Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Psychiatry
Published in: BMC Psychiatry 1/2013

Open Access 01-12-2013 | Research article

Different patterns of cortical excitability in major depression and vascular depression: a transcranial magnetic stimulation study

Authors: Carmen Concerto, Giuseppe Lanza, Mariagiovanna Cantone, Manuela Pennisi, Daniela Giordano, Concetto Spampinato, Riccardo Ricceri, Giovanni Pennisi, Eugenio Aguglia, Rita Bella

Published in: BMC Psychiatry | Issue 1/2013

Login to get access

Abstract

Background

Clinical and functional studies consider major depression (MD) and vascular depression (VD) as different neurobiological processes. Hypoexcitability of the left frontal cortex to transcranial magnetic stimulation (TMS) is frequently reported in MD, whereas little is known about the effects of TMS in VD. Thus, we aimed to assess and compare motor cortex excitability in patients with VD and MD.

Methods

Eleven VD patients, 11 recurrent drug-resistant MD patients, and 11 healthy controls underwent clinical, neuropsychological and neuroimaging evaluations in addition to bilateral resting motor threshold, cortical silent period, and paired-pulse TMS curves of intracortical excitability. All patients continued on psychotropic drugs, which were unchanged throughout the study.

Results

Scores on one of the tests evaluating frontal lobe abilities (Stroop Color-Word interference test) were worse in patients compared with controls. The resting motor threshold in patients with MD was significantly higher in the left hemisphere compared with the right (p < 0.05), and compared with the VD patients and controls. The cortical silent period was bilaterally prolonged in MD patients compared with VD patients and controls, with a statistically significant difference in the left hemisphere (p < 0.01). No differences were observed in the paired-pulse curves between patients and controls.

Conclusions

This study showed distinctive patterns of motor cortex excitability between late-onset depression with subcortical vascular disease and early-onset recurrent drug resistant MD. The data provide a TMS model of the different processes underlying VD and MD. Additionally, our results support the “Vascular depression hypothesis” at the neurophysiological level, and confirm the inter-hemispheric asymmetry to TMS in patients with MD. We were unable to support previous findings of impaired intracortical inhibitory mechanisms to TMS in patients with MD, although a drug-induced effect on our results cannot be excluded. This study may aid the understanding of the pathogenetic differences underlying the clinical spectrum of depressive disorders.
Appendix
Available only for authorised users
Literature
1.
Xekardaki A, Santos M, Hof P, Kövari E, Bouras C, Giannakopoulos P: Neuropathological substrates and structural changes in late-life depression: the impact of vascular burden. Acta Neuropathol. 2012, 124: 53-64.CrossRef
2.
Alexopoulos GS, Meyers BS, Young RC, Campbell S, Silbersweig D, Charlson M: “Vascular depression” hypothesis. Arch Gen Psychiatry. 1997, 54: 915-922.CrossRefPubMed
3.
Alexopoulos GS, Kiosses DN, Klimstra S, Kalayam B, Bruce ML: Clinical presentation of the “depression-executive dysfunction syndrome” of late life. Am J Geriat Psych. 2002, 10: 98-106.
4.
O’Brien J, Desmond P, Ames D, Schweitzer I, Harrigan S, Tress B: A magnetic resonance imaging study of white matter lesions in depression and Alzheimer’s disease. Br J Psychiatry. 1996, 168: 477-485.CrossRefPubMed
5.
Steffens DC, Helms MJ, Krishnan KR, Burke GL: Cerebrovascular disease and depression symptoms in the cardiovascular health study. Stroke. 1999, 30: 2159-2166.CrossRefPubMed
6.
Thomas AJ, O’Brien JT, Davis S, Ballard C, Barber R, Kalaria RN, Perry RH: Ischemic basis for deep white matter hyperintensities in major depression: a neuropathological study. Arch Gen Psychiatry. 2002, 59: 785-792.CrossRefPubMed
7.
Alexopoulos GS, Meyers BS, Young RC, Kakuma T, Silbersweig D, Charlson M: Clinically defined vascular depression. Am J Psychiatry. 1997, 154: 562-565.CrossRefPubMed
8.
Naismith SL, Norrie LM, Mowszowski L, Hickie IB: The neurobiology of depression in later-life: clinical, neuropsychological, neuroimaging and pathophysiological features. Prog Neurobiol. 2012, 98: 99-143.CrossRefPubMed
9.
Lockwood KA, Alexopoulos GS, Van Gorp WG: Executive dysfunction in geriatric depression. Am J Psychiatry. 2002, 159: 1119-1126.CrossRefPubMed
10.
Bella R, Pennisi G, Cantone M, Palermo F, Pennisi M, Lanza G, Zappia M, Paolucci S: Clinical presentation and outcome of geriatric depression in subcortical ischemic vascular disease. Gerontology. 2010, 56: 298-302.CrossRefPubMed
11.
Rapp MA, Dahlman K, Sano M, Grossman HT, Haroutunian V, Gorman JM: Neuropsychological differences between late-onset and recurrent geriatric major depression. Am J Psychiatry. 2005, 162: 691-698.CrossRefPubMed
12.
Fossati P, Harvey PO, Le Bastard G, Ergis AM, Jouvent R, Allilaire JF: Verbal memory performance of patients with a first depressive episode and patients with unipolar and bipolar recurrent depression. J Psychiatr Res. 2004, 38: 137-144.CrossRefPubMed
13.
Debener S, Beauducel A, Nessler D, Brocke B, Heilemann H, Kayser J: Is resting anterior EEG alpha asymmetry a trait marker for depression? Findings for healthy adults and clinically depressed patients. Neuropsychobiology. 2000, 41: 31-37.CrossRefPubMed
14.
Salustri C, Tecchio F, Zappasodi F, Bevacqua G, Fontana M, Ercolani M, Milazzo D, Squitti R, Rossini PM: Cortical excitability and rest activity properties in patients with depression. J Psychiatry Neurosci. 2007, 32: 259-266.PubMedPubMedCentral
15.
Maeda F, Keenan JP, Pascual-Leone A: Interhemispheric asymmetry of motor cortical excitability in major depression as measured by transcranial magnetic stimulation. Br J Psychiatry. 2000, 177: 169-173.CrossRefPubMed
16.
Fitzgerald PB, Brown TL, Marston NAU, Daskalakis ZJ, de Castella A, Bradshaw JL, Kulkarni J: Motor cortical excitability and clinical response to rTMS in depression. J Affect Disord. 2004, 82: 71-76.CrossRefPubMed
17.
Bajbouj M, Lisanby SH, Lang UE, Danker-Hopfe H, Heuser I, Neu P: Evidence for impaired cortical inhibition in patients with unipolar major depression. Biol Psychiatry. 2006, 59: 395-400.CrossRefPubMed
18.
Lefaucheur JP, Lucas B, Andraud F, Hogrel JY, Bellivier F, Del Cul A, Rousseva A, Leboyer M, Paillère-Martinot ML: Inter-hemispheric asymmetry of motor corticospinal excitability in major depression studied by transcranial magnetic stimulation. J Psychiatr Res. 2008, 42: 389-398.CrossRefPubMed
19.
Levinson AJ, Fitzgerald PB, Favalli G, Blumberger DM, Daigle M, Daskalakis ZJ: Evidence of cortical inhibitory deficits in major depressive disorder. Biol Psychiatry. 2010, 67: 458-464.CrossRefPubMed
20.
Kobayashi M, Pascual-Leone A: Transcranial magnetic stimulation in neurology. Lancet Neurol. 2003, 2: 145-156.CrossRefPubMed
21.
George MS, Lisanby SH, Sackeim HA: Transcranial magnetic stimulation: applications in neuropsychiatry. Arch Gen Psychiatry. 1999, 56: 300-311.CrossRefPubMed
22.
Pascual-Leone A, Walsh V, Rothwell J: Transcranial magnetic stimulation in cognitive neuroscience-virtual lesion, chronometry, and functional connectivity. Curr Opin Neurobiol. 2000, 10: 232-237.CrossRefPubMed
23.
Schönfeldt-Lecuona C, Cárdenas-Morales L, Freudenmann RW, Kammer T, Herwig U: Transcranial magnetic stimulation in depression–lessons from the multicentre trials. Restor Neurol Neurosci. 2010, 28: 569-576.PubMed
24.
Reis J, Swayne OB, Vandermeeren Y, Camus M, Dimyan MA, Harris-Love M, Perez MA, Ragert P, Rothwell JC, Cohen LG: Contribution of transcranial magnetic stimulation to the understanding of cortical mechanisms involved in motor control. J Physiol. 2008, 586: 325-351.CrossRefPubMed
25.
Fitzgerald PB, Brown TL, Marston NA, Daskalakis ZJ, De Castella A, Kulkarni J: Transcranial magnetic stimulation in the treatment of depression: a double-blind, placebo-controlled trial. Arch Gen Psychiatry. 2003, 60: 1002-1008.PubMed
26.
Hasan A, Falkai P, Wobrock T: Transcranial brain stimulation in schizophrenia: targeting cortical excitability, connectivity and plasticity. Curr Med Chem. 2013, 20: 405-413.PubMed
27.
Di Lazzaro V, Oliviero A, Profice P, Meglio M, Cioni B, Tonali P, Rothwell JC: Descending spinal cord volleys evoked by transcranial magnetic stimulation of the motor cortex leg area in conscious humans. J Physiol. 2001, 537: 1047-1058.CrossRefPubMed
28.
Di Lazzaro V, Oliviero A, Pilato F, Saturno E, Dileone M, Mazzone P, Insola A, Tonali PA, Rothwell JC: The physiological basis of transcranial motor cortex stimulation in conscious humans. Clin Neurophysiol. 2004, 115: 255-266.CrossRefPubMed
29.
30.
Bella R, Ferri R, Cantone M, Pennisi M, Lanza G, Malaguarnera G, Spampinato C, Giordano D, Raggi A, Pennisi G: Motor cortex excitability in vascular depression. Int J Psychophysiol. 2011, 82: 248-253.CrossRefPubMed
31.
Steffens DC: Establishing diagnostic criteria for vascular depression. J Neurol Sci. 2004, 226: 59-62.CrossRefPubMed
32.
Erkinjuntti T, Inzitari D, Pantoni L, Wallin A, Scheltens P, Rockwood K, Roman GC, Chui H, Desmond DW: Research criteria for subcortical vascular dementia in clinical trials. J Neural Transm Suppl. 2000, 59: 23-30.PubMed
33.
Sackeim HA: The definition and meaning of treatment-resistant depression. J Clin Psychiatry. 2001, 62: 10-17.PubMed
34.
Spampinato C, Aguglia E, Concerto C, Pennisi M, Lanza G, Bella R, Cantone M, Pennisi G, Kavasidis I, Giordano D: Transcranial magnetic stimulation in the assessment of motor cortex excitability and treatment of drug-resistant major depression. Ieee Transac Neural Syst Rehab Eng. 2013, 21: 391-403.CrossRef
35.
Caffara P, Vezzadini G, Dieci F, Zonato F, Venneri A: Una versione abbreviata del test di Stroop: dati normativi nella popolazione Italiana. Riv Neurol. 2002, 12: 111-115.
36.
Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA: MR signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging. AJR Am J Roentgenol. 1987, 149: 351-356.CrossRefPubMed
37.
Rossini PM, Barker AT, Berardelli A, Caramia MD, Caruso G, Cracco RQ, Dimitrijević MR, Hallett M, Katayama Y, Lücking CH, de Noordhout M, Marsden CD, Murray NMF, Rothwell JC, Swash M, Tomberg C: Non-invasive electrical and magnetic stimulation of the brain, spinal cord and roots: basic principles and procedures for routine clinical application. Report of an IFCN committee. Electroencephalogr Clin Neurophysiol. 1994, 91: 79-92.CrossRefPubMed
38.
Kujirai T, Caramia MD, Rothwell JC, Day BL, Thompson PD, Ferbert A, Wroe S, Asselman P, Marsden CD: Corticocortical inhibition in human motor cortex. J Physiol. 1993, 471: 501-519.CrossRefPubMedPubMedCentral
39.
Giordano D, Kavasidis I, Spampinato C, Bella R, Pennisi G, Pennisi M: An integrated computer-controlled system for assisting researchers in cortical excitability studies by using transcranial magnetic stimulation. Comput Methods Progr Biomed. 2012, 107: 4-15.CrossRef
40.
Soares JC, Mann JJ: The functional neuroanatomy of mood disorders. J Psychiatr Res. 1997, 31: 393-432.CrossRefPubMed
41.
Nusslock R, Shackman AJ, Harmon-Jones E, Alloy LB, Coan JA, Abramson LY: Cognitive vulnerability and frontal brain asymmetry: common predictors of first prospective depressive episode. J Abnorm Psychol. 2011, 120: 497-503.CrossRefPubMedPubMedCentral
42.
Tupler LA, Krishnan KR, McDonald WM, Dombeck CB, D’Souza S, Steffens DC: Anatomic location and laterality of MRI signal hyperintensities in late-life depression. J Psychosom Res. 2002, 53: 665-676.CrossRefPubMed
43.
O’Brien JT, Firbank MJ, Krishnan MS, van Straaten EC, van der Flier WM, Petrovic K, Pantoni L, Simoni M, Erkinjuntti T, Wallin A, Wahlund LO, Inzitari D, LADIS Group: White matter hyperintensities rather than lacunar infarcts are associated with depressive symptoms in older people: the LADIS study. Am J Geriatr Psychiatry. 2006, 14: 834-841.CrossRefPubMed
44.
Steele JD, Glabus MF, Shajahan PM, Ebmeier KP: Increased cortical inhibition in depression: a prolonged silent period with transcranial magnetic stimulation (TMS). Psychol Med. 2000, 30: 565-570.CrossRefPubMed
45.
Mohammadi B, Krampfl K, Petri S, Bogdanova D, Kossev A, Bufler J, Dengler R: Selective and nonselective benzodiazepine agonists have different effects on motor cortex excitability. Muscle Nerve. 2006, 33: 778-784.CrossRefPubMed
46.
Di Lazzaro V, Pilato F, Dileone M, Profice P, Ranieri F, Ricci V, Bria P, Tonali PA, Ziemann U: Segregating two inhibitory circuits in human motor cortex at the level of GABAA receptor subtypes: a TMS study. Clin Neurophysiol. 2007, 118: 2207-2214.CrossRefPubMed
47.
Bella R, Ferri R, Pennisi M, Cantone M, Lanza G, Malaguarnera G, Spampinato C, Giordano D, Alagona G, Pennisi G: Enhanced motor cortex facilitation in patients with vascular cognitive impairment-no dementia. Neurosci Lett. 2011, 503: 171-175.CrossRefPubMed
48.
Bella R, Ferri R, Lanza G, Cantone M, Pennisi M, Puglisi V, Vinciguerra L, Spampinato C, Mazza T, Malaguarnera G, Pennisi G: TMS follow-up study in patients with vascular cognitive impairment-no dementia. Neurosci Lett. 2013, 534: 155-159.CrossRefPubMed
49.
Delvendahl I, Jung NH, Kuhnke NG, Ziemann U, Mall V: Plasticity of motor threshold and motor-evoked potential amplitude–a model of intrinsic and synaptic plasticity in human motor cortex?. Brain Stimul. 2012, 5: 586-593.CrossRefPubMed
50.
Mitchell ND, Baker GB: An update on the role of glutamate in the pathophysiology of depression. Acta Psychiatr Scand. 2010, 122: 192-210.CrossRefPubMed
51.
Langguth B, Eichhammer P, Spranz C, Landgrebe M, Frick U, Sand P, Hajak G: Modulation of human motor cortex excitability by quetiapine. Psychopharmacology (Berl). 2008, 196: 623-629.CrossRef
52.
Daskalakis ZJ, Christensen BK, Chen R, Fitzgerald PB, Zipursky RB, Kapur S: Effect of antipsychotics on cortical inhibition using transcranial magnetic stimulation. Psychopharmacology (Berl). 2003, 170: 255-262.CrossRef
53.
Paulus W, Classen J, Cohen LG, Large CH, Di Lazzaro V, Nitsche M, Pascual-Leone A, Rosenow F, Rothwell JC, Ziemann U: State of the art: Pharmacologic effects on cortical excitability measures tested by transcranial magnetic stimulation. Brain Stimul. 2008, 1: 151-163.CrossRefPubMed
54.
Voytovych H, Kriváneková L, Ziemann U: Lithium: a switch from LTD- to LTP-like plasticity in human cortex. Neuropharmacology. 2012, 63: 274-279.CrossRefPubMed
55.
Andersen H, Nielsen S, Nielsen JF: Motor cortical excitability remains unaffected of short-term hyperglycemia in Type 1 diabetic patients. J Diab Complic. 2006, 20: 51-55.CrossRef
56.
Andersen H, Nielsen JF, Poulsen PL, Mogensen CE, Jakobsen J: Motor pathway function in normoalbuminuric IDDM patients. Diabetologia. 1995, 10: 1191-1196.CrossRef
Metadata
Title
Different patterns of cortical excitability in major depression and vascular depression: a transcranial magnetic stimulation study
Authors
Carmen Concerto
Giuseppe Lanza
Mariagiovanna Cantone
Manuela Pennisi
Daniela Giordano
Concetto Spampinato
Riccardo Ricceri
Giovanni Pennisi
Eugenio Aguglia
Rita Bella
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2013
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/1471-244X-13-300

Other articles of this Issue 1/2013

BMC Psychiatry 1/2013 Go to the issue

Research article

Pharmacotherapy for bipolar disorder and concordance with treatment guidelines: survey of a general population sample referred to a tertiary care service

Research article

Depression in Aboriginal men in central Australia: adaptation of the Patient Health Questionnaire 9

Research article

Integrated treatment vs. treatment-as-usual for recent onset schizophrenia; 12 year follow-up on a randomized controlled trial

Study protocol

Effectiveness of depression and anxiety prevention in adolescents with high familial risk: study protocol for a randomized controlled trial

Study protocol

Magnetic resonance imaging of a randomized controlled trial investigating predictors of recovery following psychological treatment in adolescents with moderate to severe unipolar depression: study protocol for Magnetic Resonance-Improving Mood with Psychoanalytic and Cognitive Therapies (MR-IMPACT)

Research article

Appraising the need for care in alzheimer’s disease