Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/121795
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Type: Journal article
Title: Altered transcranial magnetic stimulation–electroencephalographic markers of inhibition and excitation in the dorsolateral prefrontal cortex in major depressive disorder
Author: Voineskos, D.
Blumberger, D.
Zomorrodi, R.
Rogasch, N.
Farzan, F.
Foussias, G.
Rajji, T.
Daskalakis, Z.
Citation: Biological Psychiatry, 2019; 85(6):477-486
Publisher: Elsevier
Issue Date: 2019
ISSN: 0006-3223
1873-2402
Statement of
Responsibility: 
Daphne Voineskos, Daniel M.Blumberger, Reza Zomorrodi, Nigel C.Rogasch, Faranak Farzan, George Foussias, Tarek K.Rajji, Zafiris J.Daskalakis
Abstract: BACKGROUND:The neurophysiology of major depressive disorder (MDD) has become a particular focus of transcranial magnetic stimulation (TMS) investigational studies. TMS combined with electroencephalography (TMS-EEG) affords a window to directly measure evoked activity from the dorsolateral prefrontal cortex (DLPFC), which is of considerable interest in MDD. Our study examined TMS-EEG responses from the DLPFC in persons with MDD compared with those in healthy participants. Specifically, we examined TMS-EEG markers linked to inhibitory and excitatory neurophysiological processes and their balance. METHODS:In all, 30 participants with MDD and 30 age- and sex-matched healthy participants underwent single-pulse TMS-EEG to assess inhibition and excitation from DLPFC. TMS-EEG waveforms were analyzed through global mean field amplitude. RESULTS:MDD participants demonstrated abnormalities in TMS-EEG markers in the DLPFC. Inhibitory measures-N45 and N100-were larger in the MDD group than in healthy participants (N45 [t = -4.894, p < .001] and N100 [t = -3.496, p = .001]). In a receiver operating characteristic analysis, N45 amplitude predicted depression illness state with 80% sensitivity, 73.3% specificity, and 76.6% accuracy (area under the curve = 0.829, p < .001). The global mean field amplitude area under the curve, a neurophysiological measure of cortical reactivity, was significantly larger in persons with MDD (t = -3.114, p = .003), as was P60 (t = -3.260, p = .002). In healthy participants, there was a positive correlation between inhibitory N45 and excitatory global mean field amplitude area under the curve (r = .711, p < .001) that was not present in persons with MDD (r = .149, p = .43), demonstrating a potential imbalance between inhibition and excitation in MDD. CONCLUSIONS:As the TMS-EEG waveform and its components index inhibitory and excitatory activity from the cortex, our results suggest abnormalities in these neurophysiological processes of DLPFC in persons with MDD.
Keywords: EEG; Excitation; GABA; Inhibition; Major depressive disorder; TMS
Rights: © 2018 Society of Biological Psychiatry.
RMID: 0030120385
DOI: 10.1016/j.biopsych.2018.09.032
Appears in Collections:Psychiatry publications

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