CaltechAUTHORS
Published October 15, 2023 | Version Published
Journal Article Open

Pretreatment pupillary reactivity is associated with differential early response to 10 Hz and intermittent theta-burst repetitive transcranial magnetic stimulation (rTMS) treatment of major depressive disorder (MDD)

Creators

  • 1. ROR icon UCLA Health
  • 2. ROR icon University of California, Los Angeles
  • 3. ROR icon Cooperative Institute for Research in Environmental Sciences
  • 4. ROR icon California Institute of Technology
  • 5. ROR icon University of California, San Diego

Abstract

Background

Pre-treatment biomarkers for outcome of repetitive Transcranial Magnetic Stimulation (rTMS) treatment of Major Depressive Disorder (MDD) have proven elusive. One promising family of biomarkers involves the autonomic nervous system (ANS), which is dysregulated in individuals with MDD.

Methods

We examined the relationship between the pre-treatment pupillary light reflex (PLR) and rTMS outcome in 51 MDD patients. Outcome was measured as the percent change in the 30-item Inventory of Depressive Symptomatology Self Rated (IDS-SR) score from baseline to treatment 30.

Results

Patients showed significant improvement with rTMS treatment. There was a significant correlation between baseline pupillary Constriction Amplitude (CA) and clinical improvement over the treatment course (R = 0.41, p = 0.003).

Limitations

We examined a limited number of subjects who received heterogeneous treatment protocols. Almost all patients in the study received psychotropic medications concomitant with rTMS treatment.

Conclusion

PLR measured before treatment may be a predictive biomarker for clinical improvement from rTMS in subjects with MDD.

Copyright and License

© 2023 The Authors. Published by Elsevier Under a Creative Commons license:  Attribution-NonCommercial-NoDerivs 4.0 International.

 

Acknowledgement

We thank Ghada Elmachtoub and Sue Ellen Zhang for their expert help in manuscript preparation. Dr. Corlier's work was supported by the K01 award from the NIMH (1K01MH123887-01A1). We also gratefully acknowledge the donation of a pupillometer to UCLA by NeurOptics, Inc., which made this work possible. This work was supported by the Ryan Family Fund for TMS Research. We are grateful to the Ryan family for their visionary support of innovative research to enhance the effectiveness of TMS treatment.

Contributions

CC, JC, ACW, and AL designed the study, analyzed the data, interpreted the findings and wrote the manuscript; DN, NV-C, SW, DK, RT, NG, JL, JHL, TS, AC, PV and AL acquired data; All authors revised and approved the manuscript.

Conflict of Interest

Mr. Citrenbaum, Ms. Doan Ngo, Ms. Vince-Cruz, Mr. Wilson and Drs. Corlier, Wilke, Krantz, Tadayonnejad, Ginder, Levitt, Lee, Strouse, Corse, Vyas do not have anything to disclose. Dr. Leuchter discloses that within the past 36 months he has received research support from the National Institute of Health, Department of Defense, and eFovea, Inc. He has served as a consultant to iFovea and ElMindA. He is Chief Scientific Officer of Brain Biomarker Analytics LLC (BBA), and has equity interest in BBA.

Files

Pretreatment pupillary reactivity is associated with outcome of Repetitive Transcranial Magnetic Stimulation (rTMS) treatment of Major Depressive Disorder (MDD).pdf

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Additional details

Related works

Is supplemented by
Dataset: https://ars.els-cdn.com/content/image/1-s2.0-S0165032723008376-mmc1.docx (URL)

Funding

National Institutes of Health
1K01MH123887-01A1
University of California, Los Angeles
Ryan Family Fund for TMS Research