Translational Psychiatry (Feb 2023)

Effects of bilateral sequential theta-burst stimulation on 5-HT1A receptors in the dorsolateral prefrontal cortex in treatment-resistant depression: a proof-of-concept trial

  • Matej Murgaš,
  • Jakob Unterholzner,
  • Peter Stöhrmann,
  • Cécile Philippe,
  • Godber M. Godbersen,
  • Lukas Nics,
  • Murray B. Reed,
  • Chrysoula Vraka,
  • Thomas Vanicek,
  • Wolfgang Wadsak,
  • Georg S. Kranz,
  • Andreas Hahn,
  • Markus Mitterhauser,
  • Marcus Hacker,
  • Siegfried Kasper,
  • Rupert Lanzenberger,
  • Pia Baldinger-Melich

DOI
https://doi.org/10.1038/s41398-023-02319-3
Journal volume & issue
Vol. 13, no. 1
pp. 1 – 8

Abstract

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Abstract Theta-burst stimulation (TBS) represents a brain stimulation technique effective for treatment-resistant depression (TRD) as underlined by meta-analyses. While the methodology undergoes constant refinement, bilateral stimulation of the dorsolateral prefrontal cortex (DLPFC) appears promising to restore left DLPFC hypoactivity and right hyperactivity found in depression. The post-synaptic inhibitory serotonin-1A (5-HT1A) receptor, also occurring in the DLPFC, might be involved in this mechanism of action. To test this hypothesis, we performed PET-imaging using the tracer [carbonyl-11C]WAY-100635 including arterial blood sampling before and after a three-week treatment with TBS in 11 TRD patients compared to sham stimulation (n = 8 and n = 3, respectively). Treatment groups were randomly assigned, and TBS protocol consisted of excitatory intermittent TBS to the left and inhibitory continuous TBS to the right DLPFC. A linear mixed model including group, hemisphere, time, and Hamilton Rating Scale for Depression (HAMD) score revealed a 3-way interaction effect of group, time, and HAMD on specific distribution volume (VS) of 5-HT1A receptor. While post-hoc comparisons showed no significant changes of 5-HT1A receptor VS in either group, higher 5-HT1A receptor VS after treatment correlated with greater difference in HAMD (r = −0.62). The results of this proof-of-concept trial hint towards potential effects of TBS on the distribution of the 5-HT1A receptor. Due to the small sample size, all results must, however, be regarded with caution.