Using neuroimaging to individualize TMS treatment for depression: Toward a new paradigm for imaging-guided intervention.
Abstract
The standard clinical technique for using repetitive transcranial magnetic stimulation
(rTMS) for major depressive disorder (MDD) is associated with limited efficacy to
date. Such limited efficacy may be due to reliance on scalp-based targeting rather
than state-of-the-science methods which incorporate fMRI-guided neuronavigation based
on a specific model of neurocircuit dysfunction. In this review, we examine such a
specific model drawn from regulatory focus theory, which postulates two brain/behavior
systems, the promotion and prevention systems, underlying goal pursuit. Individual
differences in these systems have been shown to predict vulnerability to MDD as well
as to comorbid generalized anxiety disorder (GAD). Activation of an individual's promotion
or prevention goals via priming leads to motivational and affective responses modulated
by the individual's appraisal of their progress in attaining the goal. In addition,
priming promotion vs. prevention goals induces discriminable patterns of brain activation
that are sensitive to the effects of depression and anxiety: MDD is associated with
promotion system failure, anhedonic/dysphoric symptoms, and hypoactivation in specific
regions in left prefrontal cortex, whereas GAD is associated with prevention system
failure, hypervigilant/agitated symptoms, and hyperactivation in right prefrontal
cortex (PFC). These left and right PFC locations can be directly targeted in an individualized
manner for TMS. Additionally, this individually targeted rTMS can be integrated with
cognitive interventions designed to activate the neural circuitry associated with
promotion vs. prevention, thus allowing the neuroplasticity induced by the rTMS to
benefit the systems likely to be involved in remediating depression. Targeted engagement
of cortical systems involved in emotion regulation using individualized fMRI guidance
may help increase the efficacy of rTMS in depression.
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Journal articlePermalink
https://hdl.handle.net/10161/13833Published Version (Please cite this version)
10.1016/j.neuroimage.2016.12.083Publication Info
Bernhardt, Lis; Davis, Simon Wilton; Kwapil, Lori; Lisanby, Sarah Hollingsworth; Luber,
Bruce M; Neacsiu, Andrada Delia; & Strauman, Timothy J (2017). Using neuroimaging to individualize TMS treatment for depression: Toward a new paradigm
for imaging-guided intervention. Neuroimage, 148. pp. 1-7. 10.1016/j.neuroimage.2016.12.083. Retrieved from https://hdl.handle.net/10161/13833.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Simon Wilton Davis
Assistant Professor in Neurology
My research centers around the use of structural and functional imaging measures to
study the shifts in network architecture in the aging brain. I am specifically interested
in changes in how changes in structural and functional connectivity associated with
aging impact the semantic retrieval of word or fact knowledge. Currently this involves
asking why older adults have particular difficulty in certain kinds of semantic retrieval,
despite the fact that vocabularies and knowledge stores typic
Sarah Hollingsworth Lisanby
Adjunct Professor in the Department of Psychiatry and Behavioral Sciences
Andrada Delia Neacsiu
Assistant Professor in Psychiatry and Behavioral Sciences
I am a clinical psychologist with a primary interest in outpatient interventions for
difficulties managing emotional experiences that interfere with well-being. As a clinician,
I specialize in Dialectical Behavior Therapy (DBT) and Cognitive Behavioral Therapy
(CBT) for adults who report a variety of mental health problems, including personality,
mood, anxiety, eating, trauma, stress-related, adjustment, and impulse control disorders.
My approach to psychotherapy includes working collaborativ
Timothy J. Strauman
Professor of Psychology and Neuroscience
Professor Strauman's research focuses on the psychological and neurobiological processes
that enable self-regulation, conceptualized in terms of a cognitive/motivational perspective,
as well as the relation between self-regulation and affect. Particular areas of emphasis
include: (1) conceptualizing self-regulation in terms of brain/behavior motivational
systems; (2) the role of self-regulatory cognitive processes in vulnerability to depression
and other disorders; (3) the impact of tre
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