High-frequency rTMS treatment increases white matter FA in the left middle frontal gyrus in young patients with treatment-resistant depression

• Published in: Journal of affective disorders Vol. 136; no. 3; pp. 249 - 257
• Main Authors: Peng, Hongjun, Zheng, Huirong, Li, Lingjiang, Liu, Jianbin, Zhang, Yan, Shan, Baoci, Zhang, Li, Yin, Yan, Liu, Jun, Li, Weihui, Zhou, Jiansong, Li, Zexuan, Yang, Haichen, Zhang, Zhijun
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier B.V 01.02.2012; Elsevier
• Subjects: Adult; Adult and adolescent clinical studies; Anisotropy; Biological and medical sciences; Depression; Depressive Disorder, Treatment-Resistant - etiology; Depressive Disorder, Treatment-Resistant - therapy; Diffusion Tensor Imaging; Diffusion tensor imaging (DTI); Double-Blind Method; Dysfunction; Female; Fractional anisotropy (FA); Frontal Lobe; Humans; Leukoencephalopathies - complications; Leukoencephalopathies - diagnosis; Male; Medical sciences; Mood disorders; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Refractory depression; Repetitive transcranial magnetic stimulation (rTMS); Stimulation; Transcranial Magnetic Stimulation; Treatment-resistant depression (TRD); Young Adult; magnetic resonance imaging; Repetitive transcranial magnetic stimulation (rTMS); MRI; BDI; prefrontal cortex; TRD; the anterior cingulate cortex; Diagnosis and Statistical Manual of Mental Disorders; MDD; PFC; Treatment-resistant depression (TRD); dorsolateral prefrontal cortex; OFC; SPECT; tract-based spatial statistics; VBA; Functional magnetic resonance imaging; major depression disorder; Fractional anisotropy (FA); orbitofrontal cortex; DSM; repetitive transcranial magnetic stimulation; ACC; DLPFC; single photon emission computed tomography; TBSS; ROI; voxel-based analysis; Diffusion tensor imaging (DTI); Hamilton Depressive Rating Scale; fMRI; HAMD; treatment-resistant depression; region of interest; DTI; diffusion tensor imaging; fractional anisotropy; FA; rTMS; Beck Depression Inventory; Mood disorder; Human; Treatment resistance; Transcranial magnetic stimulation; Central nervous system; Depression; Frontal cortex; Nuclear magnetic resonance imaging; White matter; Encephalon; Diffusion tensor imaging; Treatment; Anisotropy; Medical imagery; High frequency
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2011.12.006

Abstract Background Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for treatment-resistant depression (TRD), but its therapeutic mechanisms are unclear. White matter abnormalities are thought to cause network dysfunction underlying TRD. Diffusion tensor imaging (DTI) is an ideal tool for examining neural connections and the integrity of white matter. Few studies have used DTI to investigate the impact of rTMS on alterations of whiter matter in TRD. Method 30 young treatment-resistant unipolar depression patients (19 males and 11 females) were enrolled in a double-blind, randomized high-frequency (15 Hz) rTMS treatment study. Seventeen patients were treated with real stimulation, and 13 were treated with sham stimulation. White-matter fractional anisotropy (FA) was evaluated using voxel-based analysis (VBA) of FA maps derived from DTI before and after treatment. Twenty-five age- and gender-matched subjects were examined as a control group. Results In an exploratory VBA method, clusters of fifty voxels or greater that survived a family-wise error (FWE)-corrected threshold of p < 0.05 were considered significant. The results revealed significantly reduced FA in the left middle frontal gyrus, with peak coordinates [− 18 46 − 14] in TRD patients. This reduced FA was significantly improved after active rTMS treatment, but not sham stimulation. FA increases were correlated with decreased depressive symptoms. Limitations This study requires replication and further clarification in a larger patient population, and optimization of stimulation locations and methods. Conclusions These results suggest that the efficacy of rTMS on TRD is related to increased white-matter FA in the left middle frontal gyrus.