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Published Online: 18 May 2022

Predictive Value of Acute Neuroplastic Response to rTMS in Treatment Outcome in Depression: A Concurrent TMS-fMRI Trial

Ruiyang Ge, Ph.D., Afifa Humaira, B.Sc., Elizabeth Gregory, M.Sc., Golnoush Alamian, Ph.D., Erin L. MacMillan, Ph.D., Laura Barlow, R.T.R., R.T.M.R., Rebecca Todd, Ph.D., Sean Nestor, M.D., Ph.D., Sophia Frangou, M.D., Ph.D., and Fidel Vila-Rodriguez, M.D., Ph.D. [email protected]Authors Info & Affiliations
Publication: American Journal of Psychiatry
Volume 179, Number 7
https://doi.org/10.1176/appi.ajp.21050541
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Abstract

Objective:

The study objective was to investigate the predictive value of functional connectivity changes induced by acute repetitive transcranial magnetic stimulation (rTMS) for clinical response in treatment-resistant depression.

Methods:

Cross-sectional changes in functional connectivity induced by a single concurrent rTMS-fMRI session were assessed in 38 outpatients with treatment-resistant depression (26 of them female; mean age, 41.87 years) who subsequently underwent a 4-week course of rTMS. rTMS was delivered at 1 Hz over the right dorsolateral prefrontal cortex. Acute rTMS-induced functional connectivity changes were computed and subjected to connectome-based predictive modeling to test their association with changes in score on the Montgomery-Åsberg Depression Rating Scale (MADRS) after rTMS treatment.

Results:

TMS-fMRI induced widespread, acute, and transient alterations in functional connectivity. The rTMS-induced connectivity changes predicted about 30% of the variance of improvement in the MADRS score. The most robust predictive associations involved connections between prefrontal regions and motor, parietal, and insular cortices and between bilateral regions of the thalamus.

Conclusions:

Acute rTMS-induced connectivity changes in patients with treatment-resistant depression may index macro-level neuroplasticity, relevant to interindividual variability in rTMS treatment response. Large-scale network phenomena occurring during rTMS might be used to inform prospective clinical trials.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Volume 179 • Number 7 • July 2022
Pages: 500 - 508
PubMed: 35582784

History

Received: 28 May 2021
Revision received: 1 October 2021
Revision received: 3 December 2021
Accepted: 1 February 2022
Published online: 18 May 2022
Published in print: July 2022

Keywords

  1. Depressive Disorders
  2. Neurostimulation
  3. TMS
  4. Brain Imaging Techniques

Authors

Details

Ruiyang Ge, Ph.D.
Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Vila-Rodriguez); Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Todd, Frangou, Vila-Rodriguez); UBC MRI Research Centre, Department of Radiology, University of British Columbia, Vancouver (Barlow, MacMillan); SFU ImageTech Lab, Simon Fraser University, Vancouver (MacMillan); Philips Canada, Mississauga, Ont. (MacMillan); Department of Psychiatry, University of Toronto, Toronto (Nestor); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Frangou).
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Afifa Humaira, B.Sc.
Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Vila-Rodriguez); Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Todd, Frangou, Vila-Rodriguez); UBC MRI Research Centre, Department of Radiology, University of British Columbia, Vancouver (Barlow, MacMillan); SFU ImageTech Lab, Simon Fraser University, Vancouver (MacMillan); Philips Canada, Mississauga, Ont. (MacMillan); Department of Psychiatry, University of Toronto, Toronto (Nestor); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Frangou).
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Elizabeth Gregory, M.Sc.
Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Vila-Rodriguez); Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Todd, Frangou, Vila-Rodriguez); UBC MRI Research Centre, Department of Radiology, University of British Columbia, Vancouver (Barlow, MacMillan); SFU ImageTech Lab, Simon Fraser University, Vancouver (MacMillan); Philips Canada, Mississauga, Ont. (MacMillan); Department of Psychiatry, University of Toronto, Toronto (Nestor); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Frangou).
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Golnoush Alamian, Ph.D.
Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Vila-Rodriguez); Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Todd, Frangou, Vila-Rodriguez); UBC MRI Research Centre, Department of Radiology, University of British Columbia, Vancouver (Barlow, MacMillan); SFU ImageTech Lab, Simon Fraser University, Vancouver (MacMillan); Philips Canada, Mississauga, Ont. (MacMillan); Department of Psychiatry, University of Toronto, Toronto (Nestor); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Frangou).
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Erin L. MacMillan, Ph.D.
Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Vila-Rodriguez); Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Todd, Frangou, Vila-Rodriguez); UBC MRI Research Centre, Department of Radiology, University of British Columbia, Vancouver (Barlow, MacMillan); SFU ImageTech Lab, Simon Fraser University, Vancouver (MacMillan); Philips Canada, Mississauga, Ont. (MacMillan); Department of Psychiatry, University of Toronto, Toronto (Nestor); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Frangou).
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Laura Barlow, R.T.R., R.T.M.R.
Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Vila-Rodriguez); Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Todd, Frangou, Vila-Rodriguez); UBC MRI Research Centre, Department of Radiology, University of British Columbia, Vancouver (Barlow, MacMillan); SFU ImageTech Lab, Simon Fraser University, Vancouver (MacMillan); Philips Canada, Mississauga, Ont. (MacMillan); Department of Psychiatry, University of Toronto, Toronto (Nestor); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Frangou).
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Rebecca Todd, Ph.D.
Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Vila-Rodriguez); Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Todd, Frangou, Vila-Rodriguez); UBC MRI Research Centre, Department of Radiology, University of British Columbia, Vancouver (Barlow, MacMillan); SFU ImageTech Lab, Simon Fraser University, Vancouver (MacMillan); Philips Canada, Mississauga, Ont. (MacMillan); Department of Psychiatry, University of Toronto, Toronto (Nestor); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Frangou).
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Sean Nestor, M.D., Ph.D.
Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Vila-Rodriguez); Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Todd, Frangou, Vila-Rodriguez); UBC MRI Research Centre, Department of Radiology, University of British Columbia, Vancouver (Barlow, MacMillan); SFU ImageTech Lab, Simon Fraser University, Vancouver (MacMillan); Philips Canada, Mississauga, Ont. (MacMillan); Department of Psychiatry, University of Toronto, Toronto (Nestor); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Frangou).
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Sophia Frangou, M.D., Ph.D.
Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Vila-Rodriguez); Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Todd, Frangou, Vila-Rodriguez); UBC MRI Research Centre, Department of Radiology, University of British Columbia, Vancouver (Barlow, MacMillan); SFU ImageTech Lab, Simon Fraser University, Vancouver (MacMillan); Philips Canada, Mississauga, Ont. (MacMillan); Department of Psychiatry, University of Toronto, Toronto (Nestor); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Frangou).
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Fidel Vila-Rodriguez, M.D., Ph.D. [email protected]
Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Vila-Rodriguez); Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver (Ge, Humaira, Gregory, Alamian, Todd, Frangou, Vila-Rodriguez); UBC MRI Research Centre, Department of Radiology, University of British Columbia, Vancouver (Barlow, MacMillan); SFU ImageTech Lab, Simon Fraser University, Vancouver (MacMillan); Philips Canada, Mississauga, Ont. (MacMillan); Department of Psychiatry, University of Toronto, Toronto (Nestor); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York (Frangou).
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Notes

Send correspondence to Dr. Vila-Rodriguez ([email protected]).

Competing Interests

Dr. MacMillan receives salary support from Philips Canada. Dr. Vila-Rodriguez has received research support from the Canadian Institutes of Health Research, Brain Canada, the Michael Smith Foundation for Health Research, the Vancouver Coastal Health Research Institute, and the Weston Brain Institute for investigator-initiated research and philanthropic support from the Seedlings Foundation; he received in-kind equipment support from MagVenture for this investigator-initiated trial; and he has received honoraria for participation on an advisory board for Janssen. The other authors report no financial relationships with commercial interests.

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