title: Frontostriatal Connectivity Changes in Major Depressive Disorder After Repetitive Transcranial Magnetic Stimulation: A Randomized Sham-Controlled Study.
abstract: The aim of this randomized, sham-controlled study was to investigate the therapeutic effects of underlying neurobiological changes after 2-week repetitive transcranial magnetic stimulation (rTMS) treatment using functional connectivity magnetic resonance imaging in patients with major depression.
  
  
  
  Twenty-four patients with major depressive disorder diagnosed with DSM-IV-TR criteria were randomly assigned to the active rTMS (n = 13) or sham (n = 11) groups from January 2009 to June 2011. rTMS was given for 2 weeks at 110% of the motor threshold for 10 minutes at 10 Hz over the left dorsolateral prefrontal cortex (DLPFC). Resting state functional connectivity was evaluated before and after rTMS. The 17-item Hamilton Depression Rating Scale (HDRS) was administered, and neurocognitive tasks were performed. We examined between-group differences in functional connectivity changes from the bilateral DLPFC.
  
  
  
  Participants in the active rTMS group showed significant clinical improvement in HDRS scores compared to those in the sham group (P < .001). After 2-week rTMS, there were significant differences in changes in DLPFC-left caudate connectivity (corrected P < .05): the active group showed a greater reduction of connectivity strength between the DLPFC and left caudate compared to the sham group. Reduced levels of DLPFC-left caudate connectivity predicted improvement in depressive symptoms (r = 0.58, P = .001). Additionally, a positive correlation between residual depressive symptoms and connectivity strength after 2-week rTMS was found (r = 0.46, P = .023).
  
  
  
  High-frequency rTMS over the left DLPFC showed therapeutic effects in patients with major depression. The therapeutic effect of rTMS is related to the modulation of functional connectivity in the frontostriatal network.
  
  
  
  ClinicalTrials.gov identifier: NCT01325831​.
authors.affiliation: Institute of Behavioral Science in Medicine & Department of Psychiatry, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Jee In
authors.initials: JI
authors.lastname: Kang
authors.affiliation: Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, South Korea.
authors.forename: Hyeongrae
authors.initials: H
authors.lastname: Lee
authors.affiliation: Department of Adolescent Psychiatry, Seoul National Hospital, Seoul, South Korea.
authors.forename: Kyungun
authors.initials: K
authors.lastname: Jhung
authors.affiliation: Institute of Behavioral Science in Medicine & Department of Psychiatry, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Kyung Ran
authors.initials: KR
authors.lastname: Kim
authors.affiliation: Institute of Behavioral Science in Medicine & Department of Psychiatry, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Suk Kyoon
authors.initials: SK
authors.lastname: An
authors.affiliation: Department of Neurosurgery, St Peter's Hospital, Seoul, South Korea.
authors.forename: Kang-Jun
authors.initials: KJ
authors.lastname: Yoon
authors.affiliation: Department of Biomedical Engineering, Hanyang University, Seoul, South Korea.
authors.forename: Sun I
authors.initials: SI
authors.lastname: Kim
authors.affiliation: Institute of Behavioral Science in Medicine & Department of Psychiatry, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Kee
authors.initials: K
authors.lastname: Namkoong
authors.affiliation: Department of Psychiatry, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, Seoul 03722, South Korea. leeeun@yuhs.ac.|Institute of Behavioral Science in Medicine & Department of Psychiatry, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Eun
authors.initials: E
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D002421:Caudate Nucleus / Q000503:physiopathology*; D063132:Connectome / Q000379:methods*; D003865:Major Depressive Disorder / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017397:Prefrontal Cortex / Q000503:physiopathology*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D055815:Young Adult