Hypothalamic-pituitary-adrenal axis hyperactivity is normalized after successful intermittent theta-burst stimulation in resistant depressed patients

IF 3.4 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Psychoneuroendocrinology Pub Date : 2024-03-30 DOI:10.1016/j.psyneuen.2024.107037
Fabrice Duval, Marie-Claude Mokrani, Vlad Danila, Thomas Weiss, Felix Gonzalez Lopera, Mihaela Tomsa
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Abstract

The present pilot study assessed the effects of multi-session intermittent theta-burst stimulation (iTBS) applied to the left dorsolateral prefrontal cortex in 17 treatment resistant depressed inpatients (TRDs) showing cortisol non-suppression to the overnight dexamethasone suppression test (DST) at baseline (i.e., maximum post-DST cortisol [CORmax] level > 130 nmol/L). After 20 iTBS sessions, the DST was repeated in all TRDs. At baseline, post-DST CORmax levels were higher in TRDs compared to healthy control subjects (HCs; n = 17) (p < 0.0001). After 20 iTBS sessions, post-DST CORmax levels decreased from baseline (p < 0.03) and were comparable to HCs. Decreases in post-DST CORmax levels were related to decreases in 17-item Hamilton Depression Rating Scale (HAMD-17) scores (ρ = 0.53; p < 0.03). At endpoint, 10 TRDs showed DST normalization (among them 7 were responders [i.e., HAMD-17 total score > 50% decrease from baseline]), and 7 did not normalize their DST (among them 6 were non-responders) (p < 0.05). Our results suggest that successful iTBS treatment may restore normal glucocorticoid receptor feedback inhibition at the pituitary level.

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间歇性θ-脉冲刺激成功后,抵抗性抑郁症患者的下丘脑-垂体-肾上腺轴亢进恢复正常
本试验性研究评估了对17名治疗耐药的抑郁症住院患者(TRDs)进行多疗程间歇性θ-脉冲刺激(iTBS)对左侧背外侧前额叶皮层的影响,这些患者在基线时皮质醇对隔夜地塞米松抑制试验(DST)无抑制作用(即DST后皮质醇[CORmax]最大水平为130 nmol/L)。经过 20 次 iTBS 治疗后,对所有 TRD 患者重复进行 DST 测试。与健康对照受试者(HCs;n = 17)相比,基线时,TRDs 的 DST 后 CORmax 水平更高(p < 0.0001)。经过20次iTBS治疗后,DST后CORmax水平从基线开始下降(p <0.03),与HC相当。DST后CORmax水平的下降与17项汉密尔顿抑郁量表(HAMD-17)评分的下降有关(ρ = 0.53; p <0.03)。在终点时,10 名 TRD 患者的 DST 恢复正常(其中 7 人是应答者[即 HAMD-17 总分比基线下降 50%]),7 人的 DST 没有恢复正常(其中 6 人是非应答者)(p < 0.05)。我们的研究结果表明,成功的 iTBS 治疗可在垂体水平恢复正常的糖皮质激素受体反馈抑制。
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来源期刊
Psychoneuroendocrinology
Psychoneuroendocrinology 医学-精神病学
CiteScore
7.40
自引率
8.10%
发文量
268
审稿时长
66 days
期刊介绍: Psychoneuroendocrinology publishes papers dealing with the interrelated disciplines of psychology, neurobiology, endocrinology, immunology, neurology, and psychiatry, with an emphasis on multidisciplinary studies aiming at integrating these disciplines in terms of either basic research or clinical implications. One of the main goals is to understand how a variety of psychobiological factors interact in the expression of the stress response as it relates to the development and/or maintenance of neuropsychiatric illnesses.
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