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.
1
The 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).To read this article in full you will need to make a payment
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References
- 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
- Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical guidelines for the management of adults with major depressive disorder: section 4. Neurostimulation treatments.Can J Psychiatry. 2016; 61: 561-575
- Deep transcranial magnetic stimulation over the prefrontal cortex: evaluation of antidepressant and cognitive effects in depressive patients.Brain Stimul. 2009; 2: 188-200
- Age-related rTMS effects on executive function in depression: a systematic review.Am J Geriatr Psychiatry. 2018; 26: 334-346
- Cognitive enhancing effects of rTMS administered to the prefrontal cortex in patients with depression: a systematic review and meta-analysis of individual task effects.Depress Anxiety. 2017; 34: 1029-1039
- Repetitive transcranial magnetic stimulation for the acute treatment of major depressive episodes: a systematic review with network meta-analysis.JAMA Psychiatry. 2017; 74: 143-152
- Inter-subject and inter-session variability of plasticity induction by non-invasive brain stimulation: boon or bane?.Brain Stimul. 2015; 8: 662-663
Article info
Publication history
Published online: December 06, 2017
Accepted:
November 27,
2017
Received:
November 1,
2017
Identification
Copyright
© 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.
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