title: Cognition-Modulated Frontal Activity in Prediction and Augmentation of Antidepressant Efficacy: A Randomized Controlled Pilot Study.
abstract: Higher rostral anterior cingulate cortex (rACC) activity correlated with frontal theta power (frontalθ) is associated with better antidepressant responses. The antidepressant efficacy of repetitive transcranial magnetic stimulation (rTMS) varied widely; however, the effects of TMS might be modulated by manipulating the pretreatment neural states. Therefore, we conducted a pilot study to investigate whether manipulated frontalθ before rTMS treatment could predict and augment antidepressant responses. A computerized rACC-engaging cognitive task (RECT) was exploited continuously for 10 min to patients with major depressive disorder. In total, 36 patients were randomized to 3 groups (Group-A: RECT[active] + rTMS[active]; Group-B: RECT[sham] + rTMS[active]; Group-C: RECT[active] + rTMS[sham]). Frontalθ and whole-brain glucose uptakes were assessed. We found that the RECT-modulated increases in frontalθ correlated well with rACC glucose uptakes. The treatment responders demonstrated a significant increase in frontalθ after RECT. Post-RECT frontalθ had good sensitivity/specificity in predicting antidepressant responses to rTMS. Group-A had more reduction in total depression scores, had more responders, and was more likely to achieve remission than other groups (Group-A [41.6%] > Group-B [16.6%] > Group-C [0%], P < 0.05). A significant enhancement in the post-1st-rTMS frontalθ was observed in Group-A responders but not in Group-B responders, supporting the argument that RECT-modulated rTMS augmented rTMS efficacy. In conclusion, this study suggests that manipulating pre-rTMS neural activity could predict and augment antidepressant effects to rTMS treatment.
authors.affiliation: Department of Psychiatry Division of Psychiatry, Faculty of Medicine and.
authors.forename: Cheng-Ta
authors.initials: CT
authors.lastname: Li
authors.affiliation: Integrated Brain Research Unit, Department of Medical Research and Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Jen-Chuen
authors.initials: JC
authors.lastname: Hsieh
authors.affiliation: Department of Psychiatry.
authors.forename: Hsiang-Hsuan
authors.initials: HH
authors.lastname: Huang
authors.affiliation: Department of Psychiatry.
authors.forename: Mu-Hong
authors.initials: MH
authors.lastname: Chen
authors.affiliation: Institute of Cognitive Neuroscience, National Central University, Jhongli, Taiwan.
authors.forename: Chi-Hung
authors.initials: CH
authors.lastname: Juan
authors.affiliation: Department of Psychiatry Division of Psychiatry, Faculty of Medicine and.
authors.forename: Pei-Chi
authors.initials: PC
authors.lastname: Tu
authors.affiliation: Department of Psychiatry Division of Psychiatry, Faculty of Medicine and.
authors.forename: Ying-Chiao
authors.initials: YC
authors.lastname: Lee
authors.affiliation: Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Shyh-Jen
authors.initials: SJ
authors.lastname: Wang
authors.affiliation: Department of Psychiatry.
authors.forename: Chih-Ming
authors.initials: CM
authors.lastname: Cheng
authors.affiliation: Department of Psychiatry Division of Psychiatry, Faculty of Medicine and Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Tung-Ping
authors.initials: TP
authors.lastname: Su
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003071:Cognition / Q000187:drug effects*; D003863:Depression / Q000188:drug therapy*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006179:Gyrus Cinguli / Q000187:drug effects* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D017397:Prefrontal Cortex / Q000187:drug effects* / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents
keywords: anterior cingulate cortex; electroencephalography; major depression; positron emission tomography; repetitive transcranial magnetic stimulation; state-dependent; theta