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Lam RW, Kennedy SH, Adams C, Bahji A, Beaulieu S, Bhat V, Blier P, Blumberger DM, Brietzke E, Chakrabarty T, Do A, Frey BN, Giacobbe P, Gratzer D, Grigoriadis S, Habert J, Ishrat Husain M, Ismail Z, McGirr A, McIntyre RS, Michalak EE, Müller DJ, Parikh SV, Quilty LS, Ravindran AV, Ravindran N, Renaud J, Rosenblat JD, Samaan Z, Saraf G, Schade K, Schaffer A, Sinyor M, Soares CN, Swainson J, Taylor VH, Tourjman SV, Uher R, van Ameringen M, Vazquez G, Vigod S, Voineskos D, Yatham LN, Milev RV. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 Update on Clinical Guidelines for Management of Major Depressive Disorder in Adults: Réseau canadien pour les traitements de l'humeur et de l'anxiété (CANMAT) 2023 : Mise à jour des lignes directrices cliniques pour la prise en charge du trouble dépressif majeur chez les adultes. Can J Psychiatry 2024:7067437241245384. [PMID: 38711351 DOI: 10.1177/07067437241245384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
BACKGROUND The Canadian Network for Mood and Anxiety Treatments (CANMAT) last published clinical guidelines for the management of major depressive disorder (MDD) in 2016. Owing to advances in the field, an update was needed to incorporate new evidence and provide new and revised recommendations for the assessment and management of MDD in adults. METHODS CANMAT convened a guidelines editorial group comprised of academic clinicians and patient partners. A systematic literature review was conducted, focusing on systematic reviews and meta-analyses published since the 2016 guidelines. Recommendations were organized by lines of treatment, which were informed by CANMAT-defined levels of evidence and supplemented by clinical support (consisting of expert consensus on safety, tolerability, and feasibility). Drafts were revised based on review by patient partners, expert peer review, and a defined expert consensus process. RESULTS The updated guidelines comprise eight primary topics, in a question-and-answer format, that map a patient care journey from assessment to selection of evidence-based treatments, prevention of recurrence, and strategies for inadequate response. The guidelines adopt a personalized care approach that emphasizes shared decision-making that reflects the values, preferences, and treatment history of the patient with MDD. Tables provide new and updated recommendations for psychological, pharmacological, lifestyle, complementary and alternative medicine, digital health, and neuromodulation treatments. Caveats and limitations of the evidence are highlighted. CONCLUSIONS The CANMAT 2023 updated guidelines provide evidence-informed recommendations for the management of MDD, in a clinician-friendly format. These updated guidelines emphasize a collaborative, personalized, and systematic management approach that will help optimize outcomes for adults with MDD.
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Affiliation(s)
- Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Camelia Adams
- Department of Psychiatry, University of Saskatchewan, Saskatoon, SK, Canada
| | - Anees Bahji
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Serge Beaulieu
- Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Venkat Bhat
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Pierre Blier
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | | | - Elisa Brietzke
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Trisha Chakrabarty
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - André Do
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Peter Giacobbe
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - David Gratzer
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Jeffrey Habert
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - M Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Zahinoor Ismail
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Alexander McGirr
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Erin E Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Daniel J Müller
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbour, MI, USA
| | - Lena S Quilty
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nisha Ravindran
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Johanne Renaud
- Department of Psychiatry, McGill University, Montréal, QC, Canada
| | | | - Zainab Samaan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Gayatri Saraf
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Kathryn Schade
- Office of Research Services, Huron University, London, ON, Canada
| | - Ayal Schaffer
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Mark Sinyor
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Claudio N Soares
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Jennifer Swainson
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Valerie H Taylor
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Smadar V Tourjman
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Michael van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Gustavo Vazquez
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Simone Vigod
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Daphne Voineskos
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Roumen V Milev
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
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Men X, Taylor ZL, Marshe VS, Blumberger DM, Karp JF, Kennedy JL, Lenze EJ, Reynolds CF, Stefan C, Mulsant BH, Ramsey LB, Müller DJ. CYP2D6 Phenotype Influences Pharmacokinetic Parameters of Venlafaxine: Results from a Population Pharmacokinetic Model in Older Adults with Depression. Clin Pharmacol Ther 2024; 115:1065-1074. [PMID: 38284409 DOI: 10.1002/cpt.3162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/07/2023] [Indexed: 01/30/2024]
Abstract
In this study, we aimed to improve upon a published population pharmacokinetic (PK) model for venlafaxine (VEN) in the treatment of depression in older adults, then investigate whether CYP2D6 metabolizer status affected model-estimated PK parameters of VEN and its active metabolite O-desmethylvenlafaxine. The model included 325 participants from a clinical trial in which older adults with depression were treated with open-label VEN (maximum 300 mg/day) for 12 weeks and plasma levels of VEN and O-desmethylvenlafaxine were assessed at weeks 4 and 12. We fitted a nonlinear mixed-effect PK model using NONMEM to estimate PK parameters for VEN and O-desmethylvenlafaxine adjusted for CYP2D6 metabolizer status and age. At both lower doses (up to 150 mg/day) and higher doses (up to 300 mg/day), CYP2D6 metabolizers impacted PK model-estimated VEN clearance, VEN exposure, and active moiety (VEN + O-desmethylvenlafaxine) exposure. Specifically, compared with CYP2D6 normal metabolizers, (i) CYP2D6 ultra-rapid metabolizers had higher VEN clearance; (ii) CYP2D6 intermediate metabolizers had lower VEN clearance; (iii) CYP2D6 poor metabolizers had lower VEN clearance, higher VEN exposure, and higher active moiety exposure. Overall, our study showed that including a pharmacogenetic factor in a population PK model could increase model fit, and this improved model demonstrated how CYP2D6 metabolizer status affected VEN-related PK parameters, highlighting the importance of genetic factors in personalized medicine.
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Affiliation(s)
- Xiaoyu Men
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Zachary L Taylor
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Victoria S Marshe
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - Daniel M Blumberger
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Jordan F Karp
- Department of Psychiatry, The University of Arizona College of Medicine, Tucson, Arizona, USA
| | - James L Kennedy
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Eric J Lenze
- Department of Psychiatry, Washington University, St. Louis, Missouri, USA
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Cristiana Stefan
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Clinical Laboratory and Diagnostic Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Benoit H Mulsant
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Laura B Ramsey
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Research in Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Daniel J Müller
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Das S, Zomorrodi R, Kirkovski M, Hill AT, Enticott PG, Blumberger DM, Rajji TK, Desarkar P. Atypical alpha band microstates produced during eyes-closed resting state EEG in autism. Prog Neuropsychopharmacol Biol Psychiatry 2024; 131:110958. [PMID: 38309329 DOI: 10.1016/j.pnpbp.2024.110958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/05/2024]
Abstract
Electroencephalogram (EEG) microstates, which represent quasi-stable patterns of scalp topography, are a promising tool that has the temporal resolution to study atypical spatial and temporal networks in autism spectrum disorder (ASD). While current literature suggests microstates are atypical in ASD, their clinical utility, i.e., relationship with the core behavioural characteristics of ASD, is not fully understood. The aim of this study was to examine microstate parameters in ASD, and examine the relationship between these parameters and core behavioural characteristics in ASD. We compared duration, occurrence, coverage, global explained variance percentage, global field power and spatial correlation of EEG microstates between autistic and neurotypical (NT) adults. Modified k-means cluster analysis was used on eyes-closed, resting state EEG from 30 ASD (10 females, 28.97 ± 9.34 years) and 30 age-equated NT (13 females, 29.33 ± 8.88 years) adults. Five optimal microstates, A to E, were selected to best represent the data. Five microstate maps explaining 80.44% of the NT and 78.44% of the ASD data were found. The ASD group was found to have atypical parameters of microstate A, C, D, and E. Of note, all parameters of microstate C in the ASD group were found to be significantly less than NT. While parameters of microstate D, and E were also found to significantly correlate with subscales of the Ritvo Autism Asperger Diagnostic Scale - Revised (RAADS-R), these findings did not survive a Bonferroni Correction. These findings, in combination with previous findings, highlight the potential clinical utility of EEG microstates and indicate their potential value as a neurophysiologic marker that can be further studied.
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Affiliation(s)
- Sushmit Das
- Centre for Addiction and Mental Health, Toronto, Canada; Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Reza Zomorrodi
- Centre for Addiction and Mental Health, Toronto, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Melissa Kirkovski
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia; Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Aron T Hill
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia; Department of Psychiatry, Central Clinical School, Monash University, Melbourne, Australia
| | - Peter G Enticott
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia
| | - Daniel M Blumberger
- Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Tarek K Rajji
- Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Toronto Dementia Research Alliance, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Pushpal Desarkar
- Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada.
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Chen X, Blumberger DM, Downar J, Middleton VJ, Monira N, Bowman J, Kriske J, Kriske J, Donachie N, Kaster TS. Depressive symptom trajectories with prolonged rTMS treatment. Brain Stimul 2024; 17:525-532. [PMID: 38641170 DOI: 10.1016/j.brs.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/05/2024] [Accepted: 04/15/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND A prolonged repetitive transcranial magnetic stimulation (rTMS) treatment course could be beneficial for some patients experiencing major depressive episodes (MDE). We identified trajectories of rTMS response in depressive patients who received an extended rTMS treatment course and sought to determine which trajectories achieved the greatest benefit with a prolonged treatment course. METHOD We applied group-based trajectory modeling to a naturalistic dataset of depressive patients receiving a prolonged course of sequential bilateral rTMS (up to 51 treatment sessions) to the dorsolateral prefrontal cortex. Trajectories of the PHQ-9 with extended treatment courses were characterized, and we explored the association between baseline clinical characteristics and group membership using multinomial logistic regression. RESULTS Among the 324 study participants, four trajectories were identified: "linear response, extended course" (N = 73; 22.5 %); "nonresponse" (N = 23; 7.1 %); "slowed response" (N = 159; 49.1 %); "rapid response, standard treatment length" (N = 69; 21.3 %). Only the "linear response, extended course" group showed considerable clinical improvement after receiving additional rTMS treatments. Greater baseline depressive symptoms were associated with linear response and non-response. CONCLUSION Our results confirmed the distinctive response trajectories in depressive patients receiving rTMS and further highlighted that prolonged rTMS treatment courses may be beneficial for a subset of patients with higher initial symptom levels and linear early treatment response.
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Affiliation(s)
- Xiao Chen
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, 100101, China; Temerty Centre for Therapeutic Brain Intervention, Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, M6J1H4, Ontario, Canada; Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100049, China; Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China; International Big-Data Center for Depression Research, Chinese Academy of Sciences, Beijing, 100101, China
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, M6J1H4, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, M5T1R8, Ontario, Canada
| | - Jonathan Downar
- Temerty Centre for Therapeutic Brain Intervention, Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, M6J1H4, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, M5T1R8, Ontario, Canada
| | | | - Naima Monira
- Salience Health Solutions, Plano, 75024, Texas, USA
| | | | | | - John Kriske
- Salience Health Solutions, Plano, 75024, Texas, USA
| | | | - Tyler S Kaster
- Temerty Centre for Therapeutic Brain Intervention, Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, M6J1H4, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, M5T1R8, Ontario, Canada.
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Ibrahim C, Tang VM, Blumberger DM, Le Foll B. Abandon du tabagisme au moyen de la stimulation magnétique transcrânienne répétitive. CMAJ 2024; 196:E497-E500. [PMID: 38621778 PMCID: PMC11019607 DOI: 10.1503/cmaj.230806-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Affiliation(s)
- Christine Ibrahim
- Laboratoire de recherche translationnelle sur les dépendances (Ibrahim, Le Foll) et Division des dépendances (Tang), Institut de recherche en santé mentale de la famille Campbell, Centre de toxicomanie et de santé mentale; Département de psychiatrie (Tang, Blumberger), Faculté de médecine Temerty, Université de Toronto; Centre Temerty d'intervention cérébrale thérapeutique (Blumberger), Institut de recherche en santé mentale de la famille Campbell, Centre de toxicomanie et de santé mentale; Département de pharmacologie (Le Foll), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont
| | - Victor M Tang
- Laboratoire de recherche translationnelle sur les dépendances (Ibrahim, Le Foll) et Division des dépendances (Tang), Institut de recherche en santé mentale de la famille Campbell, Centre de toxicomanie et de santé mentale; Département de psychiatrie (Tang, Blumberger), Faculté de médecine Temerty, Université de Toronto; Centre Temerty d'intervention cérébrale thérapeutique (Blumberger), Institut de recherche en santé mentale de la famille Campbell, Centre de toxicomanie et de santé mentale; Département de pharmacologie (Le Foll), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont
| | - Daniel M Blumberger
- Laboratoire de recherche translationnelle sur les dépendances (Ibrahim, Le Foll) et Division des dépendances (Tang), Institut de recherche en santé mentale de la famille Campbell, Centre de toxicomanie et de santé mentale; Département de psychiatrie (Tang, Blumberger), Faculté de médecine Temerty, Université de Toronto; Centre Temerty d'intervention cérébrale thérapeutique (Blumberger), Institut de recherche en santé mentale de la famille Campbell, Centre de toxicomanie et de santé mentale; Département de pharmacologie (Le Foll), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont
| | - Bernard Le Foll
- Laboratoire de recherche translationnelle sur les dépendances (Ibrahim, Le Foll) et Division des dépendances (Tang), Institut de recherche en santé mentale de la famille Campbell, Centre de toxicomanie et de santé mentale; Département de psychiatrie (Tang, Blumberger), Faculté de médecine Temerty, Université de Toronto; Centre Temerty d'intervention cérébrale thérapeutique (Blumberger), Institut de recherche en santé mentale de la famille Campbell, Centre de toxicomanie et de santé mentale; Département de pharmacologie (Le Foll), Faculté de médecine Temerty, Université de Toronto, Toronto, Ont.
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Antal A, Ganho-Ávila A, Assecondi S, Barbour T, Bjekić J, Blumberger DM, Bolognini N, Brunelin J, Chanes L, Dale M, Dubbioso R, D'Urso G, Filipcic I, Filipović SR, Hirnstein M, Konings F, Langguth B, Leocani L, Sorkhabi MM, Mulder M, Nikander M, Nowak R, Oliviero A, Onarheim B, O'Shea J, Pallanti S, Rachid F, Rajão-Saraiva J, Rossi S, Sack AT, Sauvaget A, van der Scheer R, Schellhorn K, Soria-Frisch A, Szekely D, Tankisi H, Cj Taylor P, Tendolkar I, Uusitalo S, Baeken C. The consequences of the new European reclassification of non-invasive brain stimulation devices and the medical device regulations pose an existential threat to research and treatment: An invited opinion paper. Clin Neurophysiol 2024:S1388-2457(24)00118-4. [PMID: 38679530 DOI: 10.1016/j.clinph.2024.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 05/01/2024]
Abstract
A significant amount of European basic and clinical neuroscience research includes the use of transcranial magnetic stimulation (TMS) and low intensity transcranial electrical stimulation (tES), mainly transcranial direct current stimulation (tDCS). Two recent changes in the EU regulations, the introduction of the Medical Device Regulation (MDR) (2017/745) and the Annex XVI have caused significant problems and confusions in the brain stimulation field. The negative consequences of the MDR for non-invasive brain stimulation (NIBS) have been largely overlooked and until today, have not been consequently addressed by National Competent Authorities, local ethical committees, politicians and by the scientific communities. In addition, a rushed bureaucratic decision led to seemingly wrong classification of NIBS products without an intended medical purpose into the same risk group III as invasive stimulators. Overregulation is detrimental for any research and for future developments, therefore researchers, clinicians, industry, patient representatives and an ethicist were invited to contribute to this document with the aim of starting a constructive dialogue and enacting positive changes in the regulatory environment.
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Affiliation(s)
- Andrea Antal
- Department of Neurology, University Medical Center Göttingen, Göttingen. Germany.
| | - Ana Ganho-Ávila
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Sara Assecondi
- Centre for Mind/Brain Sciences - CIMeC, University of Trento, Rovereto (TN), Italy
| | - Tracy Barbour
- Massachusetts General Hospital, Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Jovana Bjekić
- University of Belgrade, Institute for Medical Research, Human Neuroscience Group and Centre for Neuroscience and Neuromodulation Belgrade, Serbia
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nadia Bolognini
- Department of Psychology, University of Milano Bicocca, and Laboratory of Neuropsychology, IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - Jerome Brunelin
- CH Le Vinatier, Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL, Bron, France
| | - Lorena Chanes
- Department of Clinical and Health Psychology-Institute of Neurosciences, Universitat Autònoma de Barcelona, Barcelone, Spain
| | - Matthew Dale
- Magstim, Spring Gardens, Whitland, Carmarthenshire, SA34 0HR, UK
| | - Raffaele Dubbioso
- Neurophysiology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples, Naples, Italy
| | - Giordano D'Urso
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | | | - Saša R Filipović
- University of Belgrade, Institute for Medical Research, Human Neuroscience Group and Centre for Neuroscience and Neuromodulation, Belgrade, Serbia
| | - Marco Hirnstein
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Femke Konings
- Independent expert by experience contributor, Amsterdam, the Netherlands
| | - Berthold Langguth
- Chair of the German Society for Brain Stimulation in Psychiatry, Department of Psychiatry and Psychotherapy, Bezirksklinikum, University of Regensburg, Germany
| | - Letizia Leocani
- Experimental Neurophysiology Unit, Institute of Experimental Neurology-INSPE, San Raffaele Scientific Institute, Milan, Italy; Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Marc Mulder
- Independent expert by experience contributor, The Hague, the Netherlands
| | | | | | - Antonio Oliviero
- FENNSI Group, Hospital Nacional de PArapléjicos, SESCAM, Toledo, Spain; Center for Clinical Neuroscience - Hospital "Los Madroños", Brunete (Madrid), Spain
| | - Balder Onarheim
- School of Psychology and Humanities, University of Central Lancashire, U.K
| | | | - Stefano Pallanti
- Istituto di Neuroscienze (Italy) and Albert Einstein College of Medicine (NY. USA) Chair of ECNP Network on Neuromodulation
| | - Fady Rachid
- Private Practice, 7, place de la Fusterie, 1204, Geneva, Switzerland
| | | | - Simone Rossi
- Siena Brain Investigation and Neuromodulation Lab (SiBIN Lab), Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Alexander T Sack
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University (UM); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Brain+Nerve Centre, Maastricht University Medical Center (MUMC+), Center for Integrative Neuroscience (CIN), the Netherlands
| | - Anne Sauvaget
- Department of Psychiatry, University Hospital of Nantes, France
| | - Rik van der Scheer
- Independent Patient Representative Advisor in Adult, Child & Adolescent Psychiatry, Venlo, the Netherlands
| | | | | | - David Szekely
- Deputy Head of Neuromodulation Unit of Princess Grace Hospital Centre, Monaco
| | - Hatice Tankisi
- Head of the Europa, Middle East, Africa Chapter of the International Federation of Clinical Neurophysiology, Department of Clinical Neurophysiology, Aarhus University Hospital and Department of Clinical Institute, Aarhus University, Aarhus, Denmark
| | | | - Indira Tendolkar
- Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Radboud University Nijmegen, Netherlands
| | | | - Chris Baeken
- Department of Head and Skin - Psychiatry and Medical Psychology, Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium; Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Psychiatry, Brussels, Belgium; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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Siddiqi SH, Klingbeil J, Webler R, Kratter IH, Blumberger DM, Fox MD, George MS, Grafman JH, Pascual-Leone A, Pines AR, Richardson RM, Talati P, Vila-Rodriguez F, Downar J, Hershey T, Black KJ. Causal network localization of brain stimulation targets for trait anxiety. Res Sq 2024:rs.3.rs-4221074. [PMID: 38659844 PMCID: PMC11042390 DOI: 10.21203/rs.3.rs-4221074/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS) can treat some neuropsychiatric disorders, but there is no consensus approach for identifying new targets. We localized causal circuit-based targets for anxiety that converged across multiple natural experiments. Lesions (n=451) and TMS sites (n=111) that modify anxiety mapped to a common normative brain circuit (r=0.68, p=0.01). In an independent dataset (n=300), individualized TMS site connectivity to this circuit predicted anxiety change (p=0.02). Subthalamic DBS sites overlapping the circuit caused more anxiety (n=74, p=0.006), thus demonstrating a network-level effect, as the circuit was derived without any subthalamic sites. The circuit was specific to trait versus state anxiety in datasets that measured both (p=0.003). Broadly, this illustrates a pathway for discovering novel circuit-based targets across neuropsychiatric disorders.
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Affiliation(s)
- Shan H. Siddiqi
- Center for Brain Circuit Therapeutics, Brigham & Women’s Hospital, Boston, MA
- Department of Psychiatry, Harvard Medical School
| | | | - Ryan Webler
- Center for Brain Circuit Therapeutics, Brigham & Women’s Hospital, Boston, MA
- Department of Psychiatry, Harvard Medical School
| | - Ian H. Kratter
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Daniel M. Blumberger
- Department of Psychiatry, University of Toronto
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON
| | - Michael D. Fox
- Center for Brain Circuit Therapeutics, Brigham & Women’s Hospital, Boston, MA
- Department of Psychiatry, Harvard Medical School
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Mark S. George
- Department of Psychiatry, Medical University of South Carolina
- Ralph H. Johnson Veterans Affairs Hospital
| | - Jordan H. Grafman
- Shirley Ryan AbilityLab
- Northwestern University Feinberg School of Medicine
| | - Alvaro Pascual-Leone
- Department of Neurology, Harvard Medical School, Boston, MA, USA
- Hinda and Arthur Marcus Institute for Aging Research; Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Boston, MA, USA
| | - Andrew R. Pines
- Center for Brain Circuit Therapeutics, Brigham & Women’s Hospital, Boston, MA
- Department of Psychiatry, Harvard Medical School
| | - R. Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital
- Department of Neurosurgery, Harvard Medical School
| | - Pratik Talati
- Department of Neurosurgery, Massachusetts General Hospital
- Department of Neurosurgery, Harvard Medical School
| | - Fidel Vila-Rodriguez
- Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry and School of Biomedical Engineering, University of British Columbia
| | | | - Tamara Hershey
- Departments of Psychiatry, Radiology, Neurology and Neuroscience, Washington University School of Medicine
| | - Kevin J. Black
- Departments of Psychiatry, Radiology, Neurology and Neuroscience, Washington University School of Medicine
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8
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Ngoy A, Tang VM, Xiao K, Blumberger DM, George TP, Gowin JL, Le Foll B, Sloan ME. Neuromodulation for Cannabis Use: A Scoping Review. Brain Sci 2024; 14:356. [PMID: 38672008 PMCID: PMC11048669 DOI: 10.3390/brainsci14040356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024] Open
Abstract
This scoping review explores the use of neuromodulation techniques in individuals with cannabis use. Our goal was to determine whether cannabis use alters cortical excitation and inhibition in the context of neuromodulation and to determine whether neuromodulation affects craving and cannabis use patterns. A systematic search was conducted using PubMed, OVID Medline, and PsycINFO from inception to 20 December 2022. Our review identified ten relevant studies, eight of which used Transcranial Magnetic Stimulation (TMS), while two employed Transcranial Direct Current Stimulation (tDCS). Findings from TMS studies suggest that cannabis users exhibit altered cortical inhibition, with decreased short interval intracortical inhibition (SICI) compared to non-users. Single sessions of rTMS did not have any impact on cannabis craving. By contrast, two studies found that multiple sessions of rTMS reduced cannabis use, but these changes did not meet the threshold for statistical significance and both studies were limited by small sample sizes. The two included tDCS studies found contradictory results, with one showing reduced cannabis craving with active treatment and another showing no effect of active treatment on craving compared to sham. Future studies should further explore the effects of multiple treatment sessions and different neuromodulation modalities.
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Affiliation(s)
- Anthony Ngoy
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; (A.N.); (T.P.G.); (B.L.F.)
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON M5G 2C8, Canada
| | - Victor M. Tang
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; (V.M.T.); (D.M.B.)
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON M5S 2S1, Canada
| | - Kebin Xiao
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; (A.N.); (T.P.G.); (B.L.F.)
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON M5G 2C8, Canada
| | - Daniel M. Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; (V.M.T.); (D.M.B.)
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
| | - Tony P. George
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; (A.N.); (T.P.G.); (B.L.F.)
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Joshua L. Gowin
- Departments of Radiology and Psychiatry, University of Colorado School of Medicine, Aurora, CO 80045, USA;
| | - Bernard Le Foll
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; (A.N.); (T.P.G.); (B.L.F.)
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON M5G 2C8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON M5S 2S1, Canada
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health (CAMH), Toronto, ON M5S 2S1, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, ON L9M 1G3, Canada
| | - Matthew E. Sloan
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; (A.N.); (T.P.G.); (B.L.F.)
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON M5G 2C8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON M5S 2S1, Canada
- Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto, ON M1C 1A4, Canada
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9
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Xue X, Demirci D, Lenze EJ, Reynolds Iii CF, Mulsant BH, Wetherell JL, Wu GF, Blumberger DM, Karp JF, Butters MA, Mendes-Silva AP, Vieira EL, Tseng G, Diniz BS. Sex differences in plasma proteomic markers in late-life depression. Psychiatry Res 2024; 334:115773. [PMID: 38350292 PMCID: PMC10947839 DOI: 10.1016/j.psychres.2024.115773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 01/31/2024] [Accepted: 02/03/2024] [Indexed: 02/15/2024]
Abstract
Previous studies have shown significant sex-specific differences in major depressive disorder (MDD) in multiple biological parameters. Most studies focused on young and middle-aged adults, and there is a paucity of information about sex-specific biological differences in older adults with depression (aka, late-life depression (LLD)). To address this gap, this study aimed to evaluate sex-specific biological abnormalities in a large group of individuals with LLD using an untargeted proteomic analysis. We quantified 344 plasma proteins using a multiplex assay in 430 individuals with LLD and 140 healthy comparisons (HC) (age range between 60 and 85 years old for both groups). Sixty-six signaling proteins were differentially expressed in LLD (both sexes). Thirty-three proteins were uniquely associated with LLD in females, while six proteins were uniquely associated with LLD in males. The main biological processes affected by these proteins in females were related to immunoinflammatory control. In contrast, despite the smaller number of associated proteins, males showed dysregulations in a broader range of biological pathways, including immune regulation pathways, cell cycle control, and metabolic control. Sex has a significant impact on biomarker changes in LLD. Despite some overlap in differentially expressed biomarkers, males and females show different patterns of biomarkers changes, and males with LLD exhibit abnormalities in a larger set of biological processes compared to females. Our findings can provide novel targets for sex-specific interventions in LLD.
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Affiliation(s)
- Xiangning Xue
- Department of Biostatistics, University of Pittsburgh School of Public Health, PA USA
| | - Derya Demirci
- UConn Center on Aging, University of Connecticut, Farmington, CT USA
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO USA
| | - Charles F Reynolds Iii
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Benoit H Mulsant
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, & Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Julie Loebach Wetherell
- VA San Diego Healthcare System, Mental Health Impact Unit 3, University of California, San Diego Department of Psychiatry USA
| | - Gregory F Wu
- Department of Neurology, Washington University, St Louis, MO USA
| | - Daniel M Blumberger
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA USA; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, & Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Jordan F Karp
- Department of Psychiatry, The University of Arizona College of Medicine, Tucson, AZ USA
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Ana Paula Mendes-Silva
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Erica L Vieira
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - George Tseng
- Department of Biostatistics, University of Pittsburgh School of Public Health, PA USA
| | - Breno S Diniz
- UConn Center on Aging, University of Connecticut, Farmington, CT USA; Department of Psychiatry, UConn School of Medicine, Farmington, CT USA.
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10
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Göke K, Trevizol AP, Ma C, Mah L, Rajji TK, Daskalakis ZJ, Downar J, McClintock SM, Nestor SM, Noda Y, Mulsant BH, Blumberger DM. Predictors of remission after repetitive transcranial magnetic stimulation for the treatment of late-life depression. Psychiatry Res 2024; 334:115822. [PMID: 38452496 DOI: 10.1016/j.psychres.2024.115822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 02/23/2024] [Accepted: 02/24/2024] [Indexed: 03/09/2024]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment in patients with depression, yet treatment response remains variable. While previous work has identified predictors of remission in younger adults, relatively little data exists in late-life depression (LLD). To address this gap, data from 164 participants with LLD from a randomized non-inferiority treatment trial comparing standard bilateral rTMS to bilateral theta burst stimulation (TBS) (ClinicalTrials.gov identifier: NCT02998580) were analyzed using binary logistic regression and conditional inference tree (CIT) modeling. Lower baseline depression symptom severity, fewer prior antidepressant treatment failures, and higher global cognition predicted remission following rTMS treatment. The CIT predicted a higher likelihood of achieving remission for patients with a total score of 19 or lower on the Montgomery-Åsberg Depression Rating Scale, 1 or fewer prior antidepressant treatment failures, and a total score of 23 or higher on the Montreal Cognitive Assessment. Our results indicate that older adults with lower severity of depression, fewer antidepressant treatment failures, and higher global cognition benefit more from current forms of rTMS. The results suggest that there is potentially higher value in using rTMS earlier in the treatment pathway for depression in older adults.
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Affiliation(s)
- Katharina Göke
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Canada
| | - Alisson P Trevizol
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Clement Ma
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Linda Mah
- Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada; Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada
| | - Tarek K Rajji
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of California, San Diego Health, California, USA
| | - Jonathan Downar
- Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Shawn M McClintock
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sean M Nestor
- Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Yoshihiro Noda
- Department of Neuropsychiatry, Faculty of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Benoit H Mulsant
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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11
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Fassi L, Hochman S, Daskalakis ZJ, Blumberger DM, Cohen Kadosh R. The importance of individual beliefs in assessing treatment efficacy. eLife 2024; 12:RP88889. [PMID: 38547008 PMCID: PMC10977967 DOI: 10.7554/elife.88889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024] Open
Abstract
In recent years, there has been debate about the effectiveness of treatments from different fields, such as neurostimulation, neurofeedback, brain training, and pharmacotherapy. This debate has been fuelled by contradictory and nuanced experimental findings. Notably, the effectiveness of a given treatment is commonly evaluated by comparing the effect of the active treatment versus the placebo on human health and/or behaviour. However, this approach neglects the individual's subjective experience of the type of treatment she or he received in establishing treatment efficacy. Here, we show that individual differences in subjective treatment - the thought of receiving the active or placebo condition during an experiment - can explain variability in outcomes better than the actual treatment. We analysed four independent datasets (N = 387 participants), including clinical patients and healthy adults from different age groups who were exposed to different neurostimulation treatments (transcranial magnetic stimulation: Studies 1 and 2; transcranial direct current stimulation: Studies 3 and 4). Our findings show that the inclusion of subjective treatment can provide a better model fit either alone or in interaction with objective treatment (defined as the condition to which participants are assigned in the experiment). These results demonstrate the significant contribution of subjective experience in explaining the variability of clinical, cognitive, and behavioural outcomes. We advocate for existing and future studies in clinical and non-clinical research to start accounting for participants' subjective beliefs and their interplay with objective treatment when assessing the efficacy of treatments. This approach will be crucial in providing a more accurate estimation of the treatment effect and its source, allowing the development of effective and reproducible interventions.
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Affiliation(s)
- Luisa Fassi
- MRC Cognition and Brain Sciences Unit, University of CambridgeCambridgeUnited Kingdom
- Department of Psychiatry, University of CambridgeCambridgeUnited Kingdom
- Department of Experimental Psychology, University of OxfordOxfordUnited Kingdom
| | - Shachar Hochman
- School of Psychology, University of SurreySurreyUnited Kingdom
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of California, San DiegoSan DiegoUnited States
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention at the Centre for Addiction and Mental Health and Department of Psychiatry, Temerty Faculty of Medicine, University of TorontoTorontoCanada
| | - Roi Cohen Kadosh
- Department of Experimental Psychology, University of OxfordOxfordUnited Kingdom
- School of Psychology, University of SurreySurreyUnited Kingdom
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12
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Oliver LD, Jeyachandra J, Dickie EW, Hawco C, Mansour S, Hare SM, Buchanan RW, Malhotra AK, Blumberger DM, Deng ZD, Voineskos AN. Bayesian Optimization of Neurostimulation (BOONStim). bioRxiv 2024:2024.03.08.584169. [PMID: 38559269 PMCID: PMC10979934 DOI: 10.1101/2024.03.08.584169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) treatment response is influenced by individual variability in brain structure and function. Sophisticated, user-friendly approaches, incorporating both established functional magnetic resonance imaging (fMRI) and TMS simulation tools, to identify TMS targets are needed. OBJECTIVE The current study presents the development and validation of the Bayesian Optimization of Neuro-Stimulation (BOONStim) pipeline. METHODS BOONStim uses Bayesian optimization for individualized TMS targeting, automating interoperability between surface-based fMRI analytic tools and TMS electric field modeling. Bayesian optimization performance was evaluated in a sample dataset (N=10) using standard circular and functional connectivity-defined targets, and compared to grid optimization. RESULTS Bayesian optimization converged to similar levels of total electric field stimulation across targets in under 30 iterations, converging within a 5% error of the maxima detected by grid optimization, and requiring less time. CONCLUSIONS BOONStim is a scalable and configurable user-friendly pipeline for individualized TMS targeting with quick turnaround.
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13
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Brooks H, Wang W, Zomorrodi R, Blumberger DM, Bowie CR, Daskalakis ZJ, Fischer CE, Flint AJ, Herrmann N, Kumar S, Lanctôt KL, Mah L, Mulsant BH, Pollock BG, Voineskos AN, Rajji TK. Cognitive function based on theta-gamma coupling vs. clinical diagnosis in older adults with mild cognitive impairment with or without major depressive disorder. Transl Psychiatry 2024; 14:153. [PMID: 38503740 PMCID: PMC10951346 DOI: 10.1038/s41398-024-02856-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 02/21/2024] [Accepted: 02/28/2024] [Indexed: 03/21/2024] Open
Abstract
Whether individuals with mild cognitive impairment (MCI) and a history of major depressive disorder (MDD) are at a higher risk for cognitive decline than those with MCI alone is still not clear. Previous work suggests that a reduction in prefrontal cortical theta phase-gamma amplitude coupling (TGC) is an early marker of cognitive impairment. This study aimed to determine whether using a TGC cutoff is better at separating individuals with MCI or MCI with remitted MDD (MCI+rMDD) on cognitive performance than their clinical diagnosis. Our hypothesis was that global cognition would differ more between TGC-based groups than diagnostic groups. We analyzed data from 128 MCI (mean age: 71.8, SD: 7.3) and 85 MCI+rMDD (mean age: 70.9, SD: 4.7) participants. Participants completed a comprehensive neuropsychological battery; TGC was measured during the N-back task. An optimal TGC cutoff was determined during the performance of the 2-back. This TGC cutoff was used to classify participants into low vs. high-TGC groups. We then compared Cohen's d of the difference in global cognition between the high and low TGC groups to Cohen's d between the MCI and MCI+rMDD groups. We used bootstrapping to determine 95% confidence intervals for Cohen's d values using the whole sample. As hypothesized, Cohen's d for the difference in global cognition between the TGC groups was larger (0.64 [0.32, 0.88]) than between the diagnostic groups (0.10 [0.004, 0.37]) with a difference between these two Cohen's d's of 0.54 [0.10, 0.80]. Our findings suggest that TGC is a useful marker to identify individuals at high risk for cognitive decline, beyond clinical diagnosis. This could be due to TGC being a sensitive marker of prefrontal cortical dysfunction that would lead to an accelerated cognitive decline.
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Affiliation(s)
- Heather Brooks
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Adult Neurodevelopment and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Wei Wang
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Reza Zomorrodi
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Daniel M Blumberger
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Adult Neurodevelopment and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Christopher R Bowie
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Zafiris J Daskalakis
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Corinne E Fischer
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Alastair J Flint
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Mental Health, University Health Network, Toronto, ON, Canada
| | - Nathan Herrmann
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Sanjeev Kumar
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Adult Neurodevelopment and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada
| | - Krista L Lanctôt
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Linda Mah
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rotman Research Institute, Baycrest Health Sciences Centre, Toronto, ON, Canada
| | - Benoit H Mulsant
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Adult Neurodevelopment and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Bruce G Pollock
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Adult Neurodevelopment and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada
| | - Aristotle N Voineskos
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tarek K Rajji
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Adult Neurodevelopment and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada.
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14
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Ainsworth NJ, Marawi T, Maslej MM, Blumberger DM, McAndrews MP, Perivolaris A, Pollock BG, Rajji TK, Mulsant BH. Cognitive Outcomes After Antidepressant Pharmacotherapy for Late-Life Depression: A Systematic Review and Meta-Analysis. Am J Psychiatry 2024; 181:234-245. [PMID: 38321915 DOI: 10.1176/appi.ajp.20230392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
OBJECTIVE The authors evaluated whether treatment of late-life depression (LLD) with antidepressants leads to changes in cognitive function. METHODS A systematic review and meta-analysis of prospective studies of antidepressant pharmacotherapy for adults age 50 or older (or mean age of 65 or older) with LLD was conducted. MEDLINE, EMBASE, and PsycInfo were searched through December 31, 2022. The primary outcome was a change on cognitive test scores from baseline to after treatment. Secondary outcomes included the effects of specific medications and the associations between changes in depressive symptoms and cognitive test scores. Participants with bipolar disorder, psychotic depression, dementia, or neurological disease were excluded. Findings from all eligible studies were synthesized at a descriptive level, and a random-effects model was used to pool the results for meta-analysis. RESULTS Twenty-two studies were included. Thirteen of 19 studies showed an improvement on at least one cognitive test after antidepressant pharmacotherapy, with the most robust evidence for the memory and learning (nine of 16 studies) and processing speed (seven of 10 studies) domains and for sertraline (all five studies). Improvements in depressive symptoms were associated with improvement in cognitive test scores in six of seven relevant studies. The meta-analysis (eight studies; N=493) revealed a statistically significant overall improvement in memory and learning (five studies: effect size=0.254, 95% CI=0.103-0.404, SE=0.077); no statistically significant changes were seen in other cognitive domains. The evaluated risk of publication bias was low. CONCLUSION Antidepressant pharmacotherapy of LLD appears to improve certain domains of cognitive function, particularly memory and learning. This effect may be mediated by an improvement in depressive symptoms. Studies comparing individuals receiving pharmacotherapy with untreated control participants are needed.
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Affiliation(s)
- Nicholas J Ainsworth
- Centre for Addiction and Mental Health (CAMH), Toronto (Ainsworth, Marawi, Maslej, Blumberger, Pollock, Rajji, Mulsant); Department of Psychiatry, Temerty Faculty of Medicine (Ainsworth, Blumberger, Pollock, Mulsant), Institute of Medical Science, Temerty Faculty of Medicine (Marawi, Perivolaris), and Department of Psychology (McAndrews), University of Toronto, Toronto; Krembil Brain Institute, University Health Network, Toronto (McAndrews); Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto (Perivolaris); Toronto Dementia Research Alliance, Toronto (Rajji)
| | - Tulip Marawi
- Centre for Addiction and Mental Health (CAMH), Toronto (Ainsworth, Marawi, Maslej, Blumberger, Pollock, Rajji, Mulsant); Department of Psychiatry, Temerty Faculty of Medicine (Ainsworth, Blumberger, Pollock, Mulsant), Institute of Medical Science, Temerty Faculty of Medicine (Marawi, Perivolaris), and Department of Psychology (McAndrews), University of Toronto, Toronto; Krembil Brain Institute, University Health Network, Toronto (McAndrews); Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto (Perivolaris); Toronto Dementia Research Alliance, Toronto (Rajji)
| | - Marta M Maslej
- Centre for Addiction and Mental Health (CAMH), Toronto (Ainsworth, Marawi, Maslej, Blumberger, Pollock, Rajji, Mulsant); Department of Psychiatry, Temerty Faculty of Medicine (Ainsworth, Blumberger, Pollock, Mulsant), Institute of Medical Science, Temerty Faculty of Medicine (Marawi, Perivolaris), and Department of Psychology (McAndrews), University of Toronto, Toronto; Krembil Brain Institute, University Health Network, Toronto (McAndrews); Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto (Perivolaris); Toronto Dementia Research Alliance, Toronto (Rajji)
| | - Daniel M Blumberger
- Centre for Addiction and Mental Health (CAMH), Toronto (Ainsworth, Marawi, Maslej, Blumberger, Pollock, Rajji, Mulsant); Department of Psychiatry, Temerty Faculty of Medicine (Ainsworth, Blumberger, Pollock, Mulsant), Institute of Medical Science, Temerty Faculty of Medicine (Marawi, Perivolaris), and Department of Psychology (McAndrews), University of Toronto, Toronto; Krembil Brain Institute, University Health Network, Toronto (McAndrews); Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto (Perivolaris); Toronto Dementia Research Alliance, Toronto (Rajji)
| | - Mary Pat McAndrews
- Centre for Addiction and Mental Health (CAMH), Toronto (Ainsworth, Marawi, Maslej, Blumberger, Pollock, Rajji, Mulsant); Department of Psychiatry, Temerty Faculty of Medicine (Ainsworth, Blumberger, Pollock, Mulsant), Institute of Medical Science, Temerty Faculty of Medicine (Marawi, Perivolaris), and Department of Psychology (McAndrews), University of Toronto, Toronto; Krembil Brain Institute, University Health Network, Toronto (McAndrews); Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto (Perivolaris); Toronto Dementia Research Alliance, Toronto (Rajji)
| | - Argyrios Perivolaris
- Centre for Addiction and Mental Health (CAMH), Toronto (Ainsworth, Marawi, Maslej, Blumberger, Pollock, Rajji, Mulsant); Department of Psychiatry, Temerty Faculty of Medicine (Ainsworth, Blumberger, Pollock, Mulsant), Institute of Medical Science, Temerty Faculty of Medicine (Marawi, Perivolaris), and Department of Psychology (McAndrews), University of Toronto, Toronto; Krembil Brain Institute, University Health Network, Toronto (McAndrews); Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto (Perivolaris); Toronto Dementia Research Alliance, Toronto (Rajji)
| | - Bruce G Pollock
- Centre for Addiction and Mental Health (CAMH), Toronto (Ainsworth, Marawi, Maslej, Blumberger, Pollock, Rajji, Mulsant); Department of Psychiatry, Temerty Faculty of Medicine (Ainsworth, Blumberger, Pollock, Mulsant), Institute of Medical Science, Temerty Faculty of Medicine (Marawi, Perivolaris), and Department of Psychology (McAndrews), University of Toronto, Toronto; Krembil Brain Institute, University Health Network, Toronto (McAndrews); Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto (Perivolaris); Toronto Dementia Research Alliance, Toronto (Rajji)
| | - Tarek K Rajji
- Centre for Addiction and Mental Health (CAMH), Toronto (Ainsworth, Marawi, Maslej, Blumberger, Pollock, Rajji, Mulsant); Department of Psychiatry, Temerty Faculty of Medicine (Ainsworth, Blumberger, Pollock, Mulsant), Institute of Medical Science, Temerty Faculty of Medicine (Marawi, Perivolaris), and Department of Psychology (McAndrews), University of Toronto, Toronto; Krembil Brain Institute, University Health Network, Toronto (McAndrews); Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto (Perivolaris); Toronto Dementia Research Alliance, Toronto (Rajji)
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health (CAMH), Toronto (Ainsworth, Marawi, Maslej, Blumberger, Pollock, Rajji, Mulsant); Department of Psychiatry, Temerty Faculty of Medicine (Ainsworth, Blumberger, Pollock, Mulsant), Institute of Medical Science, Temerty Faculty of Medicine (Marawi, Perivolaris), and Department of Psychology (McAndrews), University of Toronto, Toronto; Krembil Brain Institute, University Health Network, Toronto (McAndrews); Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto (Perivolaris); Toronto Dementia Research Alliance, Toronto (Rajji)
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15
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Ibrahim C, Tang VM, Blumberger DM, Le Foll B. Repetitive transcranial magnetic stimulation for smoking cessation. CMAJ 2024; 196:E187-E190. [PMID: 38378215 PMCID: PMC10890232 DOI: 10.1503/cmaj.230806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Affiliation(s)
- Christine Ibrahim
- Translational Addiction Research Laboratory (Ibrahim, Le Foll) and Addictions Division (Tang), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health; Department of Psychiatry (Tang, Blumberger), Temerty Faculty of Medicine, University of Toronto; Temerty Centre for Therapeutic Brain Intervention (Blumberger), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health; Department of Pharmacology (Le Foll), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Victor M Tang
- Translational Addiction Research Laboratory (Ibrahim, Le Foll) and Addictions Division (Tang), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health; Department of Psychiatry (Tang, Blumberger), Temerty Faculty of Medicine, University of Toronto; Temerty Centre for Therapeutic Brain Intervention (Blumberger), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health; Department of Pharmacology (Le Foll), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Daniel M Blumberger
- Translational Addiction Research Laboratory (Ibrahim, Le Foll) and Addictions Division (Tang), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health; Department of Psychiatry (Tang, Blumberger), Temerty Faculty of Medicine, University of Toronto; Temerty Centre for Therapeutic Brain Intervention (Blumberger), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health; Department of Pharmacology (Le Foll), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Bernard Le Foll
- Translational Addiction Research Laboratory (Ibrahim, Le Foll) and Addictions Division (Tang), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health; Department of Psychiatry (Tang, Blumberger), Temerty Faculty of Medicine, University of Toronto; Temerty Centre for Therapeutic Brain Intervention (Blumberger), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health; Department of Pharmacology (Le Foll), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.
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16
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Dunlop K, Grosenick L, Downar J, Vila-Rodriguez F, Gunning FM, Daskalakis ZJ, Blumberger DM, Liston C. Dimensional and Categorical Solutions to Parsing Depression Heterogeneity in a Large Single-Site Sample. Biol Psychiatry 2024:S0006-3223(24)00055-6. [PMID: 38280408 DOI: 10.1016/j.biopsych.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 12/21/2023] [Accepted: 01/13/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Recent studies have reported significant advances in modeling the biological basis of heterogeneity in major depressive disorder, but investigators have also identified important technical challenges, including scanner-related artifacts, a propensity for multivariate models to overfit, and a need for larger samples with more extensive clinical phenotyping. The goals of the current study were to evaluate dimensional and categorical solutions to parsing heterogeneity in depression that are stable and generalizable in a large, single-site sample. METHODS We used regularized canonical correlation analysis to identify data-driven brain-behavior dimensions that explain individual differences in depression symptom domains in a large, single-site dataset comprising clinical assessments and resting-state functional magnetic resonance imaging data for 328 patients with major depressive disorder and 461 healthy control participants. We examined the stability of clinical loadings and model performance in held-out data. Finally, hierarchical clustering on these dimensions was used to identify categorical depression subtypes. RESULTS The optimal regularized canonical correlation analysis model yielded 3 robust and generalizable brain-behavior dimensions that explained individual differences in depressed mood and anxiety, anhedonia, and insomnia. Hierarchical clustering identified 4 depression subtypes, each with distinct clinical symptom profiles, abnormal resting-state functional connectivity patterns, and antidepressant responsiveness to repetitive transcranial magnetic stimulation. CONCLUSIONS Our results define dimensional and categorical solutions to parsing neurobiological heterogeneity in major depressive disorder that are stable, generalizable, and capable of predicting treatment outcomes, each with distinct advantages in different contexts. They also provide additional evidence that regularized canonical correlation analysis and hierarchical clustering are effective tools for investigating associations between functional connectivity and clinical symptoms.
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Affiliation(s)
- Katharine Dunlop
- Centre for Depression and Suicide Studies, St Michael's Hospital, Toronto, Ontario, Canada; Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Psychiatry and Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Logan Grosenick
- Department of Psychiatry, Weill Cornell Medicine, New York, New York
| | - Jonathan Downar
- Department of Psychiatry and Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Fidel Vila-Rodriguez
- Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Faith M Gunning
- Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, New York
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of California San Diego, San Diego, California
| | - Daniel M Blumberger
- Department of Psychiatry and Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, Weill Cornell Medicine, New York, New York; Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Conor Liston
- Department of Psychiatry, Weill Cornell Medicine, New York, New York; Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York.
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Goodman MS, Vila-Rodriguez F, Barwick M, Burke MJ, Downar J, Hunter J, Kaster TS, Knyahnytska Y, Kurdyak P, Maunder R, Thorpe K, Trevizol AP, Voineskos D, Zhang W, Blumberger DM. A randomized sham-controlled trial of high-dosage accelerated intermittent theta burst rTMS in major depression: study protocol. BMC Psychiatry 2024; 24:28. [PMID: 38191370 PMCID: PMC10773082 DOI: 10.1186/s12888-023-05470-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/19/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Intermittent theta burst stimulation (iTBS), a novel form of repetitive transcranial magnetic stimulation (rTMS), can be administered in 1/10th of the time of standard rTMS (~ 3 min vs. 37.5 min) yet achieves similar outcomes in depression. The brief nature of the iTBS protocol allows for the administration of multiple iTBS sessions per day, thus reducing the overall course length to days rather than weeks. This study aims to compare the efficacy and tolerability of active versus sham iTBS using an accelerated regimen in patients with treatment-resistant depression (TRD). As a secondary objective, we aim to assess the safety, tolerability, and treatment response to open-label low-frequency right-sided (1 Hz) stimulation using an accelerated regimen in those who do not respond to the initial week of treatment. METHODS Over three years, approximately 230 outpatients at the Centre for Addiction and Mental Health and University of British Columbia Hospital, meeting diagnostic criteria for unipolar MDD, will be recruited and randomized to a triple blind sham-controlled trial. Patients will receive five consecutive days of active or sham iTBS, administered eight times daily at 1-hour intervals, with each session delivering 600 pulses of iTBS. Those who have not achieved response by the week four follow-up visit will be offered a second course of treatment, regardless of whether they initially received active or sham stimulation. DISCUSSION Broader implementation of conventional iTBS is limited by the logistical demands of the current standard course consisting of 4-6 weeks of daily treatment. If our proposed accelerated iTBS protocol enables patients to achieve remission more rapidly, this would offer major benefits in terms of cost and capacity as well as the time required to achieve clinical response. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04255784.
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Affiliation(s)
- Michelle S Goodman
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Fidel Vila-Rodriguez
- Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Melanie Barwick
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Matthew J Burke
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Jonathan Downar
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jonathan Hunter
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Mount Sinai Hospital, Toronto, ON, Canada
| | - Tyler S Kaster
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yuliya Knyahnytska
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Paul Kurdyak
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Robert Maunder
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Mount Sinai Hospital, Toronto, ON, Canada
| | - Kevin Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Applied Health Research Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - Alisson P Trevizol
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Daphne Voineskos
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Wei Zhang
- Centre for Advancing Health Outcomes, St Paul's Hospital, Vancouver, BC, Canada
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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18
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Lai KSP, Waxman R, Blumberger DM, Giacobbe P, Hasey G, McMurray L, Milev R, Palaniyappan L, Ramasubbu R, Rybak YE, Sacevich T, Vila-Rodriguez F, Burhan AM. Competencies for Repetitive Transcranial Magnetic Stimulation in Postgraduate Medical Education: Expert Consensus Using a Modified Delphi Process. Can J Psychiatry 2023; 68:916-924. [PMID: 36959745 PMCID: PMC10657584 DOI: 10.1177/07067437231164571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is recommended in Canadian guidelines as a first-line treatment for major depressive disorder. With the shift towards competency-based medical education, it remains unclear how to determine when a resident is considered competent in applying knowledge of rTMS to patient care. Given inconsistencies between postgraduate training programmes with regards to training requirements, defining competencies will improve the standard of care in rTMS delivery. OBJECTIVE The goal of this study was to develop competencies for rTMS that can be implemented into a competency-based training curriculum in postgraduate training programmes. METHODS A working group drafted competencies for postgraduate psychiatry trainees. Fourteen rTMS experts from across Canada were invited to participate in the modified Delphi process. RESULTS Ten experts participated in all three rounds of the modified Delphi process. A total of 20 items reached a consensus. There was improvement in the Cronbach's alpha over the rounds of modified Delphi process (Cronbach's alpha increased from 0.554 to 0.824) suggesting improvement in internal consistency. The intraclass correlation coefficient (ICC) increased from 0.543 to 0.805 suggesting improved interrater agreement. CONCLUSIONS This modified Delphi process resulted in expert consensus on competencies to be acquired during postgraduate medical education programmes where a learner is training to become competent as a consultant and/or practitioner in rTMS treatment. This is a field that still requires development, and it is expected that as more evidence emerges the competencies will be further refined. These results will help the development of other curricula in interventional psychiatry.
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Affiliation(s)
- Ka Sing Paris Lai
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Robyn Waxman
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada
| | - Daniel M. Blumberger
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Peter Giacobbe
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Gary Hasey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Lisa McMurray
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Roumen Milev
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | | | | | - Yuri E. Rybak
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Tegan Sacevich
- Clinical Sciences Division, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Fidel Vila-Rodriguez
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amer M. Burhan
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada
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19
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Ainsworth NJ, Brender R, Gotlieb N, Zhao H, Blumberger DM, Karp JF, Lenze EJ, Nicol GE, Reynolds CF, Wang W, Mulsant BH. Association between lean muscle mass and treatment-resistant late-life depression in the IRL-GRey randomized controlled trial. Int Psychogeriatr 2023; 35:707-716. [PMID: 36594430 DOI: 10.1017/s1041610222000862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To investigate the relationship between lean muscle mass and treatment response in treatment-resistant late-life depression (TR-LLD). We hypothesized that lower lean muscle mass would be associated with older age, higher physical comorbidities, higher depressive symptom severity, and poorer treatment response. DESIGN Secondary analysis of a randomized, placebo-controlled trial. SETTING Three academic hospitals in the United States and Canada. PARTICIPANTS Adults aged 60+ years with major depressive disorder who did not remit following open treatment with venlafaxine extended-release (XR) (n = 178). MEASUREMENTS We estimated lean muscle mass using dual-energy X-ray absorptiometry (DEXA) scans prior to and following randomized treatment with aripiprazole or placebo added to venlafaxine XR. Multivariate regressions estimated influence of demographic and clinical factors on baseline lean muscle mass, and whether baseline lean muscle mass was associated with treatment response, adjusted for treatment arm. RESULTS Low lean muscle mass was present in 22 (12.4%) participants. Older age and female sex, but not depressive symptom severity, were independently associated with lower lean muscle mass at baseline. Marital status, baseline depressive symptom severity, and treatment group were associated with improvement of depressive symptoms in the randomized treatment phase. Baseline lean muscle mass was not associated with improvement, regardless of treatment group. CONCLUSION As expected, older age and female sex were associated with lower lean muscle mass in TR-LLD. However, contrary to prior results in LLD, lean muscle mass was not associated with depression severity or outcome. This suggests that aripiprazole augmentation may be useful for TR-LLD, even in the presence of anomalous body composition.clinicaltrials.gov Identifier: NCT00892047.
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Affiliation(s)
- Nicholas J Ainsworth
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ram Brender
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Neta Gotlieb
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Haoyu Zhao
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Daniel M Blumberger
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jordan F Karp
- Department of Psychiatry, College of Medicine Tuscon, University of Arizona, Tuscon, AZ, USA
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Ginger E Nicol
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh Medical Centre, Pittsburgh, PA, USA
| | - Wei Wang
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Tang VM, Ibrahim C, Rodak T, Goud R, Blumberger DM, Voineskos D, Le Foll B. Managing substance use in patients receiving therapeutic repetitive transcranial magnetic stimulation: A scoping review. Neurosci Biobehav Rev 2023; 155:105477. [PMID: 38007879 DOI: 10.1016/j.neubiorev.2023.105477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/16/2023] [Accepted: 11/18/2023] [Indexed: 11/28/2023]
Abstract
Repetitive Transcranial Magnetic Stimulation (rTMS) is an invaluable treatment option for neuropsychiatric disorders. Co-occurring recreational and nonmedical substance use can be common in those presenting for rTMS treatment, and it is unknown how it may affect the safety and efficacy of rTMS for the treatment of currently approved neuropsychiatric indications. This scoping review aimed to map the literature on humans receiving rTMS and had a history of any type of substance use. The search identified 274 articles providing information on inclusion/exclusion criteria, withdrawal criteria, safety protocols, type of rTMS and treatment parameters, adverse events and effect on primary outcomes that related to substance use. There are neurophysiological effects of substance use on cortical excitability, although the relevance to clinical rTMS practice is unknown. The current literature supports the safety and feasibility of delivering rTMS to those who have co-occurring neuropsychiatric disorder and substance use. However, specific details on how varying degrees of substance use alters the safety, efficacy, and mechanisms of rTMS remains poorly described.
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Affiliation(s)
- Victor M Tang
- Addictions Division, Centre for Addiction and Mental Health, Canada; Institute for Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada; Institute of Mental Health Policy Research, Centre for Addiction and Mental Health, Canada.
| | - Christine Ibrahim
- Addictions Division, Centre for Addiction and Mental Health, Canada; Institute for Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Terri Rodak
- CAMH Mental Health Sciences Library, Department of Education, Centre for Addiction and Mental Health, Canada
| | - Rachel Goud
- Addictions Division, Centre for Addiction and Mental Health, Canada
| | - Daniel M Blumberger
- Institute for Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Canada
| | - Daphne Voineskos
- Institute for Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Canada; Poul Hansen Family Centre for Depression, Krembil Research Institute, Toronto Western Hospital, University Health Network, Canada
| | - Bernard Le Foll
- Addictions Division, Centre for Addiction and Mental Health, Canada; Institute for Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada; Institute of Mental Health Policy Research, Centre for Addiction and Mental Health, Canada; CAMH Mental Health Sciences Library, Department of Education, Centre for Addiction and Mental Health, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Canada; Poul Hansen Family Centre for Depression, Krembil Research Institute, Toronto Western Hospital, University Health Network, Canada; Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Canada; Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Canada
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Wathra RA, Mulsant BH, Reynolds CF, Lenze EJ, Karp JF, Daskalakis ZJ, Blumberger DM. Differential Placebo Responses for Pharmacotherapy and Neurostimulation in Late-Life Depression. Neuromodulation 2023; 26:1585-1591. [PMID: 35088720 DOI: 10.1016/j.neurom.2021.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/21/2021] [Accepted: 10/06/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The magnitude of the placebo response depends on both the modality used as the "placebo" and the intervention with which it is compared, both of which can complicate the interpretation of randomized controlled trials (RCTs) for depression in late life. Given that neurostimulation and pharmacotherapy are among the most common interventions studied for late-life depression, comparing the relative placebo responses in studies of these interventions can aid interpretation of relative effect sizes. MATERIALS AND METHODS We analyzed data from two RCTs of adults aged ≥60 years in an episode of treatment-resistant major depression, one comparing aripiprazole and matching placebo pills and the other comparing deep repetitive transcranial magnetic stimulation (rTMS) and sham rTMS. In both RCTs, depression was assessed using the 17-item Hamilton Depression Rating Scale (HDRS-17). The primary comparison occurred after four weeks using analysis of covariance (ANCOVA) of HDRS-17 scores in participants who received placebo pills or sham rTMS. Relevant covariates included years of education, duration of depressive episode, and baseline HDRS-17 score. RESULTS Accounting for covariates, there was a larger reduction of HDRS-17 after four weeks in the sham rTMS group (estimated marginal mean ± SE: -5.90 ± 1.45; 95% CI: [-8.82, 2.98]) than in the placebo pills group (-1.07 ± 1.45; [-3.98, 1.85]). There were no significant differences between these groups in the binary outcome analysis of response and remission rates at four weeks or any outcome at trial end point comparison. CONCLUSIONS Sham rTMS may have a larger placebo response than placebo pills early in the treatment of older adults with treatment-resistant depression. Differential placebo responses should be considered in both the interpretation and design of RCTs.
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Affiliation(s)
- Rafae A Wathra
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Benoit H Mulsant
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Jordan F Karp
- Department of Psychiatry, University of Arizona College of Medicine - Tucson, Tucson, AZ, USA
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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22
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Smith SE, Kosik EL, van Engen Q, Kohn J, Hill AT, Zomorrodi R, Blumberger DM, Daskalakis ZJ, Hadas I, Voytek B. Magnetic seizure therapy and electroconvulsive therapy increase aperiodic activity. Transl Psychiatry 2023; 13:347. [PMID: 37968260 PMCID: PMC10651875 DOI: 10.1038/s41398-023-02631-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 11/17/2023] Open
Abstract
Major depressive disorder (MDD) is a leading cause of disability worldwide. One of the most efficacious treatments for treatment-resistant MDD is electroconvulsive therapy (ECT). Recently, magnetic seizure therapy (MST) was developed as an alternative to ECT due to its more favorable side effect profile. While these approaches have been very successful clinically, the neural mechanisms underlying their therapeutic effects are unknown. For example, clinical "slowing" of the electroencephalogram beginning in the postictal state and extending days to weeks post-treatment has been observed in both treatment modalities. However, a recent longitudinal study of a small cohort of ECT patients revealed that, rather than delta oscillations, clinical slowing was better explained by increases in aperiodic activity, an emerging EEG signal linked to neural inhibition. Here we investigate the role of aperiodic activity in a cohort of patients who received ECT and a cohort of patients who received MST treatment. We find that aperiodic neural activity increases significantly in patients receiving either ECT or MST. Although not directly related to clinical efficacy in this dataset, increased aperiodic activity is linked to greater amounts of neural inhibition, which is suggestive of a potential shared neural mechanism of action across ECT and MST.
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Affiliation(s)
- Sydney E Smith
- Neurosciences Graduate Program, University of California, San Diego, La Jolla, CA, USA.
| | - Eena L Kosik
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA, USA
| | - Quirine van Engen
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA, USA
| | - Jordan Kohn
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Aron T Hill
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, VIC, Australia
- Department of Psychiatry, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Reza Zomorrodi
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Itay Hadas
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Bradley Voytek
- Neurosciences Graduate Program, University of California, San Diego, La Jolla, CA, USA
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA, USA
- Halıcıoğlu Data Science Institute, University of California, San Diego, La Jolla, CA, USA
- Kavli Institute for Brain and Mind, University of California, San Diego, La Jolla, CA, USA
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23
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Dhami P, Moreno S, Croarkin PE, Blumberger DM, Daskalakis ZJ, Farzan F. Baseline markers of cortical excitation and inhibition predict response to theta burst stimulation treatment for youth depression. Sci Rep 2023; 13:19115. [PMID: 37925557 PMCID: PMC10625527 DOI: 10.1038/s41598-023-45107-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/16/2023] [Indexed: 11/06/2023] Open
Abstract
Theta burst stimulation (TBS), a specific form of repetitive transcranial magnetic stimulation (TMS), is a promising treatment for youth with Major Depressive Disorder (MDD) who do not respond to conventional therapies. However, given the variable response to TBS, a greater understanding of how baseline features relate to clinical response is needed to identify which patients are most likely to benefit from this treatment. In the current study, we sought to determine if baseline neurophysiology, specifically cortical excitation and/or inhibition, is associated with antidepressant response to TBS. In two independent open-label clinical trials, youth (aged 16-24 years old) with MDD underwent bilateral dorsolateral prefrontal cortex (DLPFC) TBS treatment. Clinical trial one and two consisted of 10 and 20 daily sessions of bilateral DLPFC TBS, respectively. At baseline, single-pulse TMS combined with electroencephalography was used to assess the neurophysiology of 4 cortical sites: bilateral DLPFC and inferior parietal lobule. Measures of cortical excitation and inhibition were indexed by TMS-evoked potentials (i.e., P30, N45, P60, N100, and P200). Depression severity was measured before, during and after treatment completion using the Hamilton Rating Scale for Depression-17. In both clinical trials, the baseline left DLPFC N45 and P60, which are believed to reflect inhibitory and excitatory mechanisms respectively, were predictors of clinical response. Specifically, greater (i.e., more negative) N45 and smaller P60 baseline values were associated with greater treatment response to TBS. Accordingly, cortical excitation and inhibition circuitry of the left DLPFC may have value as a TBS treatment response biomarker for youth with MDD.Clinical trial 1 registration number: NCT02472470 (June 15, 2015).Clinical trial 2 registration number: NCT03708172 (October 17, 2018).
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Affiliation(s)
- Prabhjot Dhami
- School of Mechatronic Systems Engineering, Simon Fraser University, 250-13450 102 Avenue, Surrey, BC, V3T 0A3, Canada
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, 1001 Queen St. W, Toronto, ON, M6J 1A8, Canada
- Institute of Medical Science, Faculty of Medicine, Medical Sciences Building, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Sylvain Moreno
- School of Interactive Arts and Technology, Simon Fraser University, 250-13450 102 Avenue, Surrey, BC, V3T 0A3, Canada
- Circle Innovation, 1200-555 W. Hastings Street, Vancouver, BC, V6B 4N6, Canada
| | - Paul E Croarkin
- College of Medicine and Science, Mayo Clinic, Rochester, MN, 55905, USA
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, 1001 Queen St. W, Toronto, ON, M6J 1A8, Canada
- Institute of Medical Science, Faculty of Medicine, Medical Sciences Building, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON, M5T 1R8, Canada
| | - Zafiris J Daskalakis
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, 1001 Queen St. W, Toronto, ON, M6J 1A8, Canada
- Institute of Medical Science, Faculty of Medicine, Medical Sciences Building, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON, M5T 1R8, Canada
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Faranak Farzan
- School of Mechatronic Systems Engineering, Simon Fraser University, 250-13450 102 Avenue, Surrey, BC, V3T 0A3, Canada.
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, 1001 Queen St. W, Toronto, ON, M6J 1A8, Canada.
- Institute of Medical Science, Faculty of Medicine, Medical Sciences Building, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON, M5T 1R8, Canada.
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24
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Wathra RA, Mulsant BH, Daskalakis ZJ, Downar J, McClintock SM, Nestor SM, Rajji TK, Trevizol AP, Blumberger DM. Effect of prior pharmacotherapy on remission with sequential bilateral theta-burst versus standard bilateral repetitive transcranial magnetic stimulation in treatment-resistant late-life depression. Br J Psychiatry 2023; 223:504-506. [PMID: 37334540 PMCID: PMC10895496 DOI: 10.1192/bjp.2023.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is used for treatment of late-life depression. In the FOUR-D study, sequential bilateral theta-burst stimulation (TBS) had comparable remission rates to standard bilateral rTMS. Data were analysed from the FOUR-D trial to compare remission rates between two types of rTMS based on the number and class of prior medication trials. The remission rate was higher in participants with ≤1 previous trial (43.9%) than in participants with 2 previous trials (26.5%) or ≥3 previous trials (24.6%; χ² = 6.36, d.f. = 2, P = 0.04). Utilising rTMS earlier in late-life depression may lead to better outcomes.
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Affiliation(s)
- Rafae A Wathra
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Benoit H Mulsant
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of California, San Diego Health, San Diego, California, USA
| | - Jonathan Downar
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shawn M McClintock
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sean M Nestor
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; and Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Tarek K Rajji
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto Dementia Research Alliance, University of Toronto, Toronto, Ontario, Canada
| | - Alisson P Trevizol
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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25
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Poorganji M, Goeke K, Zomorrodi R, Voineskos D, Rajji TK, Daskalakis ZJ, Blumberger DM. The use of theta burst stimulation in patients with schizophrenia - A systematic review. Schizophr Res 2023; 261:245-255. [PMID: 37844414 DOI: 10.1016/j.schres.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 06/02/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023]
Abstract
Transcranial magnetic stimulation (TMS) can offer therapeutic benefits and provide value in neurophysiological research. One of the newer TMS paradigms is theta burst stimulation (TBS) which can be delivered in two patterns: continuous (cTBS - inducing LTD-like effects) and intermittent (iTBS - inducing LTP-like effects). This review paper aims to explore studies that have utilized TBS protocols over different areas of the cortex to study the neurophysiological functions and treatment of patients with schizophrenia. PubMed was searched using the following keywords "schizophrenia", "schizoaffective", or "psychosis", and "theta burst stimulation". Out of the 90 articles which were found, thirty met review inclusion criteria. The inclusion criteria included studying the reported effect (clinical, physiological, or both) of at least one session of TBS on human subjects, and abstracts (at minimum) must have been in English. The main target areas included prefrontal cortex (12 studies - 10 dorsolateral prefrontal cortex (DLPFC), 2 dorsomedial prefrontal cortex (DMPFC)) vermal cerebellum (5), and temporo-parietal cortex (8). Other target areas included inferior parietal lobe (2), and motor cortex (3). TBS neurophysiological effect was explored in 5 studies using functional magnetic resonance image (fMRI), magnetic resonance spectroscopy (MRS), electroencephalography (EEG), electromyography (EMG) and positron emission topography (PET) scan. Overall, TBS can offer great therapeutic potential as it is well-tolerated, feasible, and has few, if any, adverse effects. TBS may be targeted to treat specific symptomatology, as an augmenting intervention to pharmacotherapy, or even improving patient's insight into their diagnosis.
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Affiliation(s)
- Mohsen Poorganji
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Faculty of Health, University of California San Diego, La Jolla, CA, USA
| | - Katharina Goeke
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Reza Zomorrodi
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Daphne Voineskos
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada; Poul Hansen Family Centre for Depression, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Tarek K Rajji
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Toronto Dementia Research Alliance, University of Toronto, Toronto, Ontario, Canada
| | - Zafiris J Daskalakis
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, Faculty of Health, University of California San Diego, La Jolla, CA, USA
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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26
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Smith SE, Kosik EL, van Engen Q, Kohn J, Hill AT, Zomorrodi R, Blumberger DM, Daskalakis ZJ, Hadas I, Voytek B. Magnetic seizure therapy and electroconvulsive therapy increase aperiodic activity. medRxiv 2023:2023.01.11.23284450. [PMID: 36711765 PMCID: PMC9882553 DOI: 10.1101/2023.01.11.23284450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Major depressive disorder (MDD) is a leading cause of disability worldwide. One of the most efficacious treatments for treatment-resistant MDD is electroconvulsive therapy (ECT). Recently, magnetic seizure therapy (MST) was developed as an alternative to ECT due to its more favorable side effect profile. While these approaches have been very successful clinically, the neural mechanisms underlying their therapeutic effects are unknown. For example, clinical "slowing" of the electroencephalogram beginning in the postictal state and extending days to weeks post-treatment has been observed in both treatment modalities. However, a recent longitudinal study of a small cohort of ECT patients revealed that, rather than delta oscillations, clinical slowing was better explained by increases in aperiodic activity, an emerging EEG signal linked to neural inhibition. Here we investigate the role of aperiodic activity in a cohort of patients who received ECT and a cohort of patients who received MST treatment. We find that aperiodic neural activity increases significantly in patients receiving either ECT or MST. Although not directly related to clinical efficacy in this dataset, increased aperiodic activity is linked to greater amounts of neural inhibition, which is suggestive of a potential shared neural mechanism of action across ECT and MST.
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Affiliation(s)
- Sydney E. Smith
- Neurosciences Graduate Program, University of California, San Diego, La Jolla, CA, USA
| | - Eena L. Kosik
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA, USA
| | - Quirine van Engen
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA, USA
| | - Jordan Kohn
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Aron T. Hill
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Victoria, Australia
- Department of Psychiatry, Central Clinical School, Monash University, Melbourne, Australia
| | - Reza Zomorrodi
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Daniel M. Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Zafiris J. Daskalakis
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Itay Hadas
- Department of Psychiatry, Central Clinical School, Monash University, Melbourne, Australia
| | - Bradley Voytek
- Neurosciences Graduate Program, University of California, San Diego, La Jolla, CA, USA
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA, USA
- Halıcıoğlu Data Science Institute, University of California, San Diego, La Jolla, CA, USA
- Kavli Institute for Brain and Mind, University of California, San Diego, La Jolla, CA, USA
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27
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Dharavath RN, Pina-Leblanc C, Tang VM, Sloan ME, Nikolova YS, Pangarov P, Ruocco AC, Shield K, Voineskos D, Blumberger DM, Boileau I, Bozinoff N, Gerretsen P, Vieira E, Melamed OC, Sibille E, Quilty LC, Prevot TD. GABAergic signaling in alcohol use disorder and withdrawal: pathological involvement and therapeutic potential. Front Neural Circuits 2023; 17:1218737. [PMID: 37929054 PMCID: PMC10623140 DOI: 10.3389/fncir.2023.1218737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/04/2023] [Indexed: 11/07/2023] Open
Abstract
Alcohol is one of the most widely used substances. Alcohol use accounts for 5.1% of the global disease burden, contributes substantially to societal and economic costs, and leads to approximately 3 million global deaths yearly. Alcohol use disorder (AUD) includes various drinking behavior patterns that lead to short-term or long-lasting effects on health. Ethanol, the main psychoactive molecule acting in alcoholic beverages, directly impacts the GABAergic system, contributing to GABAergic dysregulations that vary depending on the intensity and duration of alcohol consumption. A small number of interventions have been developed that target the GABAergic system, but there are promising future therapeutic avenues to explore. This review provides an overview of the impact of alcohol on the GABAergic system, the current interventions available for AUD that target the GABAergic system, and the novel interventions being explored that in the future could be included among first-line therapies for the treatment of AUD.
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Affiliation(s)
| | - Celeste Pina-Leblanc
- Campbell Family Mental Health Research Institute of CAMH, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Victor M. Tang
- Campbell Family Mental Health Research Institute of CAMH, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Addiction Division, CAMH, Toronto, ON, Canada
- Division of Neurosciences and Clinical Translation, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Institute of Mental Health Policy Research, CAMH, Toronto, ON, Canada
| | - Matthew E. Sloan
- Campbell Family Mental Health Research Institute of CAMH, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Addiction Division, CAMH, Toronto, ON, Canada
- Division of Neurosciences and Clinical Translation, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Institute of Mental Health Policy Research, CAMH, Toronto, ON, Canada
| | - Yuliya S. Nikolova
- Campbell Family Mental Health Research Institute of CAMH, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Peter Pangarov
- Campbell Family Mental Health Research Institute of CAMH, Toronto, ON, Canada
| | - Anthony C. Ruocco
- Campbell Family Mental Health Research Institute of CAMH, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Temerty Centre for Therapeutic Brain Intervention, CAMH, Toronto, ON, Canada
- Department of Psychology, University of Toronto Scarborough, Toronto, ON, Canada
| | - Kevin Shield
- Institute of Mental Health Policy Research, CAMH, Toronto, ON, Canada
| | - Daphne Voineskos
- Campbell Family Mental Health Research Institute of CAMH, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Temerty Centre for Therapeutic Brain Intervention, CAMH, Toronto, ON, Canada
| | - Daniel M. Blumberger
- Campbell Family Mental Health Research Institute of CAMH, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Temerty Centre for Therapeutic Brain Intervention, CAMH, Toronto, ON, Canada
| | - Isabelle Boileau
- Campbell Family Mental Health Research Institute of CAMH, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Brain Health Imaging Centre, CAMH, Toronto, ON, Canada
| | - Nikki Bozinoff
- Campbell Family Mental Health Research Institute of CAMH, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Philip Gerretsen
- Campbell Family Mental Health Research Institute of CAMH, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Brain Health Imaging Centre, CAMH, Toronto, ON, Canada
| | - Erica Vieira
- Campbell Family Mental Health Research Institute of CAMH, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Osnat C. Melamed
- Campbell Family Mental Health Research Institute of CAMH, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Etienne Sibille
- Campbell Family Mental Health Research Institute of CAMH, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Lena C. Quilty
- Campbell Family Mental Health Research Institute of CAMH, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Thomas D. Prevot
- Campbell Family Mental Health Research Institute of CAMH, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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28
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Tang VM, Yu D, Weissman CR, Jones BDM, Wang G, Sloan ME, Blumberger DM, Daskalakis ZJ, Le Foll B, Voineskos D. Treatment outcomes in major depressive disorder in patients with comorbid alcohol use disorder: A STAR*D analysis. J Affect Disord 2023; 339:691-697. [PMID: 37467796 PMCID: PMC10496139 DOI: 10.1016/j.jad.2023.07.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 06/26/2023] [Accepted: 07/08/2023] [Indexed: 07/21/2023]
Abstract
INTRODUCTION Guidance on Major Depressive Disorder (MDD) treatment in those with comorbid Alcohol Use Disorder (AUD) is limited. We performed a secondary analysis on the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, examining the association between comorbid AUD and depression outcomes. METHODS STAR*D was a real-world effectiveness trial starting with citalopram in level 1. Non-responding participants progressed through 3 other sequential treatment levels with different switch or augmentation options. Antidepressant outcomes were compared between MDD (n = 2826) and comorbid MDD and AUD (n = 864). Logistic regressions were performed to evaluate remission and response predictors in the total STAR*D sample and the AUD-comorbidity interaction. RESULTS Chi-squared tests showed no significant difference in response or remission rates from depression between groups across treatment levels. Higher Hamilton Rating Scale for Depression (HRSD) score was associated with overall lower odds of remission in treatment level 1 (OR = 0.93, p < 0.001) and 2 (OR = 0.95, p < 0.001), with no significant interaction with comorbid AUD. Higher baseline suicidality had overall lower odds of remission in level 1 (OR = 0.82, p < 0.001) and 2 (OR = 0.1, p < 0.001), but with comorbid AUD compared to no AUD, suicidality increased odds of level 1 remission (OR = 1.30, p = 0.012). In comorbid AUD in level 2, venlafaxine was associated with lower odds of remission (OR = 0.13, p = 0.013) and response (OR = 0.12, p = 0.006); bupropion with lower odds of response (OR = 0.22, p = 0.024). LIMITATIONS Open label study design and lack of alcohol use data. CONCLUSIONS Comorbid AUD may interact with predictors of antidepressant response in MDD and using venlafaxine or bupropion may be less effective. Addressing this comorbidity requires unique assessment and treatment approaches.
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Affiliation(s)
- Victor M Tang
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Dengdeng Yu
- Department of Mathematics, University of Texas at Arlington, Arlington, TX, USA
| | - Cory R Weissman
- Department of Psychiatry, UC San Diego Health, La Jolla, CA, USA; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Brett D M Jones
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Guan Wang
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Matthew E Sloan
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Daniel M Blumberger
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | | | - Bernard Le Foll
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada
| | - Daphne Voineskos
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Poul Hansen Family Centre for Depression, Krembil Research Institute, Toronto Western Hospital, University Health Network, Canada.
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Jones BDM, Fernandes BS, Husain MI, Ortiz A, Rajji TK, Blumberger DM, Butters MA, Gildengers AG, Shablinski T, Voineskos A, Mulsant BH. A cross-sectional study of cognitive performance in bipolar disorder across the lifespan: the cog-BD project. Psychol Med 2023; 53:6316-6324. [PMID: 36464659 PMCID: PMC10520592 DOI: 10.1017/s0033291722003622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Neuroprogressive models of the trajectory of cognitive dysfunction in patients with bipolar disorder (BD) have been proposed. However, few studies have explored the relationships among clinical characteristics of BD, cognitive dysfunction, and aging. METHODS We conducted a cross-sectional analysis in euthymic participants with the MATRICS Cognitive Consensus Battery, the Trail Making Test B, the Stroop Test, and the Wechsler Test of Adult Reading. Age- and gender-equated control participants without a mental disorder ['Healthy Controls' - HC)] were assessed similarly. We compared cognitive performance both globally and in seven domains in four groups: younger BD (age ⩽49 years; n = 70), older BD (age ⩾50 years; n = 48), younger HC (n = 153), and older HC (n = 44). We also compared the BD and HC groups using age as a continuous measure. We controlled for relevant covariates and applied a Bonferroni correction. RESULTS Our results support both an early impairment ('early hit') model and an accelerated aging model: impairment in attention/vigilance, processing speed, and executive function/working memory were congruent with the accelerated aging hypothesis whereas impairment in verbal memory was congruent with an early impairment model. BD and HC participants exhibited similar age-related decline in reasoning/problem solving and visuospatial memory. There were no age- or diagnosis-related differences in social cognition. CONCLUSION Our findings support that different cognitive domains are affected differently by BD and aging. Longitudinal studies are needed to explore trajectories of cognitive performance in BD across the lifespan.
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Affiliation(s)
- Brett D. M. Jones
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Brisa S. Fernandes
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - M. Ishrat Husain
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Abigail Ortiz
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Tarek K. Rajji
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Toronto Dementia Research Alliance, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel M. Blumberger
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Meryl A. Butters
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Tatiana Shablinski
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Aristotle Voineskos
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Benoit H. Mulsant
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Toronto Dementia Research Alliance, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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30
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Dijkstra E, van Dijk H, Vila-Rodriguez F, Zwienenberg L, Rouwhorst R, Coetzee JP, Blumberger DM, Downar J, Williams N, Sack AT, Arns M. Transcranial Magnetic Stimulation-Induced Heart-Brain Coupling: Implications for Site Selection and Frontal Thresholding-Preliminary Findings. Biol Psychiatry Glob Open Sci 2023; 3:939-947. [PMID: 37881544 PMCID: PMC10593873 DOI: 10.1016/j.bpsgos.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/21/2022] [Accepted: 01/06/2023] [Indexed: 01/26/2023] Open
Abstract
Background Neurocardiac-guided transcranial magnetic stimulation (TMS) uses repetitive TMS (rTMS)-induced heart rate deceleration to confirm activation of the frontal-vagal pathway. Here, we test a novel neurocardiac-guided TMS method that utilizes heart-brain coupling (HBC) to quantify rTMS-induced entrainment of the interbeat interval as a function of TMS cycle time. Because prior neurocardiac-guided TMS studies indicated no association between motor and frontal excitability threshold, we also introduce the approach of using HBC to establish individualized frontal excitability thresholds for optimally dosing frontal TMS. Methods In studies 1A and 1B, we validated intermittent theta burst stimulation (iTBS)-induced HBC (2 seconds iTBS on; 8 seconds off: HBC = 0.1 Hz) in 15 (1A) and 22 (1B) patients with major depressive disorder from 2 double-blind placebo-controlled studies. In study 2, HBC was measured in 10 healthy subjects during the 10-Hz "Dash" protocol (5 seconds 10-Hz on; 11 seconds off: HBC = 0.0625 Hz) applied with 15 increasing intensities to 4 evidence-based TMS locations. Results Using blinded electrocardiogram-based HBC analysis, we successfully identified sham from real iTBS sessions (accuracy: study 1A = 83%, study 1B = 89.5%) and found a significantly stronger HBC at 0.1 Hz in active compared with sham iTBS (d = 1.37) (study 1A). In study 2, clear dose-dependent entrainment (p = .002) was observed at 0.0625 Hz in a site-specific manner. Conclusions We demonstrated rTMS-induced HBC as a function of TMS cycle time for 2 commonly used clinical protocols (iTBS and 10-Hz Dash). These preliminary results supported individual site specificity and dose-response effects, indicating that this is a potentially valuable method for clinical rTMS site stratification and frontal thresholding. Further research should control for TMS side effects, such as pain of stimulation, to confirm these findings.
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Affiliation(s)
- Eva Dijkstra
- Heart & Brain Group, Brainclinics Foundation, Nijmegen, the Netherlands
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Neurowave, Amsterdam, the Netherlands
| | - Hanneke van Dijk
- Heart & Brain Group, Brainclinics Foundation, Nijmegen, the Netherlands
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Fidel Vila-Rodriguez
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lauren Zwienenberg
- Heart & Brain Group, Brainclinics Foundation, Nijmegen, the Netherlands
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Synaeda Psycho Medisch Centrum, Leeuwarden, the Netherlands
| | - Renée Rouwhorst
- Heart & Brain Group, Brainclinics Foundation, Nijmegen, the Netherlands
- Neurocare group Netherlands, The Hague, the Netherlands
| | - John P. Coetzee
- Department Of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California
| | - Daniel M. Blumberger
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jonathan Downar
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Nolan Williams
- Department Of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California
| | - Alexander T. Sack
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Martijn Arns
- Heart & Brain Group, Brainclinics Foundation, Nijmegen, the Netherlands
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
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31
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Strafella R, Momi D, Zomorrodi R, Lissemore J, Noda Y, Chen R, Rajji TK, Griffiths JD, Vila-Rodriguez F, Downar J, Daskalakis ZJ, Blumberger DM, Voineskos D. Identifying Neurophysiological Markers of Intermittent Theta Burst Stimulation in Treatment-Resistant Depression Using Transcranial Magnetic Stimulation-Electroencephalography. Biol Psychiatry 2023; 94:454-465. [PMID: 37084864 DOI: 10.1016/j.biopsych.2023.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 03/12/2023] [Accepted: 04/03/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Intermittent theta burst stimulation (iTBS) targeting the left dorsolateral prefrontal cortex is effective for treatment-resistant depression, but the effects of iTBS on neurophysiological markers remain unclear. Here, we indexed transcranial magnetic stimulation-electroencephalography (TMS-EEG) markers, specifically, the N45 and N100 amplitudes, at baseline and post-iTBS, comparing separated and contiguous iTBS schedules. TMS-EEG markers were also compared between iTBS responders and nonresponders. METHODS TMS-EEG was analyzed from a triple-blind 1:1 randomized trial for treatment-resistant depression, comparing a separated (54-minute interval) and contiguous (0-minute interval) schedule of 2 × 600-pulse iTBS for 30 treatments. Participants underwent TMS-EEG over the left dorsolateral prefrontal cortex at baseline and posttreatment. One hundred fourteen participants had usable TMS-EEG at baseline, and 98 at posttreatment. TMS-evoked potential components (N45, N100) were examined via global mean field analysis. RESULTS The N100 amplitude decreased from baseline to posttreatment, regardless of the treatment group (F1,106 = 5.20, p = .02). There were no changes in N45 amplitude in either treatment group. In responders, the N100 amplitude decreased after iTBS (F1,102 = 11.30, p = .001, pcorrected = .0004). Responders showed higher posttreatment N45 amplitude than nonresponders (F1,94 = 4.11, p = .045, pcorrected = .016). Higher baseline N100 amplitude predicted lower post-iTBS depression scores (F4,106 = 6.28, p = .00014). CONCLUSIONS These results provide further evidence for an association between the neurophysiological effects of iTBS and treatment efficacy in treatment-resistant depression. Future studies are needed to test the predictive potential for clinical applications of TMS-EEG markers.
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Affiliation(s)
- Rebecca Strafella
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Davide Momi
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Krembil Centre for Neuroinformatics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Reza Zomorrodi
- Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jennifer Lissemore
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California
| | - Yoshihiro Noda
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Robert Chen
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tarek K Rajji
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto Dementia Research Alliance, University of Toronto, Toronto, Ontario, Canada
| | - John D Griffiths
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Krembil Centre for Neuroinformatics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Fidel Vila-Rodriguez
- Non-Invasive Neurostimulation Therapies Laboratory, Vancouver, British Columbia, Canada; Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathan Downar
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of California San Diego, La Jolla, California
| | - Daniel M Blumberger
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Daphne Voineskos
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
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Miron JP, Couture M, Desbeaumes Jodoin V, Bousseau E, Massé-Leblanc C, Bolduc C, Blumberger DM, Datta A, Nitsche MA, Lespérance P. Contact dermatitis following an intensive transcranial direct current stimulation protocol for major depressive disorder. Brain Stimul 2023; 16:1273-1275. [PMID: 37619893 DOI: 10.1016/j.brs.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 08/26/2023] Open
Affiliation(s)
- Jean-Philippe Miron
- Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, QC, Canada; Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada.
| | - Maxime Couture
- Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, QC, Canada
| | - Véronique Desbeaumes Jodoin
- Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, QC, Canada
| | - Emma Bousseau
- Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, QC, Canada
| | - Camille Massé-Leblanc
- Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, QC, Canada
| | - Chantal Bolduc
- Département de Médecine, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Campbell Family Research Institute, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Abhishek Datta
- Research and Development, Soterix Medical, Woodbridge, NJ, USA; City College of New York, New York, NY, USA
| | - Michael A Nitsche
- IfADo Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund, Germany & Bielefeld University, University Hospital OWL, Protestant Hospital of Bethel Foundation, University Clinic of Psychiatry and Psychotherapy, University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Germany
| | - Paul Lespérance
- Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, QC, Canada; Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
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Ibrahim C, Tang VM, Blumberger DM, Malik S, Tyndale RF, Trevizol AP, Barr MS, Daskalakis ZJ, Zangen A, Le Foll B. Efficacy of insula deep repetitive transcranial magnetic stimulation combined with varenicline for smoking cessation: A randomized, double-blind, sham controlled trial. Brain Stimul 2023; 16:1501-1509. [PMID: 37806524 DOI: 10.1016/j.brs.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/25/2023] [Accepted: 10/01/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Current smoking cessation treatments are limited in terms of efficacy, particularly with regards to long term abstinence. There is a large amount of evidence implicating the insula in nicotine addiction. OBJECTIVE To examine the efficacy of bilateral repetitive transcranial magnetic stimulation (rTMS) directed to the insular cortex with the H11 coil, relative to sham stimulation, on smoking abstinence and smoking outcomes in smokers who are receiving standard varenicline treatment. METHODS This randomized, double-blind, sham controlled trial recruited 42 participants who were randomized to receive either active (n = 24) or sham (n = 18) high frequency rTMS directed to the insula (4 weeks), while receiving varenicline treatment (12 weeks). The primary outcome was 7-day point prevalence abstinence at the end of 12 weeks. RESULTS Smokers in the active group had significantly higher abstinence rates than those in the sham group (82.4% vs. 30.7%, p = 0.013) at the end of treatment (Week 12). Secondary outcome measures of abstinence rate at the end of rTMS treatment (Week 4), abstinence rate at 6 months, and smoking outcomes (e.g., craving, withdrawal) showed no significant differences between groups. No differences were found in adverse events reported between the groups. CONCLUSION This study provides evidence of the potential benefit of having a combined treatment for smoking cessation using insula rTMS with the H11 coil and varenicline. Maintenance rTMS sessions and continuation of varenicline for those in abstinence may induce longer-term effects and should be considered in future studies.
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Affiliation(s)
- Christine Ibrahim
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Victor M Tang
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Daniel M Blumberger
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre of Addiction and Mental Health, Toronto, ON, Canada
| | - Saima Malik
- Canadian Institutes of Health Research, Ottawa, ON, Canada
| | - Rachel F Tyndale
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alisson P Trevizol
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre of Addiction and Mental Health, Toronto, ON, Canada
| | - Mera S Barr
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry, School of Medicine, University of California, San Diego Health, San Diego, CA, United States
| | - Abraham Zangen
- Department of Life Sciences and Zelman Centre for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva Israel
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Addictions Division, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Acute Care Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada.
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Wong S, Yu AY, Fabiano N, Finkelstein O, Pasricha A, Jones BDM, Rosenblat JD, Blumberger DM, Mulsant BH, Husain MI. Beyond Psilocybin: Reviewing the Therapeutic Potential of Other Serotonergic Psychedelics in Mental and Substance Use Disorders. J Psychoactive Drugs 2023:1-17. [PMID: 37615379 DOI: 10.1080/02791072.2023.2251133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
There has been a resurgence of interest in the use of psychedelic therapies for several mental and substance use disorders. Psilocybin, a "classic" serotonergic psychedelic, has emerged as one of the primary compounds of interest in clinical research. While research on psilocybin's potential mental health benefits has grown, data on the safety and efficacy of other serotonergic psychedelics remain limited. A comprehensive scoping review on the use of mescaline, ibogaine, ayahuasca, N,N-dimethyltryptamine (DMT), and lysergic acid diethylamide (LSD) in the treatment of mental and substance disorders was conducted. Independent reviewers screened titles, abstracts, and full texts and conducted data extraction. Seventy-seven studies met the inclusion criteria. There were 43 studies of LSD, 24 studies of ayahuasca, 5 studies of DMT, 5 studies of ibogaine, and 5 studies of mescaline. Commonly reported benefits included improved mood and anxiety symptoms, improved insight, reduced substance use, improved relationships, and decreased vegetative symptoms. Commonly reported adverse effects were psychological, neurological, physical, and gastrointestinal in nature. Serious adverse events (homicide and suicide) were reported in published studies of LSD. In conclusion, there is only low-level evidence to support the safety and efficacy of non-psilocybin serotonergic psychedelics in individuals with mental and substance use disorders.
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Affiliation(s)
- Stanley Wong
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - An Yi Yu
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas Fabiano
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Ofer Finkelstein
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Aryan Pasricha
- Department of Health & Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Brett D M Jones
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Joshua D Rosenblat
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Mood Disorder Psychopharmacology Unit, Unity Health Network, Toronto, Ontario, Canada
| | - Daniel M Blumberger
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Benoit H Mulsant
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - M Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Zrenner B, Zrenner C, Balderston N, Blumberger DM, Kloiber S, Laposa JM, Tadayonnejad R, Trevizol AP, Zai G, Feusner JD. Toward personalized circuit-based closed-loop brain-interventions in psychiatry: using symptom provocation to extract EEG-markers of brain circuit activity. Front Neural Circuits 2023; 17:1208930. [PMID: 37671039 PMCID: PMC10475600 DOI: 10.3389/fncir.2023.1208930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/31/2023] [Indexed: 09/07/2023] Open
Abstract
Symptom provocation is a well-established component of psychiatric research and therapy. It is hypothesized that specific activation of those brain circuits involved in the symptomatic expression of a brain pathology makes the relevant neural substrate accessible as a target for therapeutic interventions. For example, in the treatment of obsessive-compulsive disorder (OCD), symptom provocation is an important part of psychotherapy and is also performed prior to therapeutic brain stimulation with transcranial magnetic stimulation (TMS). Here, we discuss the potential of symptom provocation to isolate neurophysiological biomarkers reflecting the fluctuating activity of relevant brain networks with the goal of subsequently using these markers as targets to guide therapy. We put forward a general experimental framework based on the rapid switching between psychiatric symptom states. This enable neurophysiological measures to be derived from EEG and/or TMS-evoked EEG measures of brain activity during both states. By subtracting the data recorded during the baseline state from that recorded during the provoked state, the resulting contrast would ideally isolate the specific neural circuits differentially activated during the expression of symptoms. A similar approach enables the design of effective classifiers of brain activity from EEG data in Brain-Computer Interfaces (BCI). To obtain reliable contrast data, psychiatric state switching needs to be achieved multiple times during a continuous recording so that slow changes of brain activity affect both conditions equally. This is achieved easily for conditions that can be controlled intentionally, such as motor imagery, attention, or memory retention. With regard to psychiatric symptoms, an increase can often be provoked effectively relatively easily, however, it can be difficult to reliably and rapidly return to a baseline state. Here, we review different approaches to return from a provoked state to a baseline state and how these may be applied to different symptoms occurring in different psychiatric disorders.
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Affiliation(s)
- Brigitte Zrenner
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- University Psychiatry Hospital, University of Tübingen, Tübingen, Germany
| | - Christoph Zrenner
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute for Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- University Neurology Hospital, University of Tübingen, Tübingen, Germany
| | - Nicholas Balderston
- Center for Neuromodulation in Depression and Stress (CNDS), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Daniel M. Blumberger
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Stefan Kloiber
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Judith M. Laposa
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Reza Tadayonnejad
- TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
- Division of the Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, United States
| | - Alisson Paulino Trevizol
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Gwyneth Zai
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jamie D. Feusner
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
- Division of the Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, United States
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
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Lynch CJ, Elbau I, Ng T, Ayaz A, Zhu S, Manfredi N, Johnson M, Wolk D, Power JD, Gordon EM, Kay K, Aloysi A, Moia S, Caballero-Gaudes C, Victoria LW, Solomonov N, Goldwaser E, Zebley B, Grosenick L, Downar J, Vila-Rodriguez F, Daskalakis ZJ, Blumberger DM, Williams N, Gunning FM, Liston C. Expansion of a frontostriatal salience network in individuals with depression. bioRxiv 2023:2023.08.09.551651. [PMID: 37645792 PMCID: PMC10461904 DOI: 10.1101/2023.08.09.551651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Hundreds of neuroimaging studies spanning two decades have revealed differences in brain structure and functional connectivity in depression, but with modest effect sizes, complicating efforts to derive mechanistic pathophysiologic insights or develop biomarkers. 1 Furthermore, although depression is a fundamentally episodic condition, few neuroimaging studies have taken a longitudinal approach, which is critical for understanding cause and effect and delineating mechanisms that drive mood state transitions over time. The emerging field of precision functional mapping using densely-sampled longitudinal neuroimaging data has revealed unexpected, functionally meaningful individual differences in brain network topology in healthy individuals, 2-5 but these approaches have never been applied to individuals with depression. Here, using precision functional mapping techniques and 11 datasets comprising n=187 repeatedly sampled individuals and >21,000 minutes of fMRI data, we show that the frontostriatal salience network is expanded two-fold in most individuals with depression. This effect was replicable in multiple samples, including large-scale, group-average data (N=1,231 subjects), and caused primarily by network border shifts affecting specific functional systems, with three distinct modes of encroachment occurring in different individuals. Salience network expansion was unexpectedly stable over time, unaffected by changes in mood state, and detectable in children before the subsequent onset of depressive symptoms in adolescence. Longitudinal analyses of individuals scanned up to 62 times over 1.5 years identified connectivity changes in specific frontostriatal circuits that tracked fluctuations in specific symptom domains and predicted future anhedonia symptoms before they emerged. Together, these findings identify a stable trait-like brain network topology that may confer risk for depression and mood-state dependent connectivity changes in frontostriatal circuits that predict the emergence and remission of depressive symptoms over time.
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Voineskos D, Blumberger DM. Transcranial direct current stimulation as a treatment for major depressive disorder. Lancet 2023; 402:506-507. [PMID: 37414063 DOI: 10.1016/s0140-6736(23)00822-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/19/2023] [Indexed: 07/08/2023]
Affiliation(s)
- Daphne Voineskos
- Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Azami H, Zrenner C, Brooks H, Zomorrodi R, Blumberger DM, Fischer CE, Flint A, Herrmann N, Kumar S, Lanctôt K, Mah L, Mulsant BH, Pollock BG, Rajji TK. Beta to theta power ratio in EEG periodic components as a potential biomarker in mild cognitive impairment and Alzheimer's dementia. Alzheimers Res Ther 2023; 15:133. [PMID: 37550778 PMCID: PMC10405483 DOI: 10.1186/s13195-023-01280-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/27/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Alzheimer's dementia (AD) is associated with electroencephalography (EEG) abnormalities including in the power ratio of beta to theta frequencies. EEG studies in mild cognitive impairment (MCI) have been less consistent in identifying such abnormalities. One potential reason is not excluding the EEG aperiodic components, which are less associated with cognition than the periodic components. Here, we investigate whether aperiodic and periodic EEG components are disrupted differently in AD or MCI vs. healthy control (HC) individuals and whether a periodic based beta/theta ratio differentiates better MCI from AD and HC groups than a ratio based on the full spectrum. METHODS Data were collected from 44 HC (mean age (SD) = 69.1 (5.3)), 114 MCI (mean age (SD) = 72.2 (7.5)), and 41 AD (mean age (SD) = 75.7 (6.5)) participants. Aperiodic and periodic components and full spectrum EEG were compared among the three groups. Receiver operating characteristic curves obtained via logistic regression classifications were used to distinguish the groups. Last, we explored the relationships between cognitive performance and the beta/theta ratios based on the full or periodic spectrum. RESULTS Aperiodic EEG components did not differ among the three groups. In contrast, AD participants showed an increase in full spectrum and periodic relative powers for delta, theta, and gamma and a decrease for beta when compared to HC or MCI participants. As predicted, MCI group differed from HC participants on the periodic based beta/theta ratio (Bonferroni corrected p-value = 0.036) measured over the occipital region. Classifiers based on beta/theta power ratio in EEG periodic components distinguished AD from HC and MCI participants, and outperformed classifiers based on beta/theta power ratio in full spectrum EEG. Beta/theta ratios were comparable in their association with cognition. CONCLUSIONS In contrast to a full spectrum EEG analysis, a periodic-based analysis shows that MCI individuals are different on beta/theta ratio when compared to healthy individuals. Focusing on periodic components in EEG studies with or without other biological markers of neurodegenerative diseases could result in more reliable findings to separate MCI from healthy aging, which would be valuable for designing preventative interventions.
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Affiliation(s)
- Hamed Azami
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Adult Neurodevelopment and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Christoph Zrenner
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Adult Neurodevelopment and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Heather Brooks
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Adult Neurodevelopment and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Reza Zomorrodi
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Daniel M Blumberger
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Adult Neurodevelopment and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Corinne E Fischer
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Alastair Flint
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
| | - Nathan Herrmann
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Sanjeev Kumar
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Adult Neurodevelopment and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Krista Lanctôt
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Linda Mah
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rotman Research Institute, Baycrest Health Sciences Centre, Toronto, ON, Canada
| | - Benoit H Mulsant
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Adult Neurodevelopment and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Bruce G Pollock
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Adult Neurodevelopment and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tarek K Rajji
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada.
- Adult Neurodevelopment and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada.
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Husain MI, Blumberger DM, Castle DJ, Ledwos N, Fellows E, Jones BDM, Ortiz A, Kloiber S, Wang W, Rosenblat JD, Mulsant BH. Psilocybin for treatment-resistant depression without psychedelic effects: study protocol for a 4-week, double-blind, proof-of-concept randomised controlled trial. BJPsych Open 2023; 9:e134. [PMID: 37489299 PMCID: PMC10375870 DOI: 10.1192/bjo.2023.535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Randomised controlled trials (RCTs) of psilocybin have reported large antidepressant effects in adults with major depressive disorder and treatment-resistant depression (TRD). Given psilocybin's psychedelic effects, all published studies have included psychological support. These effects depend on serotonin 2A (5-HT2A) receptor activation, which can be blocked by 5-HT2A receptor antagonists like ketanserin or risperidone. In an animal model of depression, ketanserin followed by psilocybin had similar symptomatic effects as psilocybin alone. AIMS To conduct a proof-of-concept RCT to (a) establish feasibility and tolerability of combining psilocybin and risperidone in adults with TRD, (b) show that this combination blocks the psychedelic effects of psilocybin and (c) provide pilot data on the antidepressant effect of this combination (compared with psilocybin alone). METHOD In a 4-week, three-arm, 'double dummy' trial, 60 adults with TRD will be randomised to psilocybin 25 mg plus risperidone 1 mg, psilocybin 25 mg plus placebo, or placebo plus risperidone 1 mg. All participants will receive 12 h of manualised psychotherapy. Measures of feasibility will include recruitment and retention rates; tolerability and safety will be assessed by rates of drop-out attributed to adverse events and rates of serious adverse events. The 5-Dimensional Altered States of Consciousness Rating Scale will be a secondary outcome measure. RESULTS This trial will advance the understanding of psilocybin's mechanism of antidepressant action. CONCLUSIONS This line of research could increase acceptability and access to psilocybin as a novel treatment for TRD without the need for a psychedelic experience and continuous monitoring.
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Affiliation(s)
- Muhammad Ishrat Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada; and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Daniel M Blumberger
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada; and Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Canada
| | - David J Castle
- Department of Psychiatry, University of Tasmania, Australia
| | - Nicole Ledwos
- General Adult Psychiatry and Health Systems Division, Centre for Addiction and Mental Health, Canada
| | - Elise Fellows
- General Adult Psychiatry and Health Systems Division, Centre for Addiction and Mental Health, Canada; and Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Brett D M Jones
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada; and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Abigail Ortiz
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada; and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Stefan Kloiber
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada; and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Wei Wang
- Centre for Complex Interventions, Centre for Addiction and Mental Health, Canada; and College of Public Health, University of South Florida, USA
| | - Joshua D Rosenblat
- Mood Disorder Psychopharmacology Program, Poul Hansen Depression Centre, Unit University Health Network, Canada
| | - Benoit H Mulsant
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada; and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada
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Tang VM, Goud R, Zawertailo L, Selby P, Coroiu A, Sloan ME, Chenoweth MJA, Buchman D, Ibrahim C, Blumberger DM, Foll BL. Repetitive transcranial magnetic stimulation for smoking cessation: Next steps for translation and implementation into clinical practice. Psychiatry Res 2023; 326:115340. [PMID: 37454610 DOI: 10.1016/j.psychres.2023.115340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
Tobacco smoking is a significant determinant of preventable morbidity and mortality worldwide. It is now possible to modulate the activity of the neurocircuitry associated with nicotine dependence using repetitive Transcranial Magnetic Stimulation (rTMS), a non-invasive neurostimulation approach, which has recently demonstrated efficacy in clinical trials and received regulatory approval in the US and Canada. However there remains a paucity of replication studies and real-world patient effectiveness data as access to this intervention is extremely limited. There are a number of unique challenges related to the delivery of rTMS that need to be addressed prior to widespread adoption and implementation of this treatment modality for smoking cessation. In this paper, we review the accessibility, scientific, technological, economical, and social challenges that remain before this treatment can be translated into clinical practice. By addressing these remaining barriers and scientific challenges with rTMS for smoking cessation and delineating implementation strategies, we can greatly reduce the burden of tobacco-related disease worldwide.
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Affiliation(s)
- Victor M Tang
- Addictions Division, Centre for Addiction and Mental Health, 100 Stokes St, Toronto, ON, Canada; Institute for Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Temerty Faculty of Medicine, Canada; Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Canada; Centre for Addiction and Mental Health, Institute of Mental Health Policy Research, Canada; Centre for Addiction and Mental Health, Temerty Centre for Therapeutic Brain Intervention, Canada.
| | - Rachel Goud
- Addictions Division, Centre for Addiction and Mental Health, 100 Stokes St, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Temerty Faculty of Medicine, Canada
| | - Laurie Zawertailo
- Addictions Division, Centre for Addiction and Mental Health, 100 Stokes St, Toronto, ON, Canada; Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Canada; Centre for Addiction and Mental Health, Institute of Mental Health Policy Research, Canada; Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Peter Selby
- Addictions Division, Centre for Addiction and Mental Health, 100 Stokes St, Toronto, ON, Canada; Institute for Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Temerty Faculty of Medicine, Canada; Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Canada; Centre for Addiction and Mental Health, Institute of Mental Health Policy Research, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Canada
| | - Adina Coroiu
- Addictions Division, Centre for Addiction and Mental Health, 100 Stokes St, Toronto, ON, Canada; Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Canada
| | - Matthew E Sloan
- Addictions Division, Centre for Addiction and Mental Health, 100 Stokes St, Toronto, ON, Canada; Institute for Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Temerty Faculty of Medicine, Canada; Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Canada; Centre for Addiction and Mental Health, Institute of Mental Health Policy Research, Canada; Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Meghan Jo-Ann Chenoweth
- Department of Psychiatry, University of Toronto, Temerty Faculty of Medicine, Canada; Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Canada; Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Daniel Buchman
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Canada; Dalla Lana School of Public Health, University of Toronto, Canada
| | - Christine Ibrahim
- Addictions Division, Centre for Addiction and Mental Health, 100 Stokes St, Toronto, ON, Canada; Institute for Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada; Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Daniel M Blumberger
- Institute for Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Temerty Faculty of Medicine, Canada; Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Canada; Centre for Addiction and Mental Health, Temerty Centre for Therapeutic Brain Intervention, Canada
| | - Bernard Le Foll
- Addictions Division, Centre for Addiction and Mental Health, 100 Stokes St, Toronto, ON, Canada; Institute for Medical Science, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Temerty Faculty of Medicine, Canada; Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Canada; Centre for Addiction and Mental Health, Institute of Mental Health Policy Research, Canada; Department of Pharmacology and Toxicology, Temerty Faculty of Medicine, University of Toronto, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Canada; Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada; Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada
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Lee HH, Trevizol AP, Mulsant BH, Rajji TK, Downar J, Daskalakis ZJ, Blumberger DM. Retreatment with theta burst stimulation (TBS) for late life depression (LLD): A retrospective chart review. J Psychiatr Res 2023; 164:454-457. [PMID: 37437317 DOI: 10.1016/j.jpsychires.2023.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/14/2023]
Affiliation(s)
- Hyewon H Lee
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Alisson P Trevizol
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Benoit H Mulsant
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Tarek K Rajji
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada
| | - Jonathan Downar
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of California, San Diego Health, California, United States
| | - Daniel M Blumberger
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
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Wathra RA, Men X, Elsheikh SSM, Marshe VS, Rajji TK, Lissemore JI, Mulsant BH, Karp JF, Reynolds CF, Lenze EJ, Daskalakis ZJ, Müller DJ, Blumberger DM. Exploratory genome-wide analyses of cortical inhibition, facilitation, and plasticity in late-life depression. Transl Psychiatry 2023; 13:234. [PMID: 37391420 DOI: 10.1038/s41398-023-02532-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 07/02/2023] Open
Abstract
Late-life depression (LLD) is a heterogenous mood disorder influenced by genetic factors. Cortical physiological processes such as cortical inhibition, facilitation, and plasticity may be markers of illness that are more strongly associated with genetic factors than the clinical phenotype. Thus, exploring the relationship between genetic factors and these physiological processes may help to characterize the biological mechanisms underlying LLD and improve diagnosis and treatment selection. Transcranial magnetic stimulation (TMS) combined with electromyography was used to measure short interval intracortical inhibition (SICI), cortical silent period (CSP), intracortical facilitation (ICF), and paired associative stimulation (PAS) in 79 participants with LLD. We used exploratory genome-wide association and gene-based analyses to assess for genetic correlations of these TMS measures. MARK4 (which encodes microtubule affinity-regulating kinase 4) and PPP1R37 (which encodes protein phosphatase 1 regulatory subunit 37) showed genome-wide significant association with SICI. EGFLAM (which encodes EGF-like fibronectin type III and laminin G domain) showed genome-wide significant association with CSP. No genes met genome-wide significant association with ICF or PAS. We observed genetic influences on cortical inhibition in older adults with LLD. Replication with larger sample sizes, exploration of clinical phenotype subgroups, and functional analysis of relevant genotypes is warranted to better characterize genetic influences on cortical physiology in LLD. This work is needed to determine whether cortical inhibition may serve as a biomarker to improve diagnostic precision and guide treatment selection in LLD.
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Affiliation(s)
- Rafae A Wathra
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, M6J 1H4, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, M5T 1R8, Canada
| | - Xiaoyu Men
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, M5T 1R8, Canada
| | - Samar S M Elsheikh
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, M5T 1R8, Canada
| | - Victoria S Marshe
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, M5T 1R8, Canada
| | - Tarek K Rajji
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, M6J 1H4, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, M5T 1R8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, M5T 1R8, Canada
- Toronto Dementia Research Alliance, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer I Lissemore
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, USA
| | - Benoit H Mulsant
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, M5T 1R8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, M5T 1R8, Canada
- Toronto Dementia Research Alliance, University of Toronto, Toronto, Ontario, Canada
| | - Jordan F Karp
- Department of Psychiatry, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Daniel J Müller
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, M5T 1R8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, M5T 1R8, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, M6J 1H4, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, M5T 1R8, Canada.
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, M5T 1R8, Canada.
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Ortiz A, Park Y, Gonzalez-Torres C, Alda M, Blumberger DM, Burnett R, Husain MI, Sanches M, Mulsant BH. Predictors of adherence to electronic self-monitoring in patients with bipolar disorder: a contactless study using Growth Mixture Models. Int J Bipolar Disord 2023; 11:18. [PMID: 37195477 DOI: 10.1186/s40345-023-00297-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/14/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Several studies have reported on the feasibility of electronic (e-)monitoring using computers or smartphones in patients with mental disorders, including bipolar disorder (BD). While studies on e-monitoring have examined the role of demographic factors, such as age, gender, or socioeconomic status and use of health apps, to our knowledge, no study has examined clinical characteristics that might impact adherence with e-monitoring in patients with BD. We analyzed adherence to e-monitoring in patients with BD who participated in an ongoing e-monitoring study and evaluated whether demographic and clinical factors would predict adherence. METHODS Eighty-seven participants with BD in different phases of the illness were included. Patterns of adherence for wearable use, daily and weekly self-rating scales over 15 months were analyzed to identify adherence trajectories using growth mixture models (GMM). Multinomial logistic regression models were fitted to compute the effects of predictors on GMM classes. RESULTS Overall adherence rates were 79.5% for the wearable; 78.5% for weekly self-ratings; and 74.6% for daily self-ratings. GMM identified three latent class subgroups: participants with (i) perfect; (ii) good; and (iii) poor adherence. On average, 34.4% of participants showed "perfect" adherence; 37.1% showed "good" adherence; and 28.2% showed poor adherence to all three measures. Women, participants with a history of suicide attempt, and those with a history of inpatient admission were more likely to belong to the group with perfect adherence. CONCLUSIONS Participants with higher illness burden (e.g., history of admission to hospital, history of suicide attempts) have higher adherence rates to e-monitoring. They might see e-monitoring as a tool for better documenting symptom change and better managing their illness, thus motivating their engagement.
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Affiliation(s)
- Abigail Ortiz
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Campbell Family Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
| | - Yunkyung Park
- Campbell Family Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Christina Gonzalez-Torres
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- National Institute of Mental Health, Klecany, Czech Republic
| | - Daniel M Blumberger
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Rachael Burnett
- Campbell Family Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - M Ishrat Husain
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Marcos Sanches
- Campbell Family Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Benoit H Mulsant
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
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Demchenko I, Tassone VK, Dunnett S, Balachandar A, Li S, Anderson M, Daskalakis ZJ, Foley K, Karkouti K, Kennedy SH, Ladha KS, Robertson J, Vaisman A, Koczerginski D, Parikh SV, Blumberger DM, Flint AJ, Bhat V. Impact of COVID-19 on electroconvulsive therapy practice across Canadian provinces during the first wave of the pandemic. BMC Psychiatry 2023; 23:327. [PMID: 37165333 PMCID: PMC10170445 DOI: 10.1186/s12888-023-04832-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/30/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is a procedural treatment that is potentially life-saving for some patients with severe psychiatric illness. At the start of the global coronavirus disease 2019 (COVID-19) pandemic, ECT practice was remarkably disrupted, putting vulnerable individuals at increased risk of symptom exacerbation and death by suicide. This study aimed to capture the self-reported experiences of psychiatrists based at healthcare facilities across Canadian provinces who were delivering ECT treatments during the first phase of the COVID-19 pandemic (i.e., from mid-March 2020 to mid-May 2020). METHODS A multidisciplinary team of experts developed a survey focusing on five domains: ECT unit operations, decision-making, hospital resources, ECT procedure, and mitigating patient impact. Responses were collected from psychiatrists providing ECT at 67 ECT centres in Canada, grouped by four geographical regions (Ontario, Quebec, Atlantic Canada, and Western Canada). RESULTS Clinical operations of ECT programs were disrupted across all four regions - however, centres in Atlantic Canada were able to best preserve outpatient and maintenance care, while centres in Western Canada were able to best preserve inpatient and acute care. Similarly, Atlantic and Western Canada demonstrated the best decision-making practices of involving the ECT team and clinical ethicists in the development of pandemic-related guidelines. Across all four regions, ECT practice was affected by the redeployment of professionals, the shortage of personal protective equipment, and the need to enforce social distancing. Attempts to introduce modifications to the ECT delivery room and minimize bag-valve-mask ventilation were consistently reported. All four regions developed a new patient prioritization framework, and Western Canada, notably, aimed to provide ECT to only the most severe cases. CONCLUSIONS The results suggest that ECT provision was disproportionately affected across different parts of Canada. Possible factors that could explain these interregional differences include population, distribution of urban vs. rural areas, pre-pandemic barriers in access to ECT, number of cases, ability to control the spread of infection, and the general reduction in physicians' activities across different areas of health care. Studying these factors in the future will inform how medical centres should respond to public health emergencies and pandemic-related circumstances in the context of procedural treatments.
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Affiliation(s)
- Ilya Demchenko
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael's Hospital, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Vanessa K Tassone
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael's Hospital, Toronto, ON, Canada
| | - Sarah Dunnett
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael's Hospital, Toronto, ON, Canada
| | - Arpana Balachandar
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael's Hospital, Toronto, ON, Canada
| | - Sophie Li
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael's Hospital, Toronto, ON, Canada
| | - Melanie Anderson
- Library and Information Services, University Health Network, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
| | - Karen Foley
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Keyvan Karkouti
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sidney H Kennedy
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael's Hospital, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Karim S Ladha
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, St. Michael's Hospital, Toronto, ON, Canada
| | - Jamie Robertson
- Centre for Clinical Ethics, St. Michael's Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Alon Vaisman
- Department of Infection Prevention and Control, University Health Network, Toronto, ON, Canada
| | - David Koczerginski
- Department of Psychiatry, North York General Hospital, Toronto, ON, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Daniel M Blumberger
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alastair J Flint
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Mental Health, University Health Network, Toronto, ON, Canada
| | - Venkat Bhat
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael's Hospital, Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Kelkar RS, Sreeraj VS, Mehta UM, Patwardhan AA, Thirthalli J, Blumberger DM. Generalized seizure induced by continuous theta-burst stimulation (cTBS) in a patient with bipolar depression: A case report. Brain Stimul 2023; 16:693-694. [PMID: 37068732 PMCID: PMC7614549 DOI: 10.1016/j.brs.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/17/2023] [Accepted: 04/15/2023] [Indexed: 04/19/2023] Open
Affiliation(s)
- Radhika Suneel Kelkar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, 560029, India.
| | - Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, 560029, India
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, 560029, India
| | - Ameya A Patwardhan
- Neurology division, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, 560029, India
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Poorganji M, Zomorrodi R, Hawco C, Hill AT, Hadas I, Zrenner C, Rajji TK, Chen R, Voineskos D, Blumberger DM, Daskalakis ZJ. Isolating sensory artifacts in the suprathreshold TMS-EEG signal over DLPFC. Sci Rep 2023; 13:6796. [PMID: 37100795 PMCID: PMC10130812 DOI: 10.1038/s41598-023-29920-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/13/2023] [Indexed: 04/28/2023] Open
Abstract
Combined transcranial magnetic stimulation and electroencephalography (TMS-EEG) is an effective way to evaluate neurophysiological processes at the level of the cortex. To further characterize the TMS-evoked potential (TEP) generated with TMS-EEG, beyond the motor cortex, we aimed to distinguish between cortical reactivity to TMS versus non-specific somatosensory and auditory co-activations using both single-pulse and paired-pulse protocols at suprathreshold stimulation intensities over the left dorsolateral prefrontal cortex (DLPFC). Fifteen right-handed healthy participants received six blocks of stimulation including single and paired TMS delivered as active-masked (i.e., TMS-EEG with auditory masking and foam spacing), active-unmasked (TMS-EEG without auditory masking and foam spacing) and sham (sham TMS coil). We evaluated cortical excitability following single-pulse TMS, and cortical inhibition following a paired-pulse paradigm (long-interval cortical inhibition (LICI)). Repeated measure ANOVAs revealed significant differences in mean cortical evoked activity (CEA) of active-masked, active-unmasked, and sham conditions for both the single-pulse (F(1.76, 24.63) = 21.88, p < 0.001, η2 = 0.61) and LICI (F(1.68, 23.49) = 10.09, p < 0.001, η2 = 0.42) protocols. Furthermore, global mean field amplitude (GMFA) differed significantly across the three conditions for both single-pulse (F(1.85, 25.89) = 24.68, p < 0.001, η2 = 0.64) and LICI (F(1.8, 25.16) = 14.29, p < 0.001, η2 = 0.5). Finally, only active LICI protocols but not sham stimulation ([active-masked (0.78 ± 0.16, P < 0.0001)], [active-unmasked (0.83 ± 0.25, P < 0.01)]) resulted in significant signal inhibition. While previous findings of a significant somatosensory and auditory contribution to the evoked EEG signal are replicated by our study, an artifact attenuated cortical reactivity can reliably be measured in the TMS-EEG signal with suprathreshold stimulation of DLPFC. Artifact attenuation can be accomplished using standard procedures, and even when masked, the level of cortical reactivity is still far above what is produced by sham stimulation. Our study illustrates that TMS-EEG of DLPFC remains a valid investigational tool.
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Affiliation(s)
- Mohsen Poorganji
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Reza Zomorrodi
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Colin Hawco
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Aron T Hill
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Itay Hadas
- Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0603, USA
| | - Christoph Zrenner
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Tarek K Rajji
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada
| | - Robert Chen
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Daphne Voineskos
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0603, USA.
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Weissman CR, Bermudes RA, Voigt J, Liston C, Williams N, Blumberger DM, Fitzgerald PB, Daskalakis ZJ. Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression: Mismatch of Evidence and Insurance Coverage Policies in the United States. J Clin Psychiatry 2023; 84. [PMID: 37103918 DOI: 10.4088/jcp.22com14575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Affiliation(s)
- Cory R Weissman
- Department of Psychiatry, University of California San Diego, La Jolla, California
- Corresponding author: Cory R. Weissman, MD, Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92161
| | | | - Jeffrey Voigt
- Medical Device Consultants of Ridgewood, LLC, Ridgewood, New Jersey
| | - Conor Liston
- Department of Psychiatry, Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York
| | - Nolan Williams
- Stanford Brain Stimulation Laboratory, Stanford University, Stanford, California
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Campbell Family Research Institute, Centre for Addiction and Mental Health and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paul B Fitzgerald
- Australian National University School of Medicine and Psychology, Canberra, Australia
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of California San Diego, La Jolla, California
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Das S, Zomorrodi R, Mirjalili M, Kirkovski M, Blumberger DM, Rajji TK, Desarkar P. Machine learning approaches for electroencephalography and magnetoencephalography analyses in autism spectrum disorder: A systematic review. Prog Neuropsychopharmacol Biol Psychiatry 2023; 123:110705. [PMID: 36574922 DOI: 10.1016/j.pnpbp.2022.110705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/04/2022] [Accepted: 12/21/2022] [Indexed: 12/26/2022]
Abstract
There are growing application of machine learning models to study the intricacies of non-linear and non-stationary characteristics of electroencephalography (EEG) and magnetoencephalography (MEG) data in neurobiologically complex and heterogeneous conditions such as autism spectrum disorder (ASD). Such tools have potential diagnostic applications, and given the highly heterogeneous presentation of ASD, might prove fruitful in early detection and therefore could facilitate very early intervention. We conducted a systematic review (PROSPERO ID#CRD42021257438) by searching PubMed, EMBASE, and PsychINFO for machine learning approaches for EEG and MEG analyses in ASD. Thirty-nine studies were identified, of which the majority (18) used support vector machines for classification; other successful methods included deep learning. Thirty-seven studies were found to employ EEG and two were found to employ MEG. This systematic review indicate that machine learning methods can be used to classify ASD, predict ASD diagnosis in high-risk infants as early as 3 months of age, predict ASD symptom severity, and classify states of cognition in ASD with high accuracy. Replication studies testing validity, reproducibility and generalizability in tandem with randomized controlled trials in ASD populations will likely benefit the field.
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Affiliation(s)
- Sushmit Das
- Centre for Addiction and Mental Health, Toronto, Canada; Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Reza Zomorrodi
- Centre for Addiction and Mental Health, Toronto, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Mina Mirjalili
- Centre for Addiction and Mental Health, Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Adult Neurodevelopmental and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Vector Institute for Artificial Intelligence, Toronto, ON, Canada
| | - Melissa Kirkovski
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia; Insitute for Health and Sport, Victoria University, Melbourne, Australia
| | - Daniel M Blumberger
- Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Tarek K Rajji
- Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Pushpal Desarkar
- Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada.
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49
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Lenze EJ, Mulsant BH, Roose SP, Lavretsky H, Reynolds CF, Blumberger DM, Brown PJ, Cristancho P, Flint AJ, Gebara MA, Gettinger TR, Lenard E, Miller JP, Nicol GE, Oughli HA, Pham VT, Rollman BL, Yang L, Karp JF. Antidepressant Augmentation versus Switch in Treatment-Resistant Geriatric Depression. N Engl J Med 2023; 388:1067-1079. [PMID: 36867173 PMCID: PMC10568698 DOI: 10.1056/nejmoa2204462] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND The benefits and risks of augmenting or switching antidepressants in older adults with treatment-resistant depression have not been extensively studied. METHODS We conducted a two-step, open-label trial involving adults 60 years of age or older with treatment-resistant depression. In step 1, patients were randomly assigned in a 1:1:1 ratio to augmentation of existing antidepressant medication with aripiprazole, augmentation with bupropion, or a switch from existing antidepressant medication to bupropion. Patients who did not benefit from or were ineligible for step 1 were randomly assigned in step 2 in a 1:1 ratio to augmentation with lithium or a switch to nortriptyline. Each step lasted approximately 10 weeks. The primary outcome was the change from baseline in psychological well-being, assessed with the National Institutes of Health Toolbox Positive Affect and General Life Satisfaction subscales (population mean, 50; higher scores indicate greater well-being). A secondary outcome was remission of depression. RESULTS In step 1, a total of 619 patients were enrolled; 211 were assigned to aripiprazole augmentation, 206 to bupropion augmentation, and 202 to a switch to bupropion. Well-being scores improved by 4.83 points, 4.33 points, and 2.04 points, respectively. The difference between the aripiprazole-augmentation group and the switch-to-bupropion group was 2.79 points (95% CI, 0.56 to 5.02; P = 0.014, with a prespecified threshold P value of 0.017); the between-group differences were not significant for aripiprazole augmentation versus bupropion augmentation or for bupropion augmentation versus a switch to bupropion. Remission occurred in 28.9% of patients in the aripiprazole-augmentation group, 28.2% in the bupropion-augmentation group, and 19.3% in the switch-to-bupropion group. The rate of falls was highest with bupropion augmentation. In step 2, a total of 248 patients were enrolled; 127 were assigned to lithium augmentation and 121 to a switch to nortriptyline. Well-being scores improved by 3.17 points and 2.18 points, respectively (difference, 0.99; 95% CI, -1.92 to 3.91). Remission occurred in 18.9% of patients in the lithium-augmentation group and 21.5% in the switch-to-nortriptyline group; rates of falling were similar in the two groups. CONCLUSIONS In older adults with treatment-resistant depression, augmentation of existing antidepressants with aripiprazole improved well-being significantly more over 10 weeks than a switch to bupropion and was associated with a numerically higher incidence of remission. Among patients in whom augmentation or a switch to bupropion failed, changes in well-being and the occurrence of remission with lithium augmentation or a switch to nortriptyline were similar. (Funded by the Patient-Centered Outcomes Research Institute; OPTIMUM ClinicalTrials.gov number, NCT02960763.).
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Affiliation(s)
- Eric J Lenze
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Benoit H Mulsant
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Steven P Roose
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Helen Lavretsky
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Charles F Reynolds
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Daniel M Blumberger
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Patrick J Brown
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Pilar Cristancho
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Alastair J Flint
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Marie A Gebara
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Torie R Gettinger
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Emily Lenard
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - J Philip Miller
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Ginger E Nicol
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Hanadi A Oughli
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Vy T Pham
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Bruce L Rollman
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Lei Yang
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
| | - Jordan F Karp
- From the Department of Psychiatry (E.J.L., P.C., T.R.G., E.L., G.E.N., V.T.P., L.Y.) and the Division of Biostatistics (J.P.M.), Washington University School of Medicine, St. Louis; the Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto (B.H.M., D.M.B., A.J.F.), the Centre for Addiction and Mental Health (B.H.M., D.M.B.), and the Centre for Mental Health, University Health Network (A.J.F.) - all in Toronto; Columbia University College of Physicians and Surgeons and the Department of Psychiatry, New York State Psychiatric Institute - both in New York (S.P.R., P.J.B.); the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles (H.L., H.A.O.); University of Pittsburgh School of Medicine, Pittsburgh (C.F.R., M.A.G., B.L.R.); and the Department of Psychiatry, College of Medicine, University of Arizona, Tucson (J.F.K.)
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Nikolin S, Moffa A, Razza L, Martin D, Brunoni A, Palm U, Padberg F, Bennabi D, Haffen E, Blumberger DM, Salehinejad MA, Loo CK. Time-course of the tDCS antidepressant effect: An individual participant data meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2023; 125:110752. [PMID: 36931456 DOI: 10.1016/j.pnpbp.2023.110752] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023]
Abstract
INTRODUCTION Prefrontal transcranial direct current stimulation (tDCS) shows promise as an effective treatment for depression. However, factors influencing treatment and the time-course of symptom improvements remain to be elucidated. METHODS Individual participant data was collected from ten randomised controlled trials of tDCS in depression. Depressive symptom scores were converted to a common scale, and a linear mixed effects individual growth curve model was fit to the data using k-fold cross-validation to prevent overfitting. RESULTS Data from 576 participants were analysed (tDCS: n = 311; sham: n = 265), of which 468 were unipolar and 108 had bipolar disorder. tDCS effect sizes reached a peak at approximately 6 weeks, and continued to diverge from sham up to 10 weeks. Significant predictors associated with worse response included higher baseline depression severity, treatment resistance, and those associated with better response included bipolar disorder and anxiety disorder. CONCLUSIONS Our findings suggest that longer treatment courses, lasting at least 6 weeks in duration, may be indicated. Further, our results show that tDCS is effective for depressive symptoms in bipolar disorder. Compared to unipolar depression, participants with bipolar disorder may require additional maintenance sessions to prevent rapid relapse.
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Affiliation(s)
- Stevan Nikolin
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia.
| | - Adriano Moffa
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Lais Razza
- Serviço Interdisciplinar de Neuromodulação (SIN), Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil; Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium; Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Donel Martin
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
| | - Andre Brunoni
- Laboratory of Neurosciences (LIM-27), Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, Brazil; Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo & Hospital Universitário, Universidade de São Paulo, Brazil
| | - Ulrich Palm
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany; Medical Park Chiemseeblick, Bernau-Felden, Germany
| | - Djamila Bennabi
- Centre d'Investigation Clinique, CIC-INSERM-1431, Centre Hospitalier Universitaire de Besançon CHU, Besançon, France
| | - Emmanuel Haffen
- Centre d'Investigation Clinique, CIC-INSERM-1431, Centre Hospitalier Universitaire de Besançon CHU, Besançon, France
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Mohammad Ali Salehinejad
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Colleen K Loo
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
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