An rs-fMRI study of taVNS for Treatment-Resistant Depression and Non-Treatment-Resistant Depression
Poster No:
2338
Submission Type:
Abstract Submission
Authors:
Qingyan Chen1, Yi Luo1, Yue Ma1, Chunlei Guo1, Shanshan Gao1, Jiliang Fang1
Institutions:
1Guanganmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
First Author:
Co-Author(s):
Introduction:
Major Depression Disorder (MDD) is a common emotional mental disorder. The main clinical characteristic are significant and persistent depression, loss of interest, sluggish thinking, persistent fatigue, and decreased volitional activity, etc., which has a high risk of disability and suicide[1]. The primary treatment for depression is pharmacological and psychological intervention. Nevertheless, significant proportion of patients, approximately 30%, remain resistant to treatment despite being administered two or more antidepressant medications with varying chemical structures in adequate doses and durations. This type of depression is classified as treatment-resistant depression (TRD)[2-3]. Therefore, searching for other non-drug therapies to effectively treat TRD has become the focus of research in the field of anti-depression.
Transcutaneous auricular vagus nerve stimulation (taVNS) is a novel type of ear electroacupuncture therapy. Its theory mainly involves stimulating the auricular point - ear nail region with micro-current to regulate the function of the corresponding Zangfu. It has been widely used in the treatment of neurological diseases, mental and behavioral disorders. The team's previous research found that taVNS is effective in the treatment of mild to moderate depression and treatment-resistant depression[4-7], and its therapeutic effect is related to the regulation of default network[4], Salience network[8], visual processing network[9], cognitive control network[10] and other networks. However, there is still a lack of research on the brain effect mechanism of taVNS in TRD and nTRD.
Transcutaneous auricular vagus nerve stimulation (taVNS) is a novel type of ear electroacupuncture therapy. Its theory mainly involves stimulating the auricular point - ear nail region with micro-current to regulate the function of the corresponding Zangfu. It has been widely used in the treatment of neurological diseases, mental and behavioral disorders. The team's previous research found that taVNS is effective in the treatment of mild to moderate depression and treatment-resistant depression[4-7], and its therapeutic effect is related to the regulation of default network[4], Salience network[8], visual processing network[9], cognitive control network[10] and other networks. However, there is still a lack of research on the brain effect mechanism of taVNS in TRD and nTRD.
Methods:
In this study, 24 patients with TRD and 31 patients with nTRD were enrolled. Both groups received taVNS treatment for eight weeks respectively. Resting-state functional magnetic resonance imaging (rs-fMRI) was performed before and after treatment for two groups. The 17-item Hamilton Rating Scale for Depression (HAMD-17) was used as the primary clinical efficacy indicator, while the Ruminative Response Scale (RRS) served as the secondary indicator. The amplitude of low frequency fluctuation (ALFF) value before and after treatment between two groups was compared by mixed effect analysis.
Results:
Both groups were found with significant reduction in HAMD-17 scores after treatment. The RRS scores of the nTRD group showed a notable reduction. The fMRI results showed that the nTRD group had significantly decreased ALFF in the left thalamus/hypothalamus/globus pallidum and primary visual cortex compared with the TRD group. After treatment, both groups demonstrated a significant increase in ALFF values in the left posterior central gyrus and a significant decrease in ALFF values in the right insular lobe. Furthermore, the nTRD group exhibited a significant increase in ALFF values in the right anterior central gyrus. Mixed-effect analysis results showed that the left orbitofrontal gyrus and right cerebellar Crus2 were the different brain regions between the TRD group and the nTRD group before and after treatment. nTRD group had significantly decreased ALFF in the left orbitofrontal gyrus and right cerebellar Crus2 after treatment, while the TRD group had significantly increased ALFF in the left orbitofrontal gyrus and the right cerebellum Crus2.
Conclusions:
Transcutaneous auricular vagus nerve stimulation alleviated depressive symptoms in patients with treatment-resistant depression and non-treatment-resistant depression. There are brain function differences between TRDs and nTRDs in thalamus/hypothalamus/globus pallidum and primary visual cortex, so taVNS can regulate brain regions related to emotion, cognition and sensorimotor function in both groups of TRDs and nTRDs. While there are different regulatory patterns in the left orbitofrontal middle gyrus and cerebellum between two groups. This study could provide some basis for the targeted cortex of taVNS for TRD and nTRD.
Brain Stimulation:
Invasive Stimulation Methods Other
Disorders of the Nervous System:
Psychiatric (eg. Depression, Anxiety, Schizophrenia) 2
Novel Imaging Acquisition Methods:
BOLD fMRI 1
Keywords:
fMRI CONTRAST MECHANISMS
Treatment
Other - Transcutaneous auricular vagus nerve stimulation; Treatment-resistant depression; Non treatment-resistant depression; Amplitude of low frequency fluctuation
1|2Indicates the priority used for review
Provide references using author date format
[2]GAYNES B.N.(2020a),'Defining treatment-resistant depression', Depress Anxiety. vol.37,no.2,pp.134-145.
[3]KVERNO K.S.(2021b),'Treatment-Resistant Depression: Approaches to Treatment', J Psychosoc Nurs Ment Health Serv. vol.59,no.9,pp.7-11.
[4]FANG J.L.(2016a),'Transcutaneous vagus nerve stimulation modulates default mode network in major depressive disorder', Biol Psychiatry.vol.79,no.4,pp.266-273.
[5]LI X.J.(2019a),'The effect of transcutaneous auricular vagus nerve stimulation on treatment-resistant depression monitored by resting-state fMRI and MRS: The first case report. Brain Stimul', vol.12,no.2,pp:377-379.
[6]SUN J.F.(2022b),'Immediate modulation of transcutaneous auricular vagus nerve stimulation in patients with treatment-resistant depression: A resting-state functional magnetic resonance imaging study', Front Psychiatry. vol.13,pp:923783.
[7]MA Y.(2022b),'Transcutaneous auricular vagus nerve immediate stimulation treatment for treatment-resistant depression: A functional magnetic resonance imaging study', Front Neurol. vol.13,pp:931838.
[8]SUN J.F.(2022a),'A comparative study of regional homogeneity of resting-state fMRI between the early-onset and late-onset recurrent depression in adults', Front Psychol.vol.13,pp:849847.
[9]SUN J.F.(2022a),'Comparison of functional connectivity of posterior cingulate cortex in resting-state between patients with treatment-resistant depression and non-treatment-resistant depression', Journal of Psychiatry. vol.35,no.1,pp:1-7.
[10]SUN J.F.(2023a),'Immediate modulatory effects of transcutaneous auricular vagus nerve stimulation on the resting state of major depressive disorder', J Affect Disord.vol.325,pp:513-521.