An Investigation of Medial Temporal Lobe Changes and Cognition Following Antidepressant Response: A Prospective rTMS Study
An Investigation of Medial Temporal Lobe Changes and Cognition Following Antidepressant Response: A Prospective rTMS Study
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DOI：
10.1016/j.brs.2012.06.006
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发表时间：
2013-05-01
影响因子：
7.7
通讯作者：
Fitzgerald, Paul B.
中科院分区：
文献类型：
--
作者：
Furtado, Christina P.;Hoy, Kate E.;Fitzgerald, Paul B.
背景：重度抑郁障碍(MDD)通常对标准方法的治疗有抵抗力。重复经颅磁刺激(RTMS)是一种新的治疗难治性MDD(TRD)的抗抑郁药物。初步证据也提高了rTMS增强神经元可塑性的可能性；发现血清脑源性神经营养因子(BDNF)水平增加。这与与MDD相关的体积减少最相关，特别是在海马体和相关结构中。大量临床前文献表明，不同类型的经典抗抑郁药物治疗可逆转MDD抑制成人神经发生所导致的海马体积减少。目的：本研究的目的是探讨rTMS的抗抑郁反应在促进HC及其周围结构的神经发生和促进相关神经认知改善方面是否具有与抗抑郁药物治疗类似的治疗潜力。方法：对29名患者在rTMS治疗前(基线)和基线后3个月(终点)进行磁共振成像和神经认知评估。结果：随着时间的推移，抗抑郁药物的反应与左侧杏仁核体积(6.58%)几乎显著增加有关。而治疗无反应者的左侧海马体体积较基线显著下降(-2.64%)。在功能上，rTMS治疗后没有认知功能恶化。结论：这些初步发现提示rTMS可能促进神经发生或其他有利于神经元可塑性的效应，也可能对TRD患者具有神经保护作用，但这些发现需要在更大的样本中复制。(C)2013 Elsevier Inc.保留所有权利。
Background: Major depressive disorder (MDD) is often resistant to treatment with standard approaches. Repetitive transcranial magnetic stimulation (rTMS) is a new treatment that has proven antidepressant efficacy in treatment resistant MDD (TRD). Preliminary evidence also raises the possibility of rTMS enhancing neuronal plasticity; with demonstrated increases in serum levels of brain derived neurotrophic factor (BDNF) found. This is of most relevance to volumetric reductions associated with MDD, particularly in the hippocampus and related structures. Extensive preclinical literature suggests that hippocampal volume reductions from MDD induced suppression of adult neurogenesis can be reversed by different types of classical antidepressant treatments which increase expression of BDNF.Objective: The aims of this study were to investigate whether antidepressant response to rTMS has similar therapeutic potential as antidepressant pharmacotherapy in promoting neurogenesis in the HC and surrounding structures and facilitating related neurocognitive improvements.Methods: Magnetic resonance imaging and neurocognitive assessments were conducted on 29 patients prior to rTMS treatment (baseline) and at three months post baseline (endpoint).Results: Over time, antidepressant response was associated with a near significant increase in left amygdala volume (6.58%), whilst treatment non-responders showed significant declines in left hippocampus volumes (-2.64%) from baseline. Functionally, there was no cognitive deterioration following rTMS treatment. The results are limited, however, by sample size.Conclusions: These preliminary findings suggest that rTMS may promote neurogenesis or other effects that favour neuronal plasticity and may also be neuroprotective for patients with TRD but these findings need replication in a larger sample. (C) 2013 Elsevier Inc. All rights reserved.