Deep brain stimulation modulates directional limbic connectivity in major depressive disorder.

IF 5.5 2区医学 Q1 PSYCHIATRY

Psychological Medicine Pub Date : 2025-08-08 DOI:10.1017/S0033291725100767

Egill A Fridgeirsson, Isidoor Bergfeld, Bart P de Kwaasteniet, Judy Luigjes, Jan van Laarhoven, Peter Notten, Guus Beute, Pepijn van den Munckhof, Rick Schuurman, Damiaan Denys, Guido van Wingen

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Abstract

Background: Deep brain stimulation (DBS) is being investigated as a treatment for patients with refractory major depressive disorder (MDD). However, little is known about how DBS exerts its antidepressive effects. Here, we investigated whether ventral anterior limb of the internal capsule stimulation modulates a limbic network centered around the amygdala in patients with treatment-resistant MDD.

Methods: Nine patients underwent resting state functional magnetic resonance scans before DBS surgery and after 1 year of treatment. In addition, they were scanned twice within 2 weeks during the subsequent double-blind cross-over phase with active and sham treatment. Twelve matched controls underwent scans at the same time intervals to account for test-retest effects. The imaging data were investigated with functional connectivity (FC) analysis and dynamic causal modelling.

Results: Results showed that 1 year of DBS treatment was associated with increased FC of the left amygdala with precentral cortex and left insula, along with decreased bilateral connectivity between nucleus accumbens and ventromedial prefrontal cortex. No changes in FC were observed during the cross-over phase. Effective connectivity analyses using dynamic causal models revealed widespread amygdala-centric changes between presurgery and 1 year follow-up, while the cross-over phase was associated with insula-centric changes between active and sham stimulation.

Conclusions: These results suggest that ventral anterior limb of the internal capsule DBS results in complex rebalancing of the limbic network involved in emotion, reward, and interoceptive processing.

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脑深部刺激调节重度抑郁症的定向边缘连通性。

背景：深部脑刺激（DBS）作为一种治疗难治性重度抑郁症（MDD）的方法正在被研究。然而，人们对DBS如何发挥其抗抑郁作用知之甚少。在这里，我们研究了在难治性重度抑郁症患者中，腹侧前肢内囊刺激是否调节了以杏仁核为中心的边缘网络。方法：9例患者在DBS手术前和治疗1年后进行静息状态功能磁共振扫描。此外，在随后的双盲交叉阶段，他们在两周内接受了两次扫描，分别进行了积极和虚假治疗。12个匹配的对照组在相同的时间间隔内接受扫描，以解释重新测试的效果。通过功能连接（FC）分析和动态因果模型对成像数据进行了研究。结果：结果显示，1年DBS治疗与左杏仁核与中央前皮层和左岛的FC增加有关，同时伏隔核与腹内侧前额叶皮层之间的双侧连性下降。在交叉期未观察到FC的变化。使用动态因果模型的有效连通性分析显示，在手术和1年随访期间，杏仁核中心发生了广泛的变化，而交叉期与主动刺激和假刺激之间的岛核中心变化有关。结论：这些结果表明，腹侧前肢内囊DBS导致涉及情绪、奖励和内感受加工的边缘网络的复杂再平衡。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Psychological Medicine 医学-精神病学

CiteScore

11.30

自引率

4.30%

发文量

711

审稿时长

3-6 weeks

期刊介绍： Now in its fifth decade of publication, Psychological Medicine is a leading international journal in the fields of psychiatry, related aspects of psychology and basic sciences. From 2014, there are 16 issues a year, each featuring original articles reporting key research being undertaken worldwide, together with shorter editorials by distinguished scholars and an important book review section. The journal''s success is clearly demonstrated by a consistently high impact factor.