiation effects; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000628:therapy*; D005260:Female; D007839:Functional Laterality; D006179:Gyrus Cinguli / Q000098:blood supply / Q000187:drug effects / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011237:Predictive Value of Tests; D017397:Prefrontal Cortex / Q000098:blood supply / Q000187:drug effects / Q000503:physiopathology; D016037:Single-Blind Method; D015899:Tomography, Emission-Computed, Single-Photon; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome
D000928:Antidepressive Agents