Cognitive-affective processes and suicidality in response to repetitive transcranial magnetic stimulation for treatment resistant depression

• Published in: Journal of affective disorders 2023-01, Vol.321, p.182-190
• Main Authors: Terpstra, Alex R., Vila-Rodriguez, Fidel, LeMoult, Joelle, Chakrabarty, Trisha, Nair, Medha, Humaira, Afifa, Gregory, Elizabeth C., Todd, Rebecca M.
• Format: Article
• Language: English
• Subjects: Cognition; Depressive Disorder, Treatment-Resistant - therapy; Humans; Repetitive transcranial magnetic stimulation; Reward sensitivity; Self-referential processing; Suicidal Ideation; Suicidality; Suicide; Transcranial Magnetic Stimulation; Treatment resistant depression
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2022.10.041

Repetitive transcranial magnetic stimulation (rTMS) can elicit 45–55 % response rates and may alleviate suicidality symptoms in treatment resistant depression (TRD). Blunted anticipatory reward sensitivity and negatively biased self-referential processing may predict trajectories of depressive and suicidality symptoms in rTMS for TRD and be modulated during treatment. Fifty-five individuals with TRD received four weeks of low-frequency rTMS applied to the right dorsolateral prefrontal cortex (LFR-rTMS) and were followed until 17 weeks post-baseline. Participants completed behavioral measures of anticipatory reward sensitivity and self-referential processing at baseline and five weeks post-baseline (approximately one-week post-treatment). We examined whether baseline anticipatory reward sensitivity and self-referential processing predicted trajectories of depressive and suicidality symptoms from baseline to follow-up and whether these cognitive-affective variables showed change from baseline to week five. Anticipatory reward sensitivity and negative self-referential encoding at baseline were associated with higher overall depressive symptoms and suicidality from baseline to 17 weeks post-baseline. At week five, participants self-attributed a higher number of positive traits and a lower number of negative traits and had a lesser tendency to remember negative relative to positive traits they had self-attributed, compared to baseline. The specificity of these results to LFR-rTMS is unknown in the absence of a comparison group, and our relatively small sample size precluded the interpretation of null results. Baseline blunted anticipatory reward sensitivity and negative biases in self-referential processing may be risk factors for higher depressive symptoms and suicidality during and after LFR-rTMS, and LFR-rTMS may modulate self-referential processing. •Repetitive transcranial magnetic stimulation can treat depression and suicidality.•Blunted reward sensitivity predicted depressive symptoms and suicidality.•Self-attribution of negative traits predicted depressive symptoms and suicidality.•Negative biases in self-referential processing decreased in response to treatment.