Improved Interhemispheric Functional Connectivity in Postpartum Depression Disorder: Associations With Individual Target-Transcranial Magnetic Stimulation Treatment Effects.

Yao Zhang,Shun Qi,Sanzhong Li,Zhaohui Zhang,Chuanzhu Sun,Xiang Li,Li Li,Xiaowei Ma,Yunfeng Mu

doi:10.3389/fpsyt.2022.859453

Abstract

Postpartum depression (PPD) is a depressive condition that is associated with a high risk of stressful life events, poor marital relationships, and even suicide. Neuroimaging techniques have enriched our understanding of cerebral mechanisms underlying PPD; namely, abnormalities in the amygdala-insula-frontal circuit might contribute to the pathogenesis of PPD. Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) is a recently validated neuroscience-informed accelerated intermittent theta-burst stimulation repetitive transcranial magnetic stimulation (rTMS) protocol. It has been shown to be effective, safe, tolerable, and rapid acting for treating treatment-resistant depression, and may be a valuable tool in the treatment of PPD. The purpose of the current study was to detect inter-hemispheric connectivity changes and their relationship with the clinical treatment effects of rTMS. Resting-state fMRI data from 32 patients with PPD treated with SAINT were collected and compared with findings from 32 age matched healthy controls. Voxel-mirrored homotopic connectivity (VMHC) was used to analyze the patterns of interhemispheric intrinsic functional connectivity in patients with PPD. Scores on the 17-item Hamilton Depression Rating Scale, Edinburgh Postnatal Depression Scale (EPDS) scores, and the relationships between these clinical characteristics and VMHC were the primary outcomes. Patients with PPD at baseline showed reduced VMHC in the amygdala, insula, and medial frontal gyrus compared with the HCs. These properties showed a renormalization after individualized rTMS treatment. Furthermore, increased connectivity between the left and right insula after SAINT was significantly correlated with the improvement of EPDS scores. Our results reveal the disruptions in the intrinsic functional architecture of interhemispheric communication in patients with PPD, and provide evidence for the pathophysiological mechanisms and the effects of rTMS.

Highlights

Postpartum depression (PPD) is characterized by a series of symptoms, such as depression, agitation, and even suicide, and affects 13% of women who have just given birth [1]
We found that Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) applied to patients with PPD significantly reduced depressive symptoms
The increased connectivity between the left and right insula after SAINT was significantly correlated with the improvement of the Edinburgh Postnatal Depression Scale score

Summary

Introduction

Postpartum depression (PPD) is characterized by a series of symptoms, such as depression, agitation, and even suicide, and affects 13% of women who have just given birth [1]. Psychotherapy, psychotropic medications, and electroconvulsive therapy are the primary and commonly used treatments for PPD [2, 3]. Psychotherapy requires a long treatment duration and is costly [4]. Women who are breastfeeding may be concerned that their infant will be exposed to psychotropic medications, and worried about the long-term developmental effects of this exposure [5]. Electroconvulsive therapy is strongly recommended for the treatment of major depression, but is associated with acute adverse effects such as memory disorder and headaches [6]. There is an urgent need for new therapies for PPD that have minimal side effects and can be used over long durations. Repetitive transcranial magnetic stimulation (rTMS) is an effective FDA-approved treatment for major depression and is a promising treatment for PPD [7]. The mechanism of rTMS in the treatment include activation of neurotransmitter systems, modulation of neural circuits and brain networks, and synaptic plasticity

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