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On the Concurrent Use of Self-System Therapy and Functional Magnetic Resonance Imaging-Guided Transcranial Magnetic Stimulation as Treatment for Depression.

Publication ,  Journal Article
Neacsiu, AD; Luber, BM; Davis, SW; Bernhardt, E; Strauman, TJ; Lisanby, SH
Published in: J ECT
December 2018

OBJECTIVES: Despite the growing use of repetitive transcranial magnetic stimulation (rTMS) as a treatment for unipolar depression, its typical effect sizes have been modest, and methodological and conceptual challenges remain regarding how to optimize its efficacy. Linking rTMS to a model of the neurocircuitry underlying depression and applying such a model to personalize the site of stimulation may improve the efficacy of rTMS. Recent developments in the psychology and neurobiology of self-regulation offer a conceptual framework for identifying mechanisms of action in rTMS for depression, as well as for developing guidelines for individualized rTMS treatment. We applied this framework to develop a multimodal treatment for depression by pairing self-system therapy (SST) with simultaneously administered rTMS delivered to an individually targeted region of dorsolateral prefrontal cortex identified via functional magnetic resonance imaging (fMRI). METHODS: In this proof-of-concept study, we examined the acceptability, feasibility, and preliminary efficacy of combining individually fMRI-targeted rTMS with SST. Using the format of a cognitive paired associative stimulation paradigm, the treatment was administered to 5 adults with unipolar depression in an open-label trial. RESULTS: The rTMS/SST combination was well tolerated, feasible, and acceptable. Preliminary evidence of efficacy also was promising. We hypothesized that both treatment modalities were targeting the same neural circuitry through cognitive paired associative stimulation, and observed changes in task-based fMRI were consistent with our model. These neural changes were directly related to improvements in depression severity. CONCLUSIONS: The new combination treatment represents a promising exemplar for theory-based, individually targeted, multimodal intervention in mood disorders.

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Published In

J ECT

DOI

EISSN

1533-4112

Publication Date

December 2018

Volume

34

Issue

4

Start / End Page

266 / 273

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Transcranial Magnetic Stimulation
  • Self Report
  • Self Concept
  • Psychiatry
  • Psychiatric Status Rating Scales
  • Prefrontal Cortex
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging
 

Citation

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Neacsiu, A. D., Luber, B. M., Davis, S. W., Bernhardt, E., Strauman, T. J., & Lisanby, S. H. (2018). On the Concurrent Use of Self-System Therapy and Functional Magnetic Resonance Imaging-Guided Transcranial Magnetic Stimulation as Treatment for Depression. J ECT, 34(4), 266–273. https://doi.org/10.1097/YCT.0000000000000545
Neacsiu, Andrada D., Bruce M. Luber, Simon W. Davis, Elisabeth Bernhardt, Timothy J. Strauman, and Sarah H. Lisanby. “On the Concurrent Use of Self-System Therapy and Functional Magnetic Resonance Imaging-Guided Transcranial Magnetic Stimulation as Treatment for Depression.J ECT 34, no. 4 (December 2018): 266–73. https://doi.org/10.1097/YCT.0000000000000545.
Neacsiu, Andrada D., et al. “On the Concurrent Use of Self-System Therapy and Functional Magnetic Resonance Imaging-Guided Transcranial Magnetic Stimulation as Treatment for Depression.J ECT, vol. 34, no. 4, Dec. 2018, pp. 266–73. Pubmed, doi:10.1097/YCT.0000000000000545.

Published In

J ECT

DOI

EISSN

1533-4112

Publication Date

December 2018

Volume

34

Issue

4

Start / End Page

266 / 273

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Transcranial Magnetic Stimulation
  • Self Report
  • Self Concept
  • Psychiatry
  • Psychiatric Status Rating Scales
  • Prefrontal Cortex
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging