Volume 32, Issue 12 pp. 871-891
Review

NEUROBIOLOGICAL PREDICTORS OF RESPONSE TO DORSOLATERAL PREFRONTAL CORTEX REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION IN DEPRESSION: A SYSTEMATIC REVIEW

William K. Silverstein B.M.Sc.

William K. Silverstein B.M.Sc.

Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada

Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

These authors contributed equally to this work.

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Yoshihiro Noda M.D., Ph.D.

Yoshihiro Noda M.D., Ph.D.

Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada

Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

These authors contributed equally to this work.

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Mera S. Barr M.Sc., Ph.D.

Mera S. Barr M.Sc., Ph.D.

Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada

Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada

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Fidel Vila-Rodriguez M.D., F.R.C.P.C.

Fidel Vila-Rodriguez M.D., F.R.C.P.C.

Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

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Tarek K. Rajji M.D., F.R.C.P.C.

Tarek K. Rajji M.D., F.R.C.P.C.

Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada

Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada

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Paul B. Fitzgerald M.B.B.S., M.P.M., Ph.D., F.R.A.N.Z.C.P.

Paul B. Fitzgerald M.B.B.S., M.P.M., Ph.D., F.R.A.N.Z.C.P.

Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, Victoria, Australia

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Jonathan Downar M.D., Ph.D., F.R.C.P.C.

Jonathan Downar M.D., Ph.D., F.R.C.P.C.

Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

MRI-Guided rTMS Clinic, Department of Psychiatry, University Health Network, Toronto, Ontario, Canada

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Benoit H. Mulsant M.D., M.Sc., F.R.C.P.C.

Benoit H. Mulsant M.D., M.Sc., F.R.C.P.C.

Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada

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Simone Vigod M.D., M.Sc., F.R.C.P.C.

Simone Vigod M.D., M.Sc., F.R.C.P.C.

Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

Reproductive Life Stages Program, Women's Mental Health Program, Women's College Hospital, Toronto, Ontario, Canada

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Zafiris J. Daskalakis M.D., Ph.D., F.R.C.P.C.

Zafiris J. Daskalakis M.D., Ph.D., F.R.C.P.C.

Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada

Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada

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Daniel M. Blumberger M.D., M.Sc., F.R.C.P.C.

Corresponding Author

Daniel M. Blumberger M.D., M.Sc., F.R.C.P.C.

Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada

Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada

Correspondence to: Daniel M. Blumberger, Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, 1001 Queen St. W. Unit 4–115, Toronto, ON, M6J 1H4, Canada. Email: [email protected]Search for more papers by this author
First published: 18 September 2015
Citations: 61

Grant sponsor: CAMH Foundation; Grant sponsor: Brain and Behavior Research Foundation; Grant sponsor: NHMRC Practitioner Fellowship; Grant number: 606907; Grant sponsor: Cervel Neurotech; Grant sponsor: Lundbeck; Grant sponsor: ANT Neuro; Grant sponsor: Roche; Grant sponsor: Ontario Mental Health Foundation (OMHF); Grant sponsor: CIHR; Grant sponsor: SickKids Foundation; Grant sponsor: The Ontario Ministry of Long Term Care; Grant sponsor: Brainsway, Ltd.; Grant sponsor: Pfizer and Merck; Grant sponsor: Sepracor, Inc., AstraZeneca; Grant sponsor: The Temerty Family and Grant Family; Grant sponsor: The Campbell Institute.

Abstract

Background

A significant proportion of patients with depression fail to respond to psychotherapy and standard pharmacotherapy, leading to treatment-resistant depression (TRD). Due to the significant prevalence of TRD, alternative therapies for depression have emerged as viable treatments in the armamentarium for this disorder. Repetitive transcranial magnetic stimulation (rTMS) is now being offered in clinical practice in broader numbers. Many studies have investigated various different neurobiological predictors of response of rTMS. However, a synthesis of this literature and an understanding of what biological targets predict response is lacking. This review aims to systematically synthesize the literature on the neurobiological predictors of rTMS in patients with depression.

Methods

Medline (1996–2014), Embase (1980-2014), and PsycINFO (1806-2014) were searched under set terms. Two authors reviewed each article and came to consensus on the inclusion and exclusion criteria. All eligible studies were reviewed, duplicates were removed, and data were extracted individually.

Results

The search identified 1,673 articles, 41 of which met both inclusion and exclusion criteria. Various biological factors at baseline appear to predict response to rTMS, including levels of certain molecular factors, blood flow in brain regions implicated in depression, electrophysiological findings, and specific genetic polymorphisms.

Conclusions

Significant methodological variability in rTMS treatment protocols limits the ability to generalize conclusions. However, response to treatment may be predicted by baseline frontal lobe blood flow, and presence of polymorphisms of the 5-hydroxytryptamine (5-HT) -1a gene, the LL genotype of the serotonin transporter linked polymorphic region (5-HTTLPR) gene, and Val/Val homozygotes of the brain-derived neurotrophic factor (BDNF) gene.

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