Association between tDCS computational modeling and clinical outcomes in depression: data from the ELECT-TDCS trial.

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation intervention investigated for the treatment of depression. Clinical results have been heterogeneous, partly due to the variability of electric field (EF) strength in the brain owing to interindividual differences in head anatomy. Therefore, we investigated whether EF strength was correlated with behavioral changes in 16 depressed patients using simulated electric fields in real patient data from a controlled clinical trial. We hypothesized that EF strength in the dorsolateral prefrontal cortex (DLPFC) and anterior cingulate cortex (ACC), brain regions implicated in depression pathophysiology, would be associated with changes in depression, mood and anxiety scores. SimNIBS were used to simulate individual electric fields based on the MRI structural T1-weighted brain scans of depressed subjects. Linear regression models showed, at the end of the acute treatment phase, that simulated EF strength was inversely associated with negative affect in the bilateral ACC (left: ß = - 160.463, CI [- 291.541, - 29.385], p = 0.021; right: ß = - 189.194, CI [- 289.479, - 88.910], p = 0.001) and DLPFC (left: ß = - 93.210, CI [- 154.960, - 31.461], p = 0.006; right: ß = - 82.564, CI [- 142.867, - 22.262], p = 0.011) and with depression scores in the left ACC (ß = - 156.91, CI [- 298.51, - 15.30], p = 0.033). No association between positive affect or anxiety scores, and simulated EF strength in the investigated brain regions was found. To conclude, our findings show preliminary evidence that EF strength simulations might be associated with further behavioral changes in depressed patients, unveiling a potential mechanism of action for tDCS. Further studies should investigate whether individualization of EF strength in key brain regions impact clinical response.

Contextual information resolves uncertainty about ambiguous facial emotions: Behavioral and magnetoencephalographic correlates.

Environmental conditions bias our perception of other peoples' facial emotions. This becomes quite relevant in potentially threatening situations, when a fellow's facial expression might indicate potential danger. The present study tested the prediction that a threatening environment biases the recognition of facial emotions. To this end, low- and medium-expressive happy and fearful faces (morphed to 10%, 20%, 30%, or 40% emotional) were presented within a context of instructed threat-of-shock or safety. Self-reported data revealed that instructed threat led to a biased recognition of fearful, but not happy facial expressions. Magnetoencephalographic correlates revealed spatio-temporal clusters of neural network activity associated with emotion recognition and contextual threat/safety in early to mid-latency time intervals in the left parietal cortex, bilateral prefrontal cortex, and the left temporal pole regions. Early parietal activity revealed a double dissociation of face-context information as a function of the expressive level of facial emotions: When facial expressions were difficult to recognize (low-expressive), contextual threat enhanced fear processing and contextual safety enhanced processing of subtle happy faces. However, for rather easily recognizable faces (medium-expressive) the left hemisphere (parietal cortex, PFC, and temporal pole) showed enhanced activity to happy faces during contextual threat and fearful faces during safety. Thus, contextual settings reduce the salience threshold and boost early face processing of low-expressive congruent facial emotions, whereas face-context incongruity or mismatch effects drive neural activity of easier recognizable facial emotions. These results elucidate how environmental settings help recognize facial emotions, and the brain mechanisms underlying the recognition of subtle nuances of fear.