No effects on heart rate variability in depression after treatment with dorsomedial prefrontal intermittent theta burst stimulation
Keywords:
Depressive disorder, non-invasive brain stimulation, autonomic nervous system, sympathetic, parasympathetic, heart–brain connection
Abstract
Background: The purpose of this study was to investigate whether treatment of a depressive episode with intermittent theta burst stimulation (iTBS) over the dorsomedial prefrontal cortex (DMPFC) had any effects on heart rate variability (HRV). We also investigated if changes in HRV covaried with symptom change after iTBS and if HRV could predict symptom change.
Methods: We included 49 patients with a current depressive episode. All were randomized to receive a double-blind treatment course with active or sham iTBS over the DMPFC. HRV data were obtained from 1 h of night data before and after the iTBS. The standard deviation of the RR interval (SDNN) was chosen as primary outcome measure. Depressive, negative, and anxiety symptoms as well as self-rated health were assessed by clinicians or by self-report.
Results: The group×time linear mixed model revealed no effect of iTBS on SDNN (estimate = −1.8, 95% confidence interval [CI]: −19.9 to 16.2). There were neither correlations between HRV and depressive, negative, or anxiety symptom change after iTBS nor with self-assessed health. No predictive value of HRV was found.
Conclusions: Treatment for depression with dorsomedial iTBS had neither negative nor positive effects on the cardiac autonomic nervous system.
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References
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13. Neyer S, Witthoft M, Cropley M, Pawelzik M, Lugo RG, Sutterlin S. Reduction of depressive symptoms during inpatient treatment is not associated with changes in heart rate variability. PLoS One. 2021;16:e0248686. doi: 10.1371/journal.pone.0248686
14. Lefaucheur JP, Aleman A, Baeken C, Benninger DH, Brunelin J, Di Lazzaro V, et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): an update (2014–2018). Clin Neurophysiol. 2020;131:474–528. doi: 10.1016/j.clinph.2019.11.002
15. Rossi S, Antal A, Bestmann S, Bikson M, Brewer C, Brockmoller J, et al. Safety and recommendations for TMS use in healthy subjects and patient populations, with updates on training, ethical and regulatory issues: expert guidelines. Clin Neurophysiol. 2021;132:269–306. doi: 10.1016/j.clinph.2020.10.003
16. Huang YZ, Edwards MJ, Rounis E, Bhatia KP, Rothwell JC. Theta burst stimulation of the human motor cortex. Neuron. 2005;45:201–6. doi: 10.1016/j.neuron.2004.12.033
17. Blumberger DM, Vila-Rodriguez F, Thorpe KE, Feffer K, Noda Y, Giacobbe P, et al. Effectiveness of theta burst versus high-frequency repetitive transcranial magnetic stimulation in patients with depression (THREE-D): a randomised non-inferiority trial. Lancet. 2018;391:1683–92. doi: 10.1016/S0140-6736(18)30295-2
18. Palma JA, Benarroch EE. Neural control of the heart: recent concepts and clinical correlations. Neurology. 2014;83:261–71. doi: 10.1212/WNL.0000000000000605
19. Thayer JF, Ahs F, Fredrikson M, Sollers JJ, 3rd, Wager TD. A meta-analysis of heart rate variability and neuroimaging studies: implications for heart rate variability as a marker of stress and health. Neurosci Biobehav Rev. 2012;36:747–56. doi: 10.1016/j.neubiorev.2011.11.009
20. Hayward G, Mehta MA, Harmer C, Spinks TJ, Grasby PM, Goodwin GM. Exploring the physiological effects of double-cone coil TMS over the medial frontal cortex on the anterior cingulate cortex: an H2(15)O PET study. Eur J Neurosci. 2007;25:2224–33. doi: 10.1111/j.1460-9568.2007.05430.x
21. Makovac E, Thayer JF, Ottaviani C. A meta-analysis of non-invasive brain stimulation and autonomic functioning: implications for brain-heart pathways to cardiovascular disease. Neurosci Biobehav Rev. 2017;74:330–41. doi: 10.1016/j.neubiorev.2016.05.001
22. Remue J, Vanderhasselt MA, Baeken C, Rossi V, Tullo J, De Raedt R. The effect of a single HF-rTMS session over the left DLPFC on the physiological stress response as measured by heart rate variability. Neuropsychology. 2016;30:756–66. doi: 10.1037/neu0000255
23. Rossi S, Santarnecchi E, Valenza G, Ulivelli M. The heart side of brain neuromodulation. Philos Trans A Math Phys Eng Sci. 2016;374. doi: 10.1098/rsta.2015.0187
24. Schestatsky P, Simis M, Freeman R, Pascual-Leone A, Fregni F. Non-invasive brain stimulation and the autonomic nervous system. Clin Neurophysiol. 2013;124:1716–28. doi: 10.1016/j.clinph.2013.03.020
25. Udupa K, Thirthalli J, Sathyaprabha TN, Kishore KR, Raju TR, Gangadhar BN. Differential actions of antidepressant treatments on cardiac autonomic alterations in depression: a prospective comparison. Asian J Psychiatr. 2011;4:100–6. doi: 10.1016/j.ajp.2011.02.006
26. Iseger TA, Arns M, Downar J, Blumberger DM, Daskalakis ZJ, Vila-Rodriguez F. Cardiovascular differences between sham and active iTBS related to treatment response in MDD. Brain Stimul. 2020;13:167–74. doi: 10.1016/j.brs.2019.09.016
27. Campana M, Wagner E, Wobrock T, Langguth B, Landgrebe M, Eichhammer P, et al. Effects of high-frequency prefrontal rTMS on heart frequency rates and blood pressure in schizophrenia. J Psychiatr Res. 2021;140:243–9. doi: 10.1016/j.jpsychires.2021.06.010
28. Michael JA, Kaur M. The heart-brain connection in depression: can it inform a personalised approach for repetitive transcranial magnetic stimulation (rTMS) treatment? Neurosci Biobehav Rev. 2021;127: 136–43. doi: 10.1016/j.neubiorev.2021.04.016
29. Choi KW, Jeon HJ. Heart rate variability for the prediction of treatment response in major depressive disorder. Front Psychiatry. 2020;11:607. doi: 10.3389/fpsyt.2020.00607
30. Meyer T, Brunovsky M, Horacek J, Novak T, Andrashko V, Seifritz E, et al. Predictive value of heart rate in treatment of major depression with ketamine in two controlled trials. Clin Neurophysiol. 2021;132:1339–46. doi: 10.1016/j.clinph.2021.01.030
31. Noda Y, Knyahnytska Y, Zomorrodi R, Downar J, Rajji TK, Daskalakis ZJ, et al. Vagally mediated heart rate variability is associated with executive function changes in patients with treatment-resistant depression following magnetic seizure therapy. Neuromodulation. 2020;25:1378–86. doi: 10.1111/ner.13262
32. Boden R, Bengtsson J, Thornblom E, Struckmann W, Persson J. Dorsomedial prefrontal theta burst stimulation to treat anhedonia, avolition, and blunted affect in schizophrenia or depression – a randomized controlled trial. J Affect Disord. 2021;290:308–15. doi: 10.1016/j.jad.2021.04.053
33. Persson J, Struckmann W, Gingnell M, Fallmar D, Boden R. Intermittent theta burst stimulation over the dorsomedial prefrontal cortex modulates resting-state connectivity in depressive patients: a sham-controlled study. Behav Brain Res. 2020;394:112834. doi: 10.1016/j.bbr.2020.112834
34. Richter J, Holz L, Hesse K, Wildgruber D, Klingberg S. Measurement of negative and depressive symptoms: discriminatory relevance of affect and expression. Eur Psychiatry. 2019;55:23–8. doi: 10.1016/j.eurpsy.2018.09.008
35. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-http://dx.doi.org/10. J Clin Psychiatry. 1998;59 Suppl 20:22–33;quiz 4–57.
36. Llerena K, Park SG, McCarthy JM, Couture SM, Bennett ME, Blanchard JJ. The Motivation and Pleasure Scale-Self-Report (MAP-SR): reliability and validity of a self-report measure of negative symptoms. Compr Psychiatry. 2013;54:568–74. doi: 10.1016/j.comppsych.2012.12.001
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Published
2023-03-27
How to Cite
Bengtsson J., Olsson E., Persson J., & Bodén R. (2023). No effects on heart rate variability in depression after treatment with dorsomedial prefrontal intermittent theta burst stimulation. Upsala Journal of Medical Sciences, 128(1). https://doi.org/10.48101/ujms.v128.8949
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Original Articles
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