A Functional Magnetic Resonance Imaging Study of the... : Journal of Clinical Psychopharmacology (original) (raw)

Brief Reports

A Functional Magnetic Resonance Imaging Study of the Effects of Low Frequency Right Prefrontal Transcranial Magnetic Stimulation in Depression

Fitzgerald, Paul B. MBBS, MPM, PhD, FRANZCP*; Sritharan, Anusha BSc, PhD*; Daskalakis, Zafiris J. MD, PhD, FRCP(C)†; de Castella, Anthony R. BA*; Kulkarni, Jayashri MBBS, MPM, FRANZCP, PhD*; Egan, Gary BSc (Hons), PhD, MBA‡

*Alfred Psychiatry Research Centre, The Alfred and Monash University Department of Psychological Medicine, Melbourne, Victoria, Australia; †Centre for Addiction and Mental Health, Clarke Division, Toronto, Ontario, Canada and ‡Howard Florey Institute, The University of Melbourne, Victoria, Australia.

Received December 27, 2006; accepted after revision July 12, 2007.

The study was supported by a grant from National Health and Medical Research Council, a NARSAD Young Investigator award (P.B.F.), and a Pfizer Neurosciences Grant. Equipment for use in the study was provided by the Neurosciences Victoria Informatics platform.

P.B.F. and Z.J.D. have received funding as part of a miltisite rTMS trial by Neuronetics Inc.

Address correspondence and reprint requests to Paul B. Fitzgerald, MBBS, MPM, PhD, FRANZCP, Alfred Psychiatry Research Centre, First Floor, Old Baker Bldg, The Alfred, Commercial Rd, Melbourne, Victoria, Australia 3004. E-mail: [email protected].

Abstract

The study aimed to explore the biological effects of low-frequency repetitive transcranial magnetic stimulation (LFR-TMS) treatment applied to the right prefrontal cortex, comparing this with the effects of high-frequency left-sided (HFL-TMS) in patients with treatment-resistant depression. Twenty-six patients with treatment-resistant depression were randomized to receive either daily LFR-TMS or HFL-TMS treatment for 3 weeks and underwent functional magnetic resonance imaging during a planning task before and after treatment. Patients responded clinically to both forms of treatment with no difference in the degree of response (F1,24 = 0.65;P > 0.05). Low-frequency repetitive transcranial magnetic stimulation resulted in no overall change in task-related activation. However, responders to LFR-TMS demonstrated a bilateral decrease in activity in middle frontal gyrus. In contrast, HFL-TMS produced an increase in activation in left precuneus with responders showing increased activation in several additional regions. Response to LFR-TMS is associated with a bilateral reduction in frontal activation that does not seem to be a nonspecific effect of treatment and differs from the response to HFL-TMS.