Cognitive-affective processes and suicidality in response to repetitive transcranial magnetic stimulation for treatment resistant depression

Alex R Terpstra; Fidel Vila-Rodriguez; Joelle LeMoult; Trisha Chakrabarty; Medha Nair; Afifa Humaira; Elizabeth C Gregory; Rebecca M Todd

doi:10.1016/j.jad.2022.10.041

Cognitive-affective processes and suicidality in response to repetitive transcranial magnetic stimulation for treatment resistant depression

J Affect Disord. 2023 Jan 15:321:182-190. doi: 10.1016/j.jad.2022.10.041. Epub 2022 Oct 28.

Authors

Alex R Terpstra¹, Fidel Vila-Rodriguez², Joelle LeMoult³, Trisha Chakrabarty⁴, Medha Nair³, Afifa Humaira⁵, Elizabeth C Gregory⁵, Rebecca M Todd⁶

Affiliations

¹ Department of Psychology, The University of British Columbia, Vancouver, BC, Canada. Electronic address: alexander.terpstra@psych.ubc.ca.
² Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada; Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, BC, Canada.
³ Department of Psychology, The University of British Columbia, Vancouver, BC, Canada.
⁴ Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada.
⁵ Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada.
⁶ Department of Psychology, The University of British Columbia, Vancouver, BC, Canada; Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, BC, Canada.

PMID: 36341803
DOI: 10.1016/j.jad.2022.10.041

Abstract

Background: Repetitive transcranial magnetic stimulation (rTMS) can elicit 45-55 % response rates and may alleviate suicidality symptoms in treatment resistant depression (TRD). Blunted anticipatory reward sensitivity and negatively biased self-referential processing may predict trajectories of depressive and suicidality symptoms in rTMS for TRD and be modulated during treatment.

Methods: Fifty-five individuals with TRD received four weeks of low-frequency rTMS applied to the right dorsolateral prefrontal cortex (LFR-rTMS) and were followed until 17 weeks post-baseline. Participants completed behavioral measures of anticipatory reward sensitivity and self-referential processing at baseline and five weeks post-baseline (approximately one-week post-treatment). We examined whether baseline anticipatory reward sensitivity and self-referential processing predicted trajectories of depressive and suicidality symptoms from baseline to follow-up and whether these cognitive-affective variables showed change from baseline to week five.

Results: Anticipatory reward sensitivity and negative self-referential encoding at baseline were associated with higher overall depressive symptoms and suicidality from baseline to 17 weeks post-baseline. At week five, participants self-attributed a higher number of positive traits and a lower number of negative traits and had a lesser tendency to remember negative relative to positive traits they had self-attributed, compared to baseline.

Limitations: The specificity of these results to LFR-rTMS is unknown in the absence of a comparison group, and our relatively small sample size precluded the interpretation of null results.

Conclusions: Baseline blunted anticipatory reward sensitivity and negative biases in self-referential processing may be risk factors for higher depressive symptoms and suicidality during and after LFR-rTMS, and LFR-rTMS may modulate self-referential processing.

Keywords: Repetitive transcranial magnetic stimulation; Reward sensitivity; Self-referential processing; Suicidality; Treatment resistant depression.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cognition
Depressive Disorder, Treatment-Resistant* / therapy
Humans
Suicidal Ideation
Suicide*
Transcranial Magnetic Stimulation

Grants and funding

CIHR/Canada