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

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2018-12

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Abstract

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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10.1097/yct.0000000000000545

Publication Info

Neacsiu, Andrada D, Bruce M Luber, Simon W Davis, Elisabeth Bernhardt, Timothy J Strauman and Sarah H Lisanby (2018). On the Concurrent Use of Self-System Therapy and Functional Magnetic Resonance Imaging-Guided Transcranial Magnetic Stimulation as Treatment for Depression. The journal of ECT, 34(4). pp. 266–273. 10.1097/yct.0000000000000545 Retrieved from https://hdl.handle.net/10161/31190.

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.

Scholars@Duke

Neacsiu

Andrada Delia Neacsiu

Associate 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 collaboratively with my patients to identify their unique life and therapy goals and implementing evidence-based interventions to achieve the identified goals. As an educator, I train clinicians nationally and teach graduate students, psychology and psychiatry residents in in how to effectively apply CBT and DBT in their clinical work. As a researcher, I focus on psychotherapy optimization and neuroscience-informed treatment development for emotion dysregulation. My research keeps me up to date with the latest evidence-based approaches to use in my clinical work, and my work with patients strongly influences the research that I do.  Outside of work, I enjoy traveling, gourmet food, nature adventures, and time with friends with family.

Davis

Simon Wilton Davis

Associate 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 typically improve with age.

A second line of research involves asking questions about how this semantic system is organized in young adults, understanding which helps form a basis for asking questions about older adults. To what degree are these semantic retrieval processes lateralized? What cognitive factors affect this laterality? How are brain structures like the corpus callosum involved in mediating distributed activation patterns associated with semantic retrieval? 


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