title: Resting-state cortico-thalamic-striatal connectivity predicts response to dorsomedial prefrontal rTMS in major depressive disorder.
abstract: Despite its high toll on society, there has been little recent improvement in treatment efficacy for major depressive disorder (MDD). The identification of biological markers of successful treatment response may allow for more personalized and effective treatment. Here we investigate whether resting-state functional connectivity predicted response to treatment with repetitive transcranial magnetic stimulation (rTMS) to dorsomedial prefrontal cortex (dmPFC). Twenty-five individuals with treatment-refractory MDD underwent a 4-week course of dmPFC-rTMS. Before and after treatment, subjects received resting-state functional MRI scans and assessments of depressive symptoms using the Hamilton Depresssion Rating Scale (HAMD17). We found that higher baseline cortico-cortical connectivity (dmPFC-subgenual cingulate and subgenual cingulate to dorsolateral PFC) and lower cortico-thalamic, cortico-striatal, and cortico-limbic connectivity were associated with better treatment outcomes. We also investigated how changes in connectivity over the course of treatment related to improvements in HAMD17 scores. We found that successful treatment was associated with increased dmPFC-thalamic connectivity and decreased subgenual cingulate cortex-caudate connectivity, Our findings provide insight into which individuals might respond to rTMS treatment and the mechanisms through which these treatments work.
authors.affiliation: 1] MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto, ON, Canada [2] Department of Psychiatry, University Health Network, Toronto, ON, Canada [3] School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.
authors.forename: Tim V
authors.initials: TV
authors.lastname: Salomons
authors.affiliation: 1] MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto, ON, Canada [2] Faculty of Arts and Sciences, University of Toronto, Toronto, ON, Canada.
authors.forename: Katharine
authors.initials: K
authors.lastname: Dunlop
authors.affiliation: 1] Department of Psychiatry, University Health Network, Toronto, ON, Canada [2] Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
authors.forename: Sidney H
authors.initials: SH
authors.lastname: Kennedy
authors.affiliation: 1] Department of Psychiatry, University Health Network, Toronto, ON, Canada [2] Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
authors.forename: Alastair
authors.initials: A
authors.lastname: Flint
authors.affiliation: 1] Department of Psychiatry, University Health Network, Toronto, ON, Canada [2] Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada.
authors.forename: Joseph
authors.initials: J
authors.lastname: Geraci
authors.affiliation: 1] MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto, ON, Canada [2] Department of Psychiatry, University Health Network, Toronto, ON, Canada [3] Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Giacobbe
authors.affiliation: 1] MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto, ON, Canada [2] Department of Psychiatry, University Health Network, Toronto, ON, Canada [3] Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Downar
mesh_terms: D000328:Adult; D000368:Aged; D003342:Corpus Striatum / Q000502:physiology*; D003865:Major Depressive Disorder / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009415:Nerve Net / Q000502:physiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D017397:Prefrontal Cortex / Q000502:physiology*; D012146:Rest / Q000502:physiology*; D013788:Thalamus / Q000502:physiology*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult