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. 2024 Oct 28;3(1):49.
doi: 10.1038/s44184-024-00099-2.

Early differences in lassitude predicts outcomes in Stanford Neuromodulation Therapy for difficult to treat depression

David Benrimoh  1   2 , Azeezat Azeez  3 , Jean-Marie Batail  3   4 , Xiaoqian Xiao  3 , Derrick Buchanan  3 , Igor D Bandeira  3 , Andrew Geoly  3 , Yaakov Keynan  3 , Ian H Kratter  3 , Nolan R Williams  3   5
Affiliations

Early differences in lassitude predicts outcomes in Stanford Neuromodulation Therapy for difficult to treat depression

David Benrimoh et al. Npj Ment Health Res. .

Abstract

Stanford Neuromodulation Therapy (SNT), has recently shown rapid efficacy in difficult to treat (DTT) depression. We conducted an exploratory analysis of individual symptom improvements during treatment, correlated with fMRI, to investigate this rapid improvement in 23 DTT participants from an SNT RCT (12 active, 11 sham). Montgomery-Åsberg Depression Rating Scale item 7 (Lassitude) was the earliest to show improvements between active and sham, as early as treatment day 2. Lassitude score at treatment day 3 was predictive of response at 4 weeks post-treatment and response immediately after treatment. Participants with lower lassitude scores at treatment day 3 had different patterns of sgACC functional connectivity compared to participants with higher scores in both baseline and post-treatment minus baseline analyses. Further work will aim to first replicate these preliminary findings, and then to extend these findings and examine how SNT may affect lassitude and behavioral activation early in treatment.

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Conflict of interest statement

N.R.W. is a named inventor on Stanford-owned intellectual property relating to accelerated TMS pulse pattern sequences and neuroimaging-based TMS targeting; he has served on scientific advisory boards for Otsuka, NeuraWell, Magnus Medical, and Nooma as a paid advisor; and he has equity/stock options in Magnus Medical, NeuraWell, and Nooma. D.B. is a founder, shareholder, and officer of Aifred Health, a digital mental health company whose work is unrelated to this article. All other investigators declare no conflicts of interest. D.B. is a founder and shareholder of CanadaNeuro, a mental health company whose work is unrelated to this publication and which did not support this work.

Figures

Fig. 1
Fig. 1. Trajectories of MADRS item 7 scores.
Results shown for repeated measures GLM between-subjects main effect between active and sham groups. There was no significant group x time interaction. Figure generated using Prism. Day 1–Day 5 are treatment days; Week 1–Week 4 are weeks post-treatment. Data available for 19 subjects. Error bars represent 95% CI. * indicates significant difference between groups on scores for that timepoint (ANOVA, p ≤ 0.05).
Fig. 2
Fig. 2. Pre-treatment resting state functional connectivity which differed between groups with high vs low lassitude score at treatment day 3.
Thickness of connections between nodes is determined by the F-statistic. Directionality of connectivity was as follows: right sgACC to LH_VN_7 - patients in the low lassitude group showed reduced FC; right sgACC and LH_DAN_Post1- patients in the low group showed reduced FC; right sgACC and LH_DMN_PFC7- patients in the low group showed increased FC. Notes: dorsal attention network (DAN); visual network (VN); default mode network (DMN).
Fig. 3
Fig. 3. Changes in resting state functional connectivity between pre-and post-treatment which differed between groups with high vs low lassitude score at treatment day 3.
Thickness of connections between nodes is determined by the F-statistic. Directionality of connectivity was as follows: left sgACC to LH_CEN_PFCl1- patients in the low group showed increased FC; left sgACC and RH_CEN_PFCl2- patients in the low group showed increased FC; right sgACC and LH_SMN_6- patients in the low group showed decreased FC. Notes: central executive network (CEN); sensorimotor network (SMN).
See this image and copyright information in PMC

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