The Effects of Bilateral Theta-burst Stimulation on Executive Functions and Affective Symptoms in Major Depressive Disorder

Adrienn Holczer,Viola Luca Németh,Teodóra Vékony,Krisztián Kocsis,András Király,Zsigmond Tamás Kincses,László Vécsei,Péter Klivényi,Anita Must

doi:10.1016/j.neuroscience.2021.03.001

Adrienn Holczer, Viola Luca Németh + Show 7 more

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https://doi.org/10.1016/j.neuroscience.2021.03.001

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Journal: Neuroscience	Publication Date: Mar 14, 2021
Citations: 5	License type: cc-by

Affiliation: University of Szeged

Abstract

Major depressive disorder (MDD) is characterized by severe affective as well as cognitive symptoms. Moreover, cognitive impairment in MDD can persist after the remission of affective symptoms. Theta-burst stimulation (TBS) is a promising tool to manage the affective symptoms of major depressive disorder (MDD); however, its cognition-enhancing effects are sparsely investigated. Here, we aimed to examine whether the administration of bilateral TBS has pro-cognitive effects in MDD. Ten daily sessions of neuronavigated active or sham TBS were delivered bilaterally over the dorsolateral prefrontal cortex to patients with MDD. The n-back task and the attention network task were administered to assess working memory and attention, respectively. Affective symptoms were measured using the 21-item Hamilton Depression Rating Scale. We observed moderate evidence that the depressive symptoms of patients receiving active TBS improved compared to participants in the sham stimulation. No effects of TBS on attention and working memory were detected, supported by a moderate-to-strong level of evidence. The effects of TBS on psychomotor processing speed should be further investigated. Bilateral TBS has a substantial antidepressive effect with no immediate adverse effects on executive functions.

Highlights

Repetitive transcranial magnetic stimulation is considered a therapeutic measure to reduce the affective symptoms of major depressive disorder (MDD)
The inhibitory pattern of Theta-burst stimulation (TBS) is continuous TBS, which applies an uninterrupted train of bursts, and the facilitatory is intermittent TBS, which is fragmented by pauses among the trains of bursts (Huang et al, 2005)
Bayesian analysis further corroborated the presence of substantial evidence in support of the antidepressive effects of TBS

Summary

Introduction

Repetitive transcranial magnetic stimulation (rTMS) is considered a therapeutic measure to reduce the affective symptoms of major depressive disorder (MDD) (see Lefaucheur et al, 2020 for review). TBS over the DLPFC mitigates the clinical symptoms of MDD with an effect estimation similar to rTMS (Li et al, 2014; Plewnia et al, 2014; Schwippel et al, 2019; Williams et al, 2018). In addition to unilateral stimulation, sequentially applied left facilitatory and right inhibitory (bilateral stimulation) by either rTMS or TBS appears to be effective (Berlim et al, 2013a, 2013b; Chen et al, 2014; Cheng et al, 2016; O’Reardon et al, 2007).

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