About this srcd poster session

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Panel information
Panel 6. Developmental Psychopathology

Abstract

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Background: Depressive disorders are a leading cause of years lived with disability in adolescents around the globe (GBD 2019 Mental Disorders Collaborators, 2022). Only 70% of adolescents improve adequately following evidence-based antidepressant treatments (Kennard et al., 2009; March et al., 2004), highlighting the need for novel interventions. Furthermore, research on neural and cognitive mechanisms of novel treatments can inform our understanding of how such treatments work and provide a framework for their optimization. Affective bias towards negatively valenced information is associated with depression and may represent a promising treatment target. Deep transcranial magnetic stimulation (dTMS) is an FDA-cleared treatment for treatment-resistant depression (TRD) in adults (Filipčić et al., 2019; Kaster et al., 2018) that was developed to increase efficacy in treating depression by targeting deeper subcortical and dorsolateral prefrontal cortex (dlPFC) connections that may be better able to normalize affective biases compared to traditional repetitive TMS. The current study examined neural correlates of affective bias in the context of dTMS in adolescents with TRD.

Methods: Adolescents completed a Word-Face Stroop (WFS) task (Başgöze et al., 2015) during an fMRI scan before and after 30 sessions of dTMS (BrainsWay H1 coil, 10 Hz, stimulation intensity 80% to 120% of motor threshold) targeting the left dlPFC. In the task, participants were asked to identify the valence of positive or negative words superimposed on happy or sad faces. The stimuli could be congruent (matching word and face valence) or incongruent (opposite word and face valence). We examined pre- post-intervention changes in fMRI activation during the task and correlations between these changes and improvement in depression severity (percent changes in Children’s Depression Rating Scale-Revised and Beck Depression Inventory) from pre- to post-treatment.

Results: 10 adolescents with TRD (Age, years: M = 16.3, SD = 1.09) had usable pre- and post-intervention WFS data. Amygdala activation during the negative word/happy face condition decreased post-treatment (Hochberg-corrected p = .044). Although non-significant, this decreased activation was associated with clinical improvement (r = -0.63, uncorrected p = .071; Hochberg-corrected p = .99). Overall, for congruent conditions, clinical improvement was associated with decreased activation across brain regions involved in cognitive control, the experience of negative affect, reward processing, and rumination and introspection. For incongruent conditions, the direction of correlations differed by brain region.

Discussion: The decreased amygdala activation during the WFS task may represent a reduction in affective bias, such that participants, particularly those who improved the most clinically, fixated less strongly on and disengaged more easily from negative stimuli. The correlations between clinical improvement and decreased neural activation may represent more efficient neural processing. Key strengths of the study include the longitudinal design, the experimental therapeutics approach using neuromodulation to probe the neural circuitry underpinning affective bias, and the focus on the understudied population of adolescents with TRD. Major limitations include the small sample size, lack of a sham control group, and unknown psychometric properties.

Conclusions: Preliminary findings indicate that improving neural efficiency and normalization of affective bias may prove critical when treating adolescent TRD with dTMS.

Author information

Author	Role
Aparna U. Nair, Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN	Presenting author
Bonnie Klimes-Dougan, Department of Psychology, University of Minnesota, Minneapolis, MN	Non-presenting author
Thanharat Silamongkol, Graduate School of Applied and Professional Psychology, Rutgers, The State University of New Jersey, New Brunswick, NJ	Non-presenting author
Zeynep Başgöze, Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN	Non-presenting author
Donovan J. Roediger, Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN	Non-presenting author
Bryon A. Mueller, Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN	Non-presenting author
Cristina S. Albott, Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN	Non-presenting author
Paul E. Croarkin, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN	Non-presenting author
Kelvin O. Lim, Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN	Non-presenting author
Alik S. Widge, Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN	Non-presenting author
Ziad Nahas, a Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN	Non-presenting author
Lynn E. Eberly, Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN	Non-presenting author
Kathryn R. Cullen, Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN	Non-presenting author
Michelle E. Thai, Department of Psychology, University of Minnesota, Minneapolis, MN & Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont & Department of Psychiatry, Harvard Medical School, Boston, MA	Non-presenting author

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