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

Cole Citrenbaum; Juliana Corlier; Doan Ngo; Nikita Vince-Cruz; Andrew Wilson; Scott Wilke; David Krantz; Reza Tadayonnejad; Nathaniel Ginder; Jennifer Levitt; John H Lee; Thomas Strouse; Andrew Corse; Pooja Vyas; Andrew F Leuchter

doi:10.1016/j.jad.2023.07.008

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

J Affect Disord. 2023 Oct 15:339:412-417. doi: 10.1016/j.jad.2023.07.008. Epub 2023 Jul 10.

Authors

Affiliations

¹ TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA.
² TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA; Division of the Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA.
³ UC San Diego, La Jolla, CA 92093, USA.
⁴ TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA. Electronic address: afl@ucla.edu.

PMID: 37437737
DOI: 10.1016/j.jad.2023.07.008

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.