Probing the Dorsolateral Prefrontal Cortex and Central Executive Network for Improving Neuromodulation in Depression

Summary

Depression is a highly prevalent condition characterized by persistent low mood, energy, and activity that can affect one's thoughts, mood, behavior, and sense of well-being. Repetitive transcranial magnetic stimulation (rTMS), a non-invasive neuromodulatory technique, is an effective treatment for depression when targeting the dorsolateral prefrontal cortex (dlPFC) of the central executive network (CEN). However, remission rates are suboptimal and individual methods to target the dlPFC are lacking. In this study, we will enroll 50 patients with major depression and in a single rTMS 'dose,' prospective, randomized, double-blind, cross-over design will assess whether rTMS targeted to an individual's central executive network (CEN) assessed by single pulse TMS can enhance network modulation. If successful, this work will lead to a clinical rTMS trial comparing this personalized targeting approach against standard rTMS.

Eligibility

Inclusion Criteria:

* Men and women, ages 18 to 65
* Depression assessed through in-depth Structured Clinical Interview for DMS-5 (SCID-I)
* PHQ9 \> 10 for disease severity
* Must comprehend English well to ensure adequate comprehension of the EEG and TMS instructions, and of clinical scales
* Right-handed
* No current or history of neurological disorders
* No seizure disorder or risk of seizures
* No use of PRN medication within 24 hours of the scheduled study appointment

Exclusion Criteria:

* Those with a contraindication for MRIs (e.g. implanted metal)
* Any unstable medical condition
* History of head trauma with loss of consciousness
* History of seizures
* Neurological or uncontrolled medical disease
* Active substance abuse
* Diagnosis of psychotic or bipolar disorder
* A prior history of ECT or rTMS failure
* Currently taking medications that substantially reduce seizure threshold (e.g., olanzapine, chlorpromazine, lithium)
* Currently pregnant or breastfeeding

Conditions2

Locations1 site

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