Comparisons of Accelerated Continuous and Intermittent Theta Burst Stimulation for Treatment-Resistant Depression and Suicidal Ideation

The Effectiveness of Transcranial Magnetic Stimulation in Suicidality: An Updated Systematic Review

Suicidal thoughts and behaviors (STB) have a substantial global burden, with over 14 million individuals attempting suicide annually. Existing biological therapies do not adequately reduce STB risk. Repetitive transcranial magnetic stimulation (rTMS) is an approved, non-invasive and low-risk treatment for several psychiatric disorders. Meta-analyses investigating TMS' effects on STB indicate therapeutic promise. Given the proliferation of TMS studies investigating its effect on STB, a repeat review of the literature is warranted.

Methods

A PRISMA-guided systematic review was conducted to evaluate the efficacy of rTMS in reducing STB. Studies assessing STB outcomes following rTMS to treat psychiatric disorders, either as monotherapy or adjunctive treatment, were included. Forty-five studies were identified (N=3515).

Results

Studies generally applied rTMS to treat primary psychiatric disorders, particularly depression, with change in suicidality evaluated as a secondary outcome. rTMS protocols differed across studies. Most studies targeted the left dorsolateral prefrontal cortex (dlPFC), although significant improvements to STB were also reported with rTMS targeting the visual cortex, right dlPFC and the bilateral PFC. High frequency rTMS and intermittent theta burst stimulation (iTBS) protocols were superior in reducing STB compared to other stimulation protocols, with studies reporting 40-100% treatment response rates. Adverse events (AEs) were mostly mild and transient.

Conclusion

rTMS appears to be a safe and effective treatment option for STB, with significant reductions observed, particularly when rTMS or iTBS is applied to the dlPFC. Mechanistically informed randomized controlled trials specifically designed to evaluate rTMS' treatment effects on STB are needed to validate this promising treatment approach.

Anxiolytic effects of accelerated continuous theta burst stimulation on mice exposed to chronic restraint stress and the underlying mechanism involving gut microbiota

BACKGROUND

Accelerated continuous theta burst stimulation (acTBS) is a more intensive and rapid protocol than continuous theta burst stimulation (cTBS). However, it remains uncertain whether acTBS exhibits anxiolytic effects. The aim of this study was to investigate the impact of acTBS on anxiety model mice and elucidate the underlying mechanisms involved, in order to provide a more comprehensive understanding of its effects.

METHODS

Chronic restraint stress (CRS) model was employed to observe the anxiolytic effects of acTBS. The study focused on evaluating the impact of acTBS on behavior, neuroinflammation, gut and gut microbiota in mice with anxiety induced by CRS.

RESULTS

The application of acTBS ameliorated anxiety-like behaviors in CRS-induced mice. Notably, it effectively suppressed the activation of microglia and reduced the level pro-inflammatory cytokines in PFC, hippocampus, and amygdala of anxiety mice. Additionally, acTBS alleviated astrocyte activation specifically in hippocampus. The NF-κB signaling pathway involved in the anti-inflammatory effects of acTBS. Furthermore, acTBS ameliorated inflammation and histological damage in colon. 16S rRNA analysis revealed that acTBS significantly enhanced the relative abundance of Lactobacillus, while normalized the dysregulated levels of Coriobacterales, Bacteroides, and Parabacteroides caused by CRS. These changes facilitated chemoheterotrophic and fermentation functions within the microbiota. Importantly, changes in microbiota composition influenced by acTBS was found to be correlated with anxiety-like behaviors and neuroinflammation.

CONCLUSIONS

acTBS exerted anxiolytic effects on mice exposed to CRS, which was associated with the modulation of gut microbiota.

Investigating the predictive models of efficacy of accelerated neuronavigation-guided rTMS for suicidal depression based on multimodal large-scale brain networks

Background

Accelerated neuronavigation-guided high-dose repetitive transcranial magnetic stimulation (NH-rTMS) can rapidly reduce suicidal ideation and alleviate depressive symptoms in one week. Exploring accelerated NH-rTMS-related biomarkers will enhance the precision of treatment decisions for patients with major depressive disorder (MDD). This study aimed to establish predictive models of treatment response to accelerated NH-rTMS in MDD based on multimodal large-scale brain networks.

Method

In this study, morphological, structural, and functional brain networks were constructed for untreated MDD patients with suicidal ideation before accelerated NH-rTMS treatment. Linear support vector regression methods were utilized to examine the ability of multimodal brain networks in predicting antidepressant and anti-suicidal effects of accelerated NH-rTMS.

Results

We found that both the morphological and structural networks predicted the percentage changes of total Beck Scale of Suicidal Ideation and 24-item Hamilton Depression Rating Scale (HAMD-24) scores. Additionally, the functional networks predicted the percentage changes of total HAMD-24 scores. Further analyses revealed that the structural networks outperformed the morphological and functional networks and the somatomotor module outperformed other subnetworks in the prediction.

Conclusions

In summary, our study provides brain connectome-based predictive models of treatment response to accelerated NH-rTMS in MDD patients with suicidal ideation.

Repetitive transcranial magnetic stimulation enhanced by neuronavigation in the treatment of depressive disorder and schizophrenia

This editorial assesses the advancements in neuronavigation enhanced repetitive transcranial magnetic stimulation for depressive disorder and schizophrenia treatment. Conventional repetitive transcranial magnetic stimulation faces challenges due to the intricacies of brain anatomy and patient variability. Neuronavigation offers innovative solutions by integrating neuroimaging with three-dimensional localization to pinpoint brain regions and refine therapeutic targeting. This systematic review of recent literature underscores the enhanced efficacy of neuronavigation in improving treatment outcomes for these disorders. This editorial highlights the pivotal role of neuronavigation in advancing psychiatric care.

Intermittent Preventive Treatment of Malaria in Pregnancy and the Impact on Neonates in African Countries as Assessed by Entropy Weight and TOPSIS Methods

Background/Objectives: In regions of Africa with a high prevalence of malaria, pregnant women in their first or second trimester should be administered intermittent preventive treatment in pregnancy (IPTp). However, infants may contract malaria despite the IPTp therapy that their mothers have received. The objective of the present investigation was to assess the symptoms and various treatments for neonatal malaria. Methods: Entropy weight and TOPSIS were used to achieve the study goal. The TOPSIS multi-attribute decision-making system was used to assess newborn malaria symptoms and select the optimal treatment, even for mothers receiving IPTp medication during pregnancy. The entropy weight approach calculated TOPSIS attribute weights. The present research used UNICEF data for 14 African nations in 2023. Results: The results indicated that neonates whose mothers received IPTp therapy ultimately contracted malaria, with diarrhea being the primary symptom. It is important to note that health providers administer a combination of zinc and oral rehydration solution (ORS) to infants as the most effective treatment for malaria symptoms, thereby abandoning the first-line treatment for malaria, artemisinin-based combination therapy (ACT). Conclusions: The most effective treatment for neonatal malaria is a combination of zinc and ORS, although less than half of children in Africa have access to ORS. Therefore, the findings of this study may encourage African countries to prioritize co-pack therapy in their procurement and supply, healthcare provider training, and expenditures. This therapy will also help alleviate the symptoms of malaria in neonates.