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    Using neuroimaging to individualize TMS treatment for depression: Toward a new paradigm for imaging-guided intervention.

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    Date
    2017-03-01
    Authors
    Bernhardt, Lis
    Davis, Simon Wilton
    Kwapil, Lori
    Lisanby, Sarah Hollingsworth
    Luber, Bruce M
    Neacsiu, Andrada Delia
    Strauman, Timothy J
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    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.
    Type
    Journal article
    Subject
    Depression
    Multimodal therapy
    Prevention
    Promotion
    Regulatory focus
    TMS
    Translation
    fMRI
    Permalink
    https://hdl.handle.net/10161/13833
    Published Version (Please cite this version)
    10.1016/j.neuroimage.2016.12.083
    Publication 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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    Scholars@Duke

    Davis

    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
    Lisanby

    Sarah Hollingsworth Lisanby

    Adjunct Professor in the Department of Psychiatry and Behavioral Sciences
    Neacsiu

    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
    Strauman

    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
    Alphabetical list of authors with Scholars@Duke profiles.
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