The current frontier in the treatment of depression involves the use of non-invasive brain stimulation to target underlying circuit dysfunction. The focal nature of brain stimulation treatments carry the potential for clinician investigators to test hypotheses about treatment that can be verified through discrete cognitive and behavioral measures in combination with assays of biological function (i.e., electroencephalography and functional neuroimaging). The most common form of non-invasive brain stimulation, in use clinically, is repetitive transcranial magnetic stimulation (rTMS). This treatment involves the delivery of time-varying magnetic field pulses to superficial cortical structures, usually in the frontal and prefrontal cortices. These magnetic field pulses lead to a change in neuronal firing patterns and connectivity within brain circuitry, yet the direct mechanism of action of rTMS has not been fully elucidated.
1The pattern of stimulation can lead to excitatory (high frequency) or inhibitory (low frequency) brain responses. The vast majority of clinical treatment studies investigating rTMS for depression have used an excitatory stimulation protocol targeted over the left dorsolateral prefrontal cortex (DLPFC).
- Noda Y.
- Silverstein W.K.
- Barr M.S.
- et al.
Neurobiological mechanisms of repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex in depression: a systematic review.
Psychol Med. 2015; 45: 3411-3432
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- Neurobiological mechanisms of repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex in depression: a systematic review.Psychol Med. 2015; 45: 3411-3432
- A meta-analysis of executive dysfunction and antidepressant treatment response in late-life depression.Am J Geriatr Psychiatry. 2016; 24: 31-41
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Published online: December 06, 2017
Accepted: November 27, 2017
Received: November 1, 2017
© 2017 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.
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- Age-Related Repetitive Transcranial Magnetic Stimulation Effects on Executive Function in Depression: A Systematic ReviewThe American Journal of Geriatric PsychiatryVol. 26Issue 3
- PreviewGeriatric depression is often accompanied by executive dysfunction,1 defined as an impairment in the ability to plan, prioritize, and initiate action; flexibly shift between tasks; and inhibit automatic responses for the sake of more effortful yet more optimal actions. Executive functions are supported by the cognitive control network (CCN), a network that includes the dorsolateral prefrontal cortex (DLPFC), dorsal anterior cingulate cortex, and posterior parietal regions.2,3 Late-life depression with executive dysfunction is characterized by poor antidepressant response4–6 and disability.