Imaging-informed targeting approaches for NIBS in PPD

Symposium title: A neglected condition: NIBS approaches for depressive symptoms during pregnancy and breastfeeding Symposium description: Depressive symptoms during pregnancy and breastfeeding are subject to special care. First, because failed intervention will result in maladaptive bonding patterns and impact the development of the offspring. Second, because a variety of treatment approaches during this period might present some challenges. ECT shows disadvantageous effects on the fetus and mother. Women might be resistant to pharmaco-treatment and professional psychological support is not always available. Since the beneficial treatment effects of NIBS applications have become more and more clear with improved methodological approaches, these techniques are very promising in terms of treating women with depressive symptoms during pregnancy and breastfeeding. In this symposium we will discuss recent advancements and applications of NIBS treatment during the peripartum period to treat depressive symptoms. First, we will discuss meta-analytical data providing multimodal imaging results on NIBS stimulation targets in PPD. Then we will discuss feasibility, safety and patient acceptance of home-based tDCS approaches during the peripartum period. This will be followed by presenting an RCT of home-based tDCS treatment for MDD highlighting the need to foster such approaches in specific patient populations. Finally, we will discuss how concurrent TMS/fMRI can be applied to personalize stimulation parameters to the female brain. This symposium aims at showing the potential of NIBS and imaging-guided personalization for the treatment of depressive symptoms during the peripartum period. It will mark an important step in tackling challenges in this neglected condition. Talk 1: Anna-Lisa Schuler Imaging-informed targeting approaches for NIBS in PPD Talk 2: Ana Ganho-Ávila Transcranial direct current stimulation in perinatal mental health: current status and future directions Talk 3: André Brunoni Home-based transcranial direct current stimulation combined with behavioral therapy delivered through smartphone to treat major depressive disorder: a randomized, double-blind placebo-controlled trial Talk 4: Martin Tik Interleaved TMS/fMRI for personalized gender-sensitive treatment Abstract Imaging-guided approaches for NIBS have been shown to provide improved outcomes in the treatment of major depressive disorder. These approaches are mainly based on the connectivity between anterior cingulate cortex (ACC) and dorsolateral prefrontal cortex (DLPFC) using resting state fMRI data. In this meta-analytical approach, we were interested: 1. if the same pattern applies to a specific patient population, namely women with depressive symptoms during the peripartum period, 2. if there might be alternative targets to treat these patients, and 3. if this pattern holds for multimodal imaging conditions. Based on these questions we performed a systematic literature search including task-based and resting state fMRI data as well as tractography, cortical thickness and PET data. We then performed a meta-analysis based on activation likelihood estimation. In order to evaluate connectivity patterns between ACC and DLPFC we performed additional seed-based connectivity analysis based on large sample repository data. Modelling anticorrelations we could replicate earlier results suggested for MDD patients. Beyond that we will discuss alternative cortical targets beyond DLPFC. This talk will discuss targeting strategies for NIBS treatment for women during the peripartum period to improve treatment response. Research Category and Technology and Methods Translational Research: 18. Functional Brain Imaging Keywords: PPD, ALE, connectivity, target optimization