Non-inferiority of intermittent theta burst stimulation over the left V1 vs. classical target for depression: A randomized, double-blind trial

BACKGROUND

Repetitive transcranial magnetic stimulation (rTMS) targeting the visual cortex (VC) has shown antidepressant effects for major depressive disorder (MDD) in sham-controlled trials, but comparisons with rTMS targeting the left dorsolateral prefrontal cortex (DLPFC) are lacking. We aimed to determine the non-inferiority of intermittent theta-burst stimulation (iTBS) over VC vs DLPFC for MDD.

METHODS

Participants randomly received navigated iTBS over the left V1 or the left DLPFC twice daily for 14 days with a 3-month follow-up. The primary outcome was change in Hamilton Depression Rating Scale (HAMD-17) score from baseline to treatment end, with 2.5 points as the non-inferiority margin. Secondary outcomes included: improvement in Montgomery-Asberg Depression Rating Scale (MADRS), Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA); response and remission rates; suicidal ideation and adverse events.

RESULTS

Of 75 randomized patients, 67 completed full treatment, including 52 first-episode patients and 15 relapsers. The primary outcome indicated the non-inferiority of VC (adjusted difference 1.14, lower 97.5 % CI -1.24; p = .002), confirmed by improvements in objective cognitive task and protein levels, as did most secondary outcomes. Reduced suicidal ideation after treatment, incidence of eye discomfort and pain score were lower in the VC group.

CONCLUSIONS

Left VC iTBS has the potential to be non-inferior to DLPFC iTBS in most first-episode MDD in improving depressive symptoms and cognitive function, with less suicidal ideation and adverse events.

LIMITATIONS

Given the limited sample size, the lack of a sham control and the use of antidepressants, the findings should be interpreted with caution.

Negative bias in early and late cognitive processing of coronary heart disease patients with depressive symptoms: an EPR study

BACKGROUND

The purpose of this research was to explore the underlying mechanisms of cognitive impairments in patients with coronary heart disease (CHD) who exhibit depressive symptoms. This was accomplished by recording Event-related potentials (ERPs) during the emotional Stroop task, with a specific focus on the temporal dynamics of attentional bias towards various emotional words.

METHODS

We selected 17 CHD patients with depressive symptoms and 23 CHD patients without depression using a convenience sampling method from the Affiliated Hospital of Weifang Medical University. Each participant completed an emotional Stroop color-word task, and ERPs were recorded during the task to examine cognitive processing.

RESULTS

CHD patients with depressive symptoms exhibited generally smaller amplitudes of N1, N2, P3 and longer latency of P3 compared to CHD patients without depression. Specifically, the N1 amplitude of negative words was smaller and the P3 amplitude of negative words was larger in the CHD with depressive group compared to the CHD group. Furthermore, within the group of CHD patients with depressive symptoms, negative words elicited a smaller N1 amplitude and larger P3 amplitude compared to positive and neutral words.

CONCLUSIONS

CHD patients with depressive symptoms demonstrate decreased attentional resources, leading to cognitive impairments. Notably, significant attentional bias occurs during both early and later stages of cognitive processing. This bias is primarily characterized by an enhanced automatic processing of negative information at the early stage and difficulty disengaging from such information at the later stage. These findings contribute to the existing literature on the cognitive neural mechanisms underlying depression in CHD patients.

Feelings of fear, sadness, and loneliness during the COVID-19 pandemic: Findings from two studies in the UK

During the COVID-19 pandemic, exposure to COVID-related stimuli, has been enormous. Exposure to threat-related stimuli, can have a significant impact on people's wellbeing particularly in relation to COVID-related anxiety. The present research comprises two empirical studies. In Study 1, a newly developed Emotional Stroop Task (EST) and an Image Rating Task (IRT) were used to assess, automatic and non-automatic affective responses to COVID-related words and images during the first wave of the pandemic in the UK general population. In Study 2, the same tasks were used to evaluate the affective responses of University students during the second wave of the pandemic. Additionally, loneliness and pro-social behaviours were explored in relation COVID-related anxiety in the same population. Overall, the results showed that automatic affective responses as measured by interference effects on the EST, remained unaffected during the pandemic. However, non-automatic affective responses to COVID-related images measured by the IRT, indicated that participants rated these images as more fearful sadder and higher in anger, compared to non-COVID negative images matched for arousal and negativity and this was more evident in people with high COVID-anxiety. Trait anxiety was related to higher levels of loneliness, more prosocial behaviour and higher intentions to help others, while COVID-related anxiety mediated these effects, suggesting that for high levels of trait anxiety, participants were more likely to have helped someone in need during the pandemic when their COVID-anxiety levels were low.

Depressed mood, brooding rumination and affective interference: The moderating role of heart rate variability

Facilitated processing of negative information might contribute to the etiopathogenesis and maintenance of depressive symptoms. Cardiac vagal tone, indexed by heart rate variability (HRV), is believed to represent a proxy of the functional integrity of the neural networks implicated in brooding rumination, affective interference and depression. The present study examined whether HRV may moderate the relation between brooding rumination, affective interference and depressive symptoms in a sample of healthy individuals (n = 68) with different degrees of depressed mood. Self-report measures of depression and brooding were collected, whereas the emotional Stroop task was employed to measure affective interference. Three-minute resting-state electrocardiogram was recorded to obtain time- and frequency-domain vagally mediated HRV parameters. Stepwise linear regression analyses revealed that HRV was a significant moderator of the positive association between depression and brooding rumination, but not of the association between depression and affective interference. An integrated model is supported, in which vagally mediated HRV appeared to potentiate the positive link between depressive symptoms and brooding rumination. Considering that HRV and brooding rumination were found to have an interacting role in determining the severity of depressive symptoms, they may represent potential clinical targets in the prevention and treatment of depressive symptoms.

Fronto-temporal brain activity and connectivity track implicit attention to positive and negative social words in a novel socio-emotional Stroop task

Previous inconsistencies on the effects of implicitly processing positively - vs. negatively - connotated emotional words might reflect the influence of uncontrolled psycholinguistic dimensions, and/or social facets inherent in putative "emotional" stimuli. Based on the relevance of social features in semantic cognition, we developed a socio-emotional Stroop task to assess the influence of social vs. individual (non-social) emotional content, besides negative vs. positive valence, on implicit word processing. The effect of these variables was evaluated in terms of performance and RTs, alongside associated brain activity/connectivity. We matched conditions for several psycholinguistic variables, and assessed a modulation of brain activity/connectivity by trial-wise RT, to characterize the maximum of condition- and subject-specific variability. RTs were tracked by insular and anterior cingulate activations likely reflecting implicit attention to stimuli, interfering with task-performance based on condition-specific processing of their subjective salience. Slower performance for negative than neutral/positive words was tracked by left-hemispheric structures processing negative stimuli and emotions, such as fronto-insular cortex, while the lack of specific activations for positively-connotated words supported their marginal facilitatory effect. The speeding/slowing effects of processing positive/negative individual emotional stimuli were enhanced by social words, reflecting in specific activations of the right anterior temporal and orbitofrontal cortex, respectively. RTs to social positive and negative words modulated connectivity from these regions to fronto-striatal and sensorimotor structures, respectively, likely promoting approach vs. avoidance dispositions shaping their facilitatory vs. inhibitory effect. These results might help assessing the neural correlates of impaired social cognition and emotional regulation, and the effects of rehabilitative interventions.

Binary vs. continuous experimental designs for the study of unconscious perceptual processing

Binary vs. continuous conceptualizations of consciousness may have an unstated influence on experimental designs in unconscious perception research. The binary approach aims to compare a conscious condition (e.g., supraliminal, no or weak stimulus masking) to an unconscious condition (e.g., subliminal, heavy stimulus masking). In contrast, continuous designs tend to vary stimulus energy along a near-threshold continuum to determine changes in perception as a function of stimulus energy (or duration). The present study compared two experimental designs, binary vs. continuous, for the influence of target-masked prime stimuli on a Stroop task. The display parameters were inspired by emotional Stroop studies reporting unconscious perception. Neither experiment produced strong evidence of unconscious perception, but the experiment with a continuous design was more informative. We thus recommend sampling a range of near-threshold display parameters to yield straight-forward, unambiguous interpretations.

Bayesian informed evidence against modulation of androstadienone-effects by genotypic receptor variants and participant sex: A study assessing Stroop interference control, mood and olfaction

The androgen derivative androstadienone (AND) is present in human sweat and may act as human chemosignal. Though effects of AND have been reported with respect to emotional and cognitive processes, results have been highly inconsistent. For this reason, it is likely that AND-action is dependent on modulatory factors. Here we wanted to specifically investigate the impact of genotypic variations of the AND-receptor OR7D4, as well as the influence of participant sex and concomitant hormonal fluctuations on AND-action during emotional interference processing, olfactory performance and mood assessments. To this end 80 healthy individuals (women taking oral contraceptives; naturally cycling women measured during the luteal phase and men) were tested twice on two consecutive days (AND vs. placebo exposure) with an emotional Stroop task. Also, olfactory performance and mood was assessed. Participants provided saliva samples to measure testosterone, progesterone and estradiol and a blood sample to assess genotypic variations of the AND-receptor OR7D4. We found a small task-dependent reduction of overall error rates under AND but no modulation of effects by genetic variation or group (female OC, female NC, male) with respect to olfactory performance and mood. Additional analyses with help of Bayesian statistics gave strong evidence in favor of specific null hypotheses suggesting that the action of AND was not modulated by either genotypic variations or sex of participants with respect to interference control (bias indices), olfactory self-reports and mood parameters. Additional effects of AND in connection with hormonal fluctuations are reported.

Gender and neural substrates subserving implicit processing of death-related linguistic cues

Our recent functional magnetic resonance imaging study revealed decreased activities in the anterior cingulate cortex (ACC) and bilateral insula for women during the implicit processing of death-related linguistic cues. Current work tested whether aforementioned activities are common for women and men and explored potential gender differences. We scanned twenty males while they performed a color-naming task on death-related, negative-valence, and neutral-valence words. Whole-brain analysis showed increased left frontal activity and decreased activities in the ACC and bilateral insula to death-related versus negative-valence words for both men and women. However, relative to women, men showed greater increased activity in the left middle frontal cortex and decreased activity in the right cerebellum to death-related versus negative-valence words. The results suggest, while implicit processing of death-related words is characterized with weakened sense of oneself for both women and men, men may recruit stronger cognitive regulation of emotion than women.

Emotional interference and attentional processing in premenstrual syndrome

BACKGROUND AND OBJECTIVES

Premenstrual syndrome (PMS) is characterized by menstrual cycle-related affective, behavioral, and/or somatic symptoms. By applying the emotional Stroop task (EST) the current study examined if changes in processing emotional information, which have been demonstrated in affective disorders, are also present in PMS.

METHODS

Via online screening, telephone interviews, and daily records over two months 55 women for the PMS group (on the basis of the specific inclusion criteria and a prospectively confirmed PMS) and 55 'non-PMS' controls were recruited. All participants completed three emotional Stroop tasks (EST) with neutral and negative word, picture, and facial stimuli, during the follicular and luteal phase of the menstrual cycle.

RESULTS

Mixed 2 × 2 univariate analyses of variance and post-hoc comparisons showed primarily a greater emotional Stroop effect with respect to picture and facial stimuli in the luteal menstrual cycle phase in women with PMS, compared to the control group. No significant group differences were observed for word stimuli. With respect to the facial stimuli, a kind of paradox effect was revealed (Stroop facilitation) in the PMS group.

LIMITATIONS

This study provides important information regarding cognitive processes in women suffering from PMS that have to be interpreted in the light of the following limitations: a limited representativeness of the sample, the determination of menstrual cycle phases based on symptom diaries but not hormone levels, and a limited interpretability of our results as causal relationships.

CONCLUSIONS

Our findings are in line with the assumption that alterations in cognitive-emotional processes are associated with PMS. Further research on the etiology of PMS should focus more on cognitive-emotional processing and its interaction with biological changes relating to the menstrual cycle.

The locus of the emotional Stroop effect: a study with the PRP paradigm

Stimuli that are clearly positive or negative (hence valence-laden stimuli) have the potential to interrupt unrelated task processing. A typical example is the emotional Stroop effect (ESE) in which responding to a certain task feature (e.g., color) is delayed by the presentation of task-irrelevant valent stimuli (e.g., negative pictures) compared to valence-neutral stimuli. Here we scrutinize which processes are slowed down by irrelevant but valent stimulation. In Experiment 1, participants performed in a Psychological Refractory Period (PRP) experiment with tone discrimination as Task 1 and color discrimination as Task 2. Importantly, colors in Task 2 were accompanied by valent or neutral pictures. Valent pictures delayed responding in Task 2 (thus an ESE) and this delay was additive to the time interval between tasks. In Experiment 2, task order was reversed and the ESE in Task 1 fully propagated to the Task 2 tone discrimination. These results imply that irrelevant valence-laden stimulation delays capacity-limited processes, and we suggest that this is a late perceptual process acting on stimulus categorization.

Electrophysiological evidence of early attentional bias to drug-related pictures in chronic cannabis users

Behavioral and electrophysiological correlates of attentional bias to cannabis-related cues were investigated in a marijuana dependent group and a non-user group employing a drug Stroop task in which cannabis-related, negative and neutral images were presented. Behaviorally, cannabis users were less accurate during drug-containing blocks than non-users. Electrophysiologically, in chronic marijuana-users, an early positive ERP enhancement over left frontal scalp (EAP, 200-350ms) was present in response to drug-containing blocks relative to negative blocks. This effect was absent in the non-user group. Furthermore, drug-containing blocks gave rise to enhanced voltage of a posterior P300 (300-400ms), and a posterior sustained slow wave (LPP, 400-700ms) relative to negative blocks. However, such effects were similar between cannabis users and non-users. Brain source imaging in cannabis users revealed a generator for the EAP effect to drug stimuli in left ventromedial prefrontal cortex/medial orbitofrontal cortex, a region active in fMRI studies of drug cue-reactivity and a target of the core dopaminergic mesolimbic pathway involved in the processing of substances of abuse. This study identifies the timing and brain localization of an ERP correlate of early attentional capture to drug-related pictures in chronic marijuana users. The EAP to drug cues may identify a new electrophysiological marker with clinical implications for predicting abstinence versus relapse or to evaluate treatment interventions.