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.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1016/j.neuroimage.2016.12.083

Publication Info

Luber, Bruce M, Simon Davis, Elisabeth Bernhardt, Andrada Neacsiu, Lori Kwapil, Sarah H Lisanby and Timothy J Strauman (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.

Scholars@Duke

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? 

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.

Lisanby

Sarah Hollingsworth Lisanby

Professor Emeritus of Psychiatry and Behavioral Sciences

Sarah Hollingsworth “Holly” Lisanby, MD, is an experienced translational researcher and innovator of neuromodulation technologies to study and treat psychiatric disorders. Dr. Lisanby is Director of the Division of Translational Research at NIMH, which funds research on the discovery of preventions, treatments, and cures for mental illness across the lifespan.  She is Founder and Director of the Noninvasive Neuromodulation Unit in the NIMH Intramural Research Program, a multi-disciplinary clinical research program specializing in the innovation of new brain stimulation tools to measure and modulate neuroplasticity to improve mental health.  Dr. Lisanby is former Chair of the Duke Department of Psychiatry & Behavioral Sciences, and JP Gibbons Endowed Professor at Duke University.  She founded and directed both the Duke and the Columbia University Divisions of Brain Stimulation, where she built interdisciplinary research programs specializing in the convergence of Psychiatry, Neuroscience and Engineering. She co-led the NIH BRAIN Initiative Team focused on large-scale neural recording and modulation devices. Dr. Lisanby has been principal investigator on a series of federally funded grants on the development of novel neuromodulation technologies, including the rational design of magnetic and electrical seizure therapies.  Her team pioneered magnetic seizure therapy (MST) as a novel depression treatment from the stages of animal testing, first-in-human, and international clinical trials.  She led a series of studies involving transcranial magnetic stimulation, electroconvulsive therapy (ECT), MST, vagus nerve stimulation, and deep brain stimulation. She has received numerous international recognitions, including the Max Hamilton Memorial Prize of the Collegium Internationale Neuro-Psychopharmacologicum, the Gerald Klerman Award from the National Depression and Manic Depression Association, and the Eva King Killam Research Award from the American College of Neuropsychopharmacology.  She has been a member of the NIMH Board of Scientific Counselors. Dr. Lisanby served on the FDA Neurological Devices Advisory Panel and has held key leadership positions with numerous professional associations, including serving as President for the Association for Convulsive Therapy/International Society of Neurostimulation, and the International Society for Transcranial Stimulation, and Chair of the American Psychiatric Association Task Force to Revise the Practice on ECT. 

Strauman

Timothy J. Strauman

Professor of Psychology and Neuroscience

FOR POTENTIAL STUDENTS (fall 2024 class): 

Dr. Timothy Strauman and Dr. Ann Brewster will be seeking to admit a student for Fall 2024 who will be an important member of their collaborative projects. Dr. Brewster is an intervention scientist and a faculty member in Duke’s Social Science Research Institute. The collaborative projects focus on creating, testing, and implementing school-based therapeutic and preventive interventions for adolescents at risk for negative academic and mental health outcomes. We are partnering with the Durham Public Schools as well as with other local school districts, and Dr. Brewster has extensive experience and expertise in developing the partnerships, working with community members, and the intervention process itself. We are especially interested in applicants with experience in community-based interventions, with interests in adolescence, and with knowledge and experience working with both behavioral and neuroimaging data.



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 treatments for depression, such as psychotherapy and medication, on self-regulatory function and dysfunction in depression; (4) how normative and non-normative socialization patterns influence the development of self-regulatory systems; (5) the contributory roles of self-regulation, affect, and psychopathology in determining immunologically-mediated susceptibility to illness; (6) development of novel multi-component treatments for depression targeting self-regulatory dysfunction; (7) utilization of brain imaging techniques to test hypotheses concerning self-regulation, including the nature and function of hypothetical regulatory systems and characterizing the breakdowns in self-regulation that lead to and accompany depression.

Unless otherwise indicated, scholarly articles published by Duke faculty members are made available here with a CC-BY-NC (Creative Commons Attribution Non-Commercial) license, as enabled by the Duke Open Access Policy. If you wish to use the materials in ways not already permitted under CC-BY-NC, please consult the copyright owner. Other materials are made available here through the author’s grant of a non-exclusive license to make their work openly accessible.