The Impact of Accelerated HF-rTMS on the Subgenual Anterior Cingulate Cortex in Refractory Unipolar Major Depression: Insights From 18FDG PET Brain Imaging.
BACKGROUND
Although one of the most frequent diagnosed mental illnesses worldwide, it appears to be challenging to successfully treat major depressive disorder (MDD). Although the phenomenon of treatment-resistant depression (TRD) still remains unclear, the subgenual anterior cingulate cortex (sgACC) has been put forward as a possible neurobiological marker to evaluate clinical effects of a variety of antidepressant treatments, including repetitive transcranial magnetic stimulation (rTMS). Accelerated high-frequency (HF)-rTMS may have the potential to rapidly result in beneficial clinical outcomes in TRD. No studies yet examined the clinical effects of such accelerated stimulation treatment paradigms on sgACC regional glucose metabolism (CMRglc), nor the predictive value of the latter for clinical outcome.


OBJECTIVE
First, we investigated the predictive value of baseline sgACC metabolic activity for clinical outcome. Second, we hypothesized that in clinical responders only accelerated HF-rTMS treatment would result in significant metabolic decreases.


METHODS
We recruited right-handed antidepressant-free unipolar melancholic TRD patients to participate in a two-week randomized sham-controlled crossover HF-rTMS treatment study. Stimulation was applied to the left dorsolateral prefrontal cortex (DLPFC). Fifteen patients underwent 18FDG PET (CMRglc) at baseline (T0), after the first week (T1) of accelerated HF-rTMS and at the end of the treatment after the second week (T2).


RESULTS
Higher baseline sgACC metabolic activity may indicate beneficial clinical outcome to this kind of accelerated HF-rTMS treatment. Moreover, clinical response resulted in a significant decrease in sgACC CMRglc. Non-response did not affect sgACC CMRglc.


CONCLUSIONS
Our results add to the sgACC as a specific neurobiological marker for anti-depressive response in accelerated HF-rTMS treatment paradigms. Such protocols may not only have the ability to result in fast clinical responses but they may also have potential to acutely modulate a dysfunctional sgACC.
Ghent University, Department of Psychiatry and Medical Psychology, Ghent, Belgium; Department of Psychiatry, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium; Ghent University, Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium. Electronic address: chris.baeken@UGent.be.
Chris
C
Baeken
Ghent University, Department of Data Analysis, Ghent, Belgium.
Daniele
D
Marinazzo
Department of Nuclear Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium.
Hendrik
H
Everaert
Ghent University, Department of Data Analysis, Ghent, Belgium; Key Laboratory of Cognition and Personality, Faculty of Psychology, Southwest University, Chongqing, China.
Guo-Rong
GR
Wu
iMinds Medical IT-IBiTech - MEDISIP, Department of Electronics and Information Systems, Ghent University, Ghent, Belgium.
Christian
C
Van Hove
Ghent University, Department of Psychiatry and Medical Psychology, Ghent, Belgium.
Kurt
K
Audenaert
Ghent University, Department of Nuclear Medicine, Ghent, Belgium.
Ingeborg
I
Goethals
Ghent University, Laboratory of Radiopharmacy, Faculty of Pharmaceutical Sciences, Ghent, Belgium.
Filip
F
De Vos
Ghent University, Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Faculty of Veterinary Medicine, Merelbeke, Belgium.
Kathelijne
K
Peremans
Ghent University, Department of Experimental Clinical and Health Psychology, Ghent, Belgium.
Rudi
R
De Raedt
D000928:Antidepressive Agents / Q000627:therapeutic use; D018592:Cross-Over Studies; D003865:Major Depressive Disorder / Q000378:metabolism / Q000628:therapy*; D061218:Depressive Disorder, Treatment-Resistant / Q000378:metabolism / Q000628:therapy*; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism*; D059907:Functional Neuroimaging; D006179:Gyrus Cinguli / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D017397:Prefrontal Cortex / Q000502:physiology; D050781:Transcranial Magnetic Stimulation / Q000379:methods; D016896:Treatment Outcome
D000928:Antidepressive Agents; D019788:Fluorodeoxyglucose F18
(18)FDG PET; CMRglc; HF-rTMS; Treatment-resistance; Unipolar major depression; sgACC