Abstract
Suicidal ideation increases precipitously in patients with depression, contributing to the risk of suicidal attempts. Despite the recent advancement in transcranial magnetic stimulation, its effectiveness in depression disorder and its wide acceptance, the network mechanisms of the clinical response to suicidal ideation in major depressive disorder remain unclear. Independent component analysis for neuroimaging data allows the identification of functional network connectivity which may help to explore the neural basis of suicidal ideation in major depressive disorder. Resting-state functional magnetic resonance imaging data and clinical scales were collected from 30 participants (15 major depressive patients with suicidal ideation and 15 healthy subjects). Individual target-transcranial magnetic stimulation (IT-TMS) was then used to decrease the subgenual anterior cingulate cortex activity through the left dorsolateral prefrontal cortex. Thirty days post IT-TMS therapy, seven of 15 patients (46.67%) met suicidal remission criteria, and 12 patients (80.00%) met depression remission criteria. We found that IT-TMS could restore the abnormal functional network connectivity between default mode network and precuneus network, left executive control network and sensory-motor network. Furthermore, the changes in functional network connectivity between the default mode network and precuneus network were associated with suicidal ideation, and depressive symptoms were related to connectivity between left executive control network and sensory-motor network. These findings illustrate that IT-TMS is an effective protocol for the accurate restoration of impaired brain networks, which is consistent with clinical symptoms.
Highlights
Major depressive disorder (MDD) is the most common mental disorder, with 58% of MDD patients having suicidal ideation (SI) and 15% having attempted suicide [1, 2]
We found that ITTMS significantly decreased suicidal ideation and depressive symptoms within five continuous days
Northoff reported that various depressive and suicidal symptoms can be translated as intrinsic brain activity in spatiotemporal disturbances, which is the organization of the resting-state network activity [35]
Summary
Major depressive disorder (MDD) is the most common mental disorder, with 58% of MDD patients having suicidal ideation (SI) and 15% having attempted suicide [1, 2]. Few studies have investigated the functional network connectivity (FNC) of MDD patients with SI and reported inconsistent results regarding the brain regions associated with resting-state functional alterations [13]. Various rest state function Magnetic Resonance Imaging (rsfMRI) studies have revealed functional alterations in brain regions and networks, the network restoration mechanism of IT-TMS rapid action in MDD patients with SI is not yet known. We hypothesized that compared with HCs, depressed patients with suicidal ideation show altered patterns of neural activity, and individual target was generated for the guide intelligent neural navigation system over rsfMRI analysis.
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