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Cited by 106Transcranial Magnetic Stimulation StudiesTreatment of Major DepressionTraumatic Brain Injury Research

Repetitive transcranial magnetic stimulation with resting-state network targeting for treatment-resistant depression in traumatic brain injury: a randomized, controlled, double-blinded pilot study

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Siddiqi, Shan H., Trapp, Nicholas T., Hacker, Carl D., Laumann, Timothy O., Kandala, Sridhar, Hong, Xin, Trillo, Ludwig, Shahim, Pashtun +3 more·2019·Journal of Neurotrauma
DOI 10.1089/neu.2018.5889PMC PMC6909726
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Abstract

Repetitive transcranial magnetic stimulation (rTMS) has demonstrated antidepressant efficacy but has limited evidence in depression associated with traumatic brain injury (TBI). Here, we investigate the use of rTMS targeted with individualized resting-state network mapping (RSNM) of dorsal attention network (DAN) and default mode network (DMN) in subjects with treatment-resistant depression associated with concussive or moderate TBI. The planned sample size was 50 with first interim analysis planned at 20, but only 15 were enrolled before the study was terminated for logistical reasons. Subjects were randomized to 20 sessions of bilateral rTMS (4000 left-sided excitatory pulses, 1000 right-sided inhibitory pulses) or sham. Treatment was targeted to the dorsolateral prefrontal cluster with maximal difference between DAN and DMN correlations based on resting-state functional magnetic resonance imaging with individualized RSNM. Mean improvement in the primary outcome, Montgomery-Asberg Depression Rating Scale (MADRS), was 56% ± 14% (n = 9) with active treatment and 27% ± 25% (n = 5) with sham (Cohen's d = 1.43). One subject randomized to sham withdrew before starting treatment. There were no seizures or other significant adverse events. MADRS improvement was inversely correlated with functional connectivity between the right-sided stimulation site and the subgenual anterior cingulate cortex (sgACC; r = -0.68, 95% confidence interval 0.03-0.925). Active treatment led to increased sgACC-DMN connectivity (d = 1.55) and increased sgACC anti-correlation with the left- and right-sided stimulation sites (d = -1.26 and -0.69, respectively). This pilot study provides evidence that RSNM-targeted rTMS is feasible in TBI patients with depression. Given the dearth of existing evidence-based treatments for depression in this patient population, these preliminarily encouraging results indicate that larger controlled trials are warranted.

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Cited by

Sorted by citations

Authors
Siddiqi, S. H., Trapp, N. T., Hacker, C. D., Laumann, T. O., Kandala, S., Hong, X., Trillo, L., Shahim, P., Leuthardt, E. C., Carter, A. R., & Brody, D. L.
Affiliations
  • National Institutes of Health (US)
  • University of Iowa (US)
  • Washington University in St. Louis (US)
Corresponding author
Siddiqi, Shan H.
ORCID
Venue
Journal of Neurotrauma
Publisher
SAGE Publications
Published
2019-04-15
Volume
36
Issue
8
Pages
1361-1374
ISSN
  • 0897-7151 (ISSN-L)
  • 1557-9042
DOI
10.1089/neu.2018.5889
PMC
PMC6909726
OpenAlex
W2898834153
Cited by
106
References
12
Citations by year
2026: 9 · 2025: 10 · 2024: 18 · 2023: 17 · 2022: 13 · 2021: 16 · 2020: 14 · 2019: 9
FWCI
4.39
Type
journal article
Language
en
Open access
Licence
www.liebertpub.com/nv/resources-tools/text-and-data-mining-policy/121/ (tdm)
Locations
  • Journal of Neurotrauma (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Digital Commons@Becker (Washington University School of Medicine) (submittedVersion)
Topics
  • Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
Keywords
repetitive transcranial magnetic stimulation, treatment-resistant depression, traumatic brain injury, dorsal attention network, default mode network, dorsolateral prefrontal cortex, subgenual anterior cingulate cortex, functional connectivity, concussion
MeSH terms
Brain Injuries, Traumatic, Adult, Brain Mapping, Double-Blind Method, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Pilot Projects, Transcranial Magnetic Stimulation, Depressive Disorder, Treatment-Resistant

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