Work

Neuronavigated rTMS combined with SSRIs for adolescent depression: Efficacy and neural mechanisms

Year: 2025

Type: article

Abstract: Adolescents with Major Depressive Disorder (A-MDD) experience recurrent depressive episodes with symptoms like low mood and suicidal ideation. This study investigated the antidepressant efficacy of neuronavigation-guided repetitive transcranial magnetic stimulation (rTMS) combined with pharmacotherapy, as well as its associated neural mechanisms, to identify biomarkers for personalized treatment. A total of 49 patients with Adolescent major depressive disorder (A-MDD) and 31 healthy controls (HC) were recruited. The A-MDD group received SSRIs pharmacotherapy combined with neuronavigated high-frequency repetitive transcranial magnetic stimulation (HF-rTMS), which was delivered once daily for a total of 10 sessions. While the HC group only underwent baseline data collection and magnetic resonance imaging (MRI) scanning at enrollment. At baseline, the A-MDD group exhibited significantly higher Hamilton Depression Rating Scale (HAMD) scores and reduced amplitude of low-frequency fluctuations (ALFF) in the left middle frontal gyrus (MFG.L), left inferior parietal gyrus (IPG.L), left precuneus (PCN.L), and left angular gyrus (Ang.L) compared to the healthy HC group. After treatment, HAMD scores significantly decreased ( P < 0.05), and increased ALFF was observed in the MFG.L, left putamen (PUT.L), right precentral gyrus (PRC.R), and right superior occipital gyrus (SOG.R). Post-treatment FC analysis revealed increased connectivity across multiple regions, with no decreases observed. These findings suggest that neuronavigation-guided rTMS promotes neural activity changes and connectivity, offering insights into biomarkers and mechanisms for personalized A-MDD therapy. https://www.medicalresearch.org.cn/index , identifier MR-33-24-030536. • Adolescents with Major Depressive Disorder (A-MDD) show reduced activity in key brain regions, including the left middle frontal gyrus (MFG.L) and left inferior parietal gyrus (IPG.L), compared to healthy controls (HC). • A two-week treatment combining high-frequency repetitive Transcranial Magnetic Stimulation (HF-rTMS) and antidepressants significantly reduced depressive symptoms, as indicated by decreased HAMD scores in the A-MDD group. • Resting-state functional MRI (rs-fMRI) revealed post-treatment increases in amplitude of low-frequency fluctuations (ALFF) in the MFG.L, left putamen (PUT.L), right superior occipital gyrus (SOG.R), and right precentral gyrus (PRC.R). • Seed-based functional connectivity (FC) analysis demonstrated enhanced FC between the MFG.L and multiple regions, including the right inferior frontal gyrus (IFG.R), and between the PUT.L and left middle occipital gyrus (Occipital_Mid.L). • The findings highlight potential neural mechanisms and biomarkers underlying rTMS efficacy, offering insights into personalized treatment strategies for A-MDD.

Source: Journal of Affective Disorders

DOI: 10.1016/j.jad.2025.120436