A frontal-vagal network theory for Major Depressive Disorder: Implications for optimizing neuromodulation techniques

Tabitha A Iseger, Nienke E R van Bueren, J Leon Kenemans, Richard Gevirtz, Martijn Arns*

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

40 Citations (Web of Science)

Abstract

Major Depressive Disorder (MDD) is a psychiatric disorder characterized by high comorbidity with cardiovascular disease. Furthermore, a combination of high heart rate (HR) and low heart rate variability (HRV) has been frequently reported in depressed patients. The present review proposes a frontal-vagal (brain-heart) network that overlaps with functional nodes of the depression network. Moreover, we summarize neuromodulation studies that have targeted key nodes in this depression network, with subsequent impact on heart rate (HR) or heart-rate-variability (HRV), such as the dorsolateral prefrontal cortex (DLPFC), subgenual anterior cingulate cortex (sgACC), and the vagus nerve (VN). Based on the interplay of this frontal-vagal network, we emphasize the importance of including HR and HRV measurements in human depression studies, in particular those that conduct neuromodulation, in order to obtain a better understanding of the pathways that are affected, and we explore the possibilities of using this frontal-vagal interplay as a method for target engagement in neuromodulation treatments. This frontal-vagal network theory opens-up the possibility for individualizing neuromodulation treatments such as rTMS. A recent development called Neuro-Cardiac-Guided TMS (NCG-TMS), was developed based on this theory, and an individual-participant meta-analysis is presented. Four studies provide consistent and replicable support for NCG-TMS as a target engagement method, with consistent HR deceleration during frontal TMS and HR acceleration during motor strip TMS.

Original languageEnglish
Pages (from-to)1-9
Number of pages9
JournalBrain stimulation
Volume13
Issue number1
DOIs
Publication statusPublished - 2020
Externally publishedYes

Keywords

  • ANTIDEPRESSANT TREATMENT
  • BIOFEEDBACK
  • CARDIAC AUTONOMIC FUNCTIONS
  • CINGULATE CORTEX
  • DEFAULT MODE NETWORK
  • Depressive Disorder, Major/physiopathology
  • Dorsolateral prefrontal cortex
  • EMOTION REGULATION
  • Gyrus Cinguli/physiopathology
  • HEART-RATE-VARIABILITY
  • Heart Rate/physiology
  • Heart rate
  • Heart rate variability
  • Humans
  • Major depressive disorder
  • Motor Cortex/physiopathology
  • Neuro-cardiac-guided TMS
  • Neuromodulation
  • Prefrontal Cortex/physiopathology
  • RESPIRATORY SINUS ARRHYTHMIA
  • Subgenual anterior cingulate cortex
  • TRANSCRANIAL MAGNETIC STIMULATION
  • Target engagement
  • Transcranial Magnetic Stimulation/methods
  • VAGUS NERVE-STIMULATION
  • Vagus Nerve/physiopathology
  • Vagus nerve
  • DEEP BRAIN-STIMULATION

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