Elevated prefrontal cortex GABA in patients with major depressive disorder after TMS treatment measured with proton magnetic resonance spectroscopy
Elevated prefrontal cortex GABA in patients with major depressive disorder after TMS treatment measured with proton magnetic resonance spectroscopy
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DOI：
10.1503/jpn.150223
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发表时间：
2016-05-01
影响因子：
4.3
通讯作者：
Shungu, Dikoma C.
中科院分区：
文献类型：
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作者：
Dubin, Marc J.;Mao, Xiangling;Shungu, Dikoma C.
背景GABA能和多巴胺能神经递质系统在抑郁症的病理生理学中起着重要作用，是重复经颅磁刺激（rTMS）的潜在靶点。我们评估了重性抑郁症患者左侧背外侧前额叶皮层（DLPFC）10 Hz rTMS对内侧前额叶皮层（MPFC）-氨基丁酸（GABA）水平以及谷氨酸和谷氨酰胺（Glx）联合共振水平的影响，并采用质子磁共振波谱（H-1 MRS）进行了体内评估。方法对23 ~ 68岁的抑郁症患者进行为期5周的rTMS自然开放性治疗研究，采用H-1 MRS测量基线和rTMS干预5周后MPFC GABA和Glx水平。我们在左侧DLPFC上以10 Hz和运动阈值的80%-120%施加rTMS脉冲，每天25次，每次3000个脉冲。我们使用24项汉密尔顿抑郁量表（HAMD 24）评估治疗反应。GABA和Glx水平表示为峰面积相对于同步采集的面积的比率，同样适合未抑制的体素水信号（W）。结果23个目前抑郁的个人（7名男子）参加了这项研究。在所有抑郁症患者中，MPFC中的GABA/W增加了13.8%（p = 0.013）。rTMS对Glx/W无明显影响。GABA/W和Glx/W高度相关的严重抑郁症患者在基线，但不后TMS.Limitations-主要研究的局限性是开放标签设计和纳入的参与者目前正在服用稳定的抗抑郁药物治疗方案。结论这些结果牵连GABA能和谷氨酸能系统的作用机制rTMS的抑郁症，在更大的样本进一步调查。
Background GABAergic and glutamatergic neurotransmitter systems are central to the pathophysiology of depression and are potential targets of repetitive transcranial magnetic stimulation (rTMS). We assessed the effect of 10-Hz rTMS over the left dorsolateral prefrontal cortex (DLPFC) of patients with major depressive disorder on the levels of medial prefrontal cortex (MPFC) -aminobutyric acid (GABA) and the combined resonance of glutamate and glutamine (Glx) as assessed in vivo with proton magnetic resonance spectroscopy (H-1 MRS).Methods Currently depressed individuals between the ages of 23 and 68 years participated in a 5-week naturalistic, open-label treatment study of rTMS, with H-1 MRS measurements of MPFC GABA and Glx levels at baseline and following 5 weeks of the rTMS intervention. We applied rTMS pulses over the left DLPFC at 10 Hz and 80%-120% of motor threshold for 25 daily sessions, with each session consisting of 3000 pulses. We assessed therapeutic response using the 24-item Hamilton Rating Scale for Depression (HAMD24). The GABA and Glx levels are expressed as ratios of peak areas relative to the area of the synchronously acquired and similarly fitted unsuppressed voxel water signal (W).Results Twenty-three currently depressed individuals (7 men) participated in the study. GABA/W in the MPFC increased 13.8% (p = 0.013) in all depressed individuals. There were no significant effects of rTMS on Glx/W. GABA/W and Glx/W were highly correlated in severely depressed patients at baseline but not after TMS.Limitations The primary study limitations are the open-label design and the inclusion of participants currently taking stable regimens of antidepressant medications.Conclusion These results implicate GABAergic and glutamatergic systems in the mechanism of action of rTMS for major depression, warranting further investigation in larger samples.