Longer depressive episode duration negatively influences HF-rTMS treatment response: a cerebellar metabolic deficiency?
Repetitive transcranial magnetic stimulation (rTMS) is an evidence based neurostimulation modality used to treat patients with Major Depressive Disorder (MDD). In spite that the duration of current a depressive episode has been put forward as a negative predictor for clinical outcome, little is known about the underlying neurobiological mechanisms of this phenomenon. To address this important issue, in a sample of 43 melancholic stage III treatment resistant antidepressant-free refractory MDD patients, we reanalysed regional cerebral glucose metabolism (CMRglc) before high frequency (HF)-rTMS treatment, applied to the left dorsolateral prefrontal cortex (DLPFC). Besides that a lower baseline cerebellar metabolic activity indicated negative clinical response, a longer duration of the depressive episode was a negative indicator for recovery and negatively influenced cerebellar CMRglc. This exploratory 18FDG PET study is the first to demonstrate that the clinical response of HF-rTMS treatment in TRD patients may depend on the metabolic state of the cerebellum. Our observations could imply that for left DLPFC HF-rTMS non-responders other brain localisations for stimulation, more specifically the cerebellum, may be warranted.
KeywordsTreatment-resistance Major depressive disorder 18FDG PET Cerebellum HF-rTMS
This research was supported by a grant from the Scientific Fund W. Gepts and by the Ghent University Multidisciplinary Research Partnership “The integrative neuroscience of behavioural control”. G.R.W. was supported by the Natural Science Foundation of China (Grant No. 61403312), and the Fundamental Research Funds for the Central Universities (Grant No. 2362014xk04).
Compliance with ethical standards
Conflict of interest
Author Guo-Rong Wu and Author Chris Baeken declare that they have no conflict of interest.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975 (http://www.wma.net/en/30publications/10policies/b3/), and the applicable revisions at the time of the investigation. Informed consent was obtained from all patients for being included in the study.
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