HF-rTMS treatment in medication-resistant melancholic depression: results from 18FDG-PET brain imaging.
BACKGROUND
High frequency repetitive transcranial magnetic stimulation (HF-rTMS) of the left dorsolateral prefrontal cortex (DLPFC) might be a promising strategy to treat depression, but not all patients show a positive outcome.


OBJECTIVE
In this open study, we evaluate whether a favorable HF-rTMS treatment outcome could be predicted by baseline prefrontal brain glucose metabolism (CMRglc), measured by 18fluorodeoxyglucose positron emission tomography (18FDG-PET).


METHODS
A sample of 21 antidepressant-free, treatment-resistant depression (TRD) patients of the melancholic subtype received 10 sessions of HF-rTMS delivered on the left DLPFC. Patients underwent a static 18FDG-PET before and after HF-rTMS treatment.


RESULTS
Forty-three percent of the patients showed a reduction of at least 50% on their Hamilton Rating Scale for Depression scores. Higher baseline metabolic activities in the DLPFC and the anterior cingulate cortex (ACC) were associated with better clinical outcome. Successful HF-rTMS treatment was related to metabolic changes in subdivisions of the ACC (Brodmann areas 24 and 32).


CONCLUSIONS
This biological impact of HF-rTMS on regional brain CMRglc explains to some extent how HF-rTMS may improve moods in TRD patients. Larger sham-controlled HF-rTMS treatment studies are needed to confirm these results.
Baeken
Chris
C
Department of Psychiatry, University Hospital, Free University of Brussels, Belgium. chris.baeken@uzbrussel.be
De Raedt
Rudi
R
Van Hove
Christian
C
Clerinx
Peter
P
De Mey
Johan
J
Bossuyt
Axel
A
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging*; D003865:Major Depressive Disorder / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000628:therapy*; D004351:Drug Resistance; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome
D000928:Antidepressive Agents; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18