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, and Pia Baldinger-Melich
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 in 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 5-HT1A receptor specific binding VS. While post-hoc comparisons showed no significant changes of 5-HT1A VS in either group, higher 5-HT1A VS after treatment correlated with greater difference in HAMD (r=-0.62), indicative of potential effects of TBS on the 5-HT1A receptor. Due to the small sample size, all results, however, must be regarded with caution.