Background
Repetitive transcranial magnetic stimulation (TMS) of the dorsolateral prefrontal
cortex (DLPFC) is an established treatment for depression, but its underlying mechanism
of action remains unknown. Abnormalities in two large-scale neuronal networks—the
frontoparietal central executive network (CEN) and the medial prefrontal-medial parietal
default mode network (DMN)—are consistent findings in depression and potential therapeutic
targets for TMS. Here, we assessed the impact of TMS on activity in these networks
and their relation to treatment response.
Methods
We used resting state functional magnetic resonance imaging to measure functional
connectivity within and between the DMN and CEN in 17 depressed patients, before and
after a 5-week course of TMS. Motivated by prior reports, we focused on connectivity
seeded from the DLPFC and the subgenual cingulate, a key region closely aligned with
the DMN in depression. Connectivity was also compared with a cohort of 35 healthy
control subjects.
Results
Before treatment, functional connectivity in depressed patients was abnormally elevated
within the DMN and diminished within the CEN, and connectivity between these two networks
was altered. Transcranial magnetic stimulation normalized depression-related subgenual
hyperconnectivity in the DMN but did not alter connectivity in the CEN. Transcranial
magnetic stimulation also induced anticorrelated connectivity between the DLPFC and
medial prefrontal DMN nodes. Baseline subgenual connectivity predicted subsequent
clinical improvement.
Conclusions
Transcranial magnetic stimulation selectively modulates functional connectivity both
within and between the CEN and DMN, and modulation of subgenual cingulate connectivity
may play an important mechanistic role in alleviating depression. The results also
highlight potential neuroimaging biomarkers for predicting treatment response.
Key Words
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Article info
Publication history
Published online: February 07, 2014
Accepted:
January 11,
2014
Received in revised form:
December 18,
2013
Received:
July 29,
2013
Footnotes
Authors CL and ACC contributed equally to this work.
Identification
Copyright
© 2014 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
