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Effects of bilateral sequential theta-burst stimulation on 5-HT 1A receptors in the dorsolateral prefrontal cortex in treatment-resistant depression: a proof-of-concept trial.

Matej MurgašJakob UnterholznerPeter StöhrmannCécile PhilippeGodber Mathis GodbersenLukas NicsMurray B ReedChrysoula VrakaThomas VanicekWolfgang WadsakGeorg S KranzAndreas HahnMarkus MitterhauserMarcus HackerSiegfried KasperRupert LanzenbergerPia Baldinger-Melich
Published in: Translational psychiatry (2023)
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-HT 1A ) 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- 11 C]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 (V S ) of 5-HT 1A receptor. While post-hoc comparisons showed no significant changes of 5-HT 1A receptor V S in either group, higher 5-HT 1A receptor V S 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-HT 1A receptor. Due to the small sample size, all results must, however, be regarded with caution.
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