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Brazil-England Study on Mechanisms and Response Predictors of iTBS Treatment (BRAEN-MAP) - FERT and Task fMRI
Date created: 2024-03-04 03:22 PM | Last Updated: 2024-12-02 01:48 PM
Category: Uncategorized
Description: Transcranial Magnetic Stimulation (TMS) is an FDA-approved treatment for treatment-resistant depression. The response rate is estimated to be around 50%. To further improve TMS treatment, a better understanding of the mechanisms of action and response predictors is necessary. Antidepressant drugs have been shown to increase the processing of positive vs. negative information early on in the treatment before clinical improvement (Godlewska et al. 2012; Godlewska et al. 2016). This early change in information processing predicts treatment response, suggesting that antidepressants might act by increasing the focus on positive vs. negative information (Browning et al. 2019). Some evidence suggests that brain stimulation might also increase processing of positive vs. negative information (Overman et al. 2023; Brunoni et al. 2014; Ironside et al. 2019). The aim of this study is to test whether intermittent theta-burst stimulation (iTBS), leads to an increase in the processing of positive vs. negative information early on during treatment, and whether this change can predict who will respond to the treatment. 49 patients with major depressive disorders (MINI structured interview) completed the study. All participants underwent 5 weekly TMS sessions (Monday-Friday) over the course of 4 weeks. ITBS was applied to the left dorsolateral prefrontal cortex at 100% resting motor threshold. This study employed an extended iTBS protocol using 1,800 pulses (compared to 600 pulses in conventional iTBS protocols (Blumberger et al. 2018)) applied in 2s trains of 10 bursts (3 pulses at 50Hz), repeated at 5Hz. Prior to starting the treatment (baseline) and after 7-10 days of treatment, participants performed the Facial Expression Recognition Task (FERT)(Young et al. 1997) and underwent an MRI scan, including task fMRI using an emotional faces task (Fu et al. 2004). As the clinical outcome measure, the HAM-D was recorded at baseline, at the end of each treatment week, and 6 weeks after treatment onset. We will analyse whether ~8 days of TMS treatment increases behavioural and fMRI measures of positive vs. negative information processing. We will also test whether early changes in these measures can predict treatment response which would indicate that these changes in information processing might be a mechanism underlying the antidepressant effect TMS treatment.
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