TMS in combination with a pain directed intervention for the treatment of fibromyalgia - A randomized, double-blind, sham-controlled trial.

BACKGROUND: Fibromyalgia Syndrome (FMS) is a highly prevalent condition, that causes chronic pain and severe reduction in quality of life and productivity, as well as social isolation. Despite the significant morbidity and economic burden of FMS, current treatments are scarce. OBJECTIVE: To investigate whether stimulation of ACC -mPFC activity by dTMS enhances a pain-directed psychotherapeutic intervention. METHODS: 19 FMS patients were randomised to receive either 20 sessions of dTMS or sham stimulation, each followed by a pain-directed psychotherapeutic intervention. With the H7 HAC coil or sham stimulation, we targeted the ACC -mPFC; specific brain areas that play a central role in pain processing. Clinical response to treatment was assessed with the McGill Pain Questionnaire Short Form (SF-MPQ), the Visual Analogue Fibromyalgia Impact Questionnaire, the Brief Pain Inventory questionnaire, and the Hamilton Depression Rating Scale. RESULTS: DTMS treatment was safe and well tolerated by FMS patients. A significant decrease in the combined sensory and affective pain dimensions was specifically demonstrated in the dTMS cohort, as measured by the SF-MPQ (Significant group × time interaction [F(2, 32) = 3.51, p < .05,ηp2 = 0.18]; No significant changes were found in depressive symptoms in both the dTMS and sham groups. CONCLUSION: Our results suggest that a course of dTMS combined with a pain-directed psychotherapeutic intervention can alleviate pain symptoms in FMS patients. Beyond clinical possibilities, future studies are needed to substantiate the innovative hypothesis that it is not dTMS alone, but rather dTMS-induced plasticity of pain-related networks, that enables the efficacy of pain-directed psychotherapeutic interventions.

Emotion perception and theory of mind in adolescents with major depression.

BACKGROUND: The research of theory of mind (ToM) and emotion perception (EP) in adolescents with major depressive disorder (MDD) is scarce, and no study to date has investigated the association between EP and long-term outcomes of adolescents with MDD. The aim of the current study was to evaluate ToM and EP in adolescents with MDD, as compared to healthy controls (HCs). In addition, we aimed to assess the association between impairment in ToM and EP, depressive symptom severity, and long-term outcome in the MDD group. METHODS: We compared the performance of 14 adolescents with MDD and 25 HC in the Facial Expression Recognition Task (FERT) and the Interpersonal Perception Task. We followed up with the MDD group 2 years later to assess the level of their depressive symptoms using the Children's Depression Rating Scale-Revised (CDRS-R). RESULTS: No differences were found between adolescents with MDD and HC in the ToM and FERT tasks. Also, within the MDD group, there was no association between the severity of depressive symptoms and task performance. In the MDD group, there was a significant correlation between lower levels of accuracy in the FERT during the index depressive episode and lower CDRS-R scores on follow-up 2 years later (r2 = 0.35, p = 0.021). CONCLUSIONS: EP impairments in adolescents with MDD might predict worse long-term outcome. Further research is needed to verify our findings and to assess for a possible neurobiological underpinning for the state and trait impairments in EP in adolescents with MDD.