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a b s t r a c tBackground: Intermittent theta-burst stimulation (iTBS), a novel repetitive transcranial magnetic stimulation (rTMS) technique, appears to have antidepressant effects when applied over left dorsolateral prefrontal cortex (DLPFC). However, its underlying neurobiological mechanisms are unclear. Proton magnetic resonance spectroscopy ( 1 H-MRS) provides in vivo measurements of cerebral metabolites altered in major depressive disorder (MDD) like N-acetyl-aspartate (NAA) and choline-containing compounds (Cho). We used MRS to analyse effects of iTBS on the associations between the shifts in the NAA and Cho levels during therapy and MDD improvement. Methods: In-patients with unipolar MDD (N ¼ 57), in addition to treatment as usual, were randomized to receive 20 iTBS or sham stimulations applied over left DLPFC over four weeks. Single-voxel 1 H-MRS of the anterior cingulate cortex (ACC) was performed at baseline and follow-up. Increments of concentrations, as well as MDD improvement, were defined as endpoints. We tested a moderated mediation model of effects using the PROCESS macro (an observed variable ordinary least squares and logistic regression path analysis modeling tool) for SPSS. Results: Improvement of depressive symptoms was significantly associated with decrease of Cho/NAA ratio, mediated by NAA. iTBS had a significant moderating effect enhancing the relationship between NAA change and depression improvement. Conclusions: Our findings suggest a potential neurochemical pathway and mechanisms of antidepressant action of iTBS, which may moderate the improvement of metabolic markers of neuronal viability. iTBS might increase neuroplasticity, thus facilitating normalization of neuronal circuit function.

The amygdala plays a crucial role in the pathogenesis of major depressive disorder (MDD). While robust findings support a negative impact of illness duration on hippocampal volume in MDD, morphometric studies of the amygdala have yielded inhomogeneous results. Considering the methodical problems of automatic segmentation methods, a standardized segmentation protocol with proven inter- and intra-rater reliability was employed using high-resolution magnetic resonance imaging. To identify the effect of MDD on amygdala morphometry, 23 unipolar depressed patients who responded to antidepressant medication and 30 age-matched healthy controls (HC) were enrolled. First, gray matter volumes (GMV) of the bilateral amygdala were delineated manually in 3D by three blinded experts using the MultiTracer. The whole brain GMV was determined by using voxel-based morphometry. Second, the differences of the whole brain and the bilateral amygdala GMV values between MDD and HC were calculated with t-statistics. The GMV of the whole brain and the amygdala did not differ between HC and MDD patients. Third, MDD characteristics were correlated with amygdala GMV. Within the normal range, the left amygdala GMV was larger in patients with later onset and smaller in cases of prolonged depression. In line with prior reports of depressed patients responding to antidepressant treatment, amygdala GMV was negatively related to illness duration, suggesting volume loss with disease progression. It remains unclear as to whether the association between illness duration and GMV reduced left amygdala volume indicates a neurotoxic effect of prolonged MDD or is rather a negative predictor of chronic depression.

HighlightsWe here present a structural neuroimaging study reporting on a large multi-site patient sample with unipolar depression that underwent ECT.Patients showed grey matter increases in the medial temporal lobe.Connectivity modeling revealed that this altered brain region was involved in networks related to affect processing and memory.This provides a potential explanation, how these structural changes during ECT are involved in both main and side effects of the treatment.

Background The COVID-19 pandemic expanded the need for timely information on acute respiratory illness at population level. Aim We explored the potential of routine emergency department data for syndromic surveillance of acute respiratory illness in Germany. Methods We used routine attendance data from emergency departments, which continuously transferred data between week 10 2017 and 10 2021, with ICD-10 codes available for > 75% of attendances. Case definitions for acute respiratory infection (ARI), severe acute respiratory infection (SARI), influenza-like illness (ILI), respiratory syncytial virus infection (RSV) and COVID-19 were based on a combination of ICD-10 codes, and/or chief complaints, sometimes combined with information on hospitalisation and age. Results We included 1,372,958 attendances from eight emergency departments. The number of attendances dropped in March 2020 during the first COVID-19 pandemic wave, increased during summer, and declined again during the resurge of COVID-19 cases in autumn and winter of 2020/21. A pattern of seasonality of respiratory infections could be observed. By using different case definitions (i.e. for ARI, SARI, ILI, RSV) both the annual influenza seasons in the years 2017–2020 and the dynamics of the COVID-19 pandemic in 2020/21 were apparent. The absence of the 2020/21 influenza season was visible, parallel to the resurge of COVID-19 cases. SARI among ARI cases peaked in April–May 2020 (17%) and November 2020–January 2021 (14%). Conclusion Syndromic surveillance using routine emergency department data can potentially be used to monitor the trends, timing, duration, magnitude and severity of illness caused by respiratory viruses, including both influenza viruses and SARS-CoV-2.

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Zusammenfassung Hintergrund Die Häufigkeit von Suizidversuchen ist ein zentraler Indikator der psychischen Gesundheit der Bevölkerung und daher Gegenstand der Mental Health Surveillance am Robert Koch-Institut. Da bisher keine Datenquellen systematisch zur kontinuierlichen Erfassung von psychiatrischen Notfällen – zu denen Suizidversuche zählen – herangezogen werden, wird die Nutzung von Routinedaten aus Notaufnahmen zu diesem Zweck geprüft. Methoden Routinedaten aus 12 Notaufnahmen wurden für den Zeitraum 01.01.2018–28.03.2021 ausgewertet. Syndromdefinitionen für Suizidversuche, psychiatrische Notfälle und psychische Symptomatik wurden als Kombinationen aus Vorstellungsgründen und Diagnosen entwickelt. Fälle wurden alters- und geschlechtsspezifisch sowie im Zeitverlauf dargestellt. Ergebnisse Von insgesamt 1.516.883 Notaufnahmevorstellungen wurden 5133 (0,3 %) als Suizidversuche, 31.085 (2,1 %) als psychiatrische Notfälle und 34.230 (2,3 %) als Fälle mit einer psychischen Symptomatik identifiziert. 16,5 % der psychiatrischen Notfälle wurden so als Suizidversuch eingeschätzt. Unter den Suizidversuchen entfallen 53,4 % auf Männer und insgesamt 20,2 % auf die Altersgruppe der 25- bis 34-Jährigen. Alle 3 Syndromdefinitionen können über den gesamten Beobachtungszeitraum Fälle sowie deren zeitliche Variation abbilden. Fazit Notaufnahmedaten zeigen Potenzial zur syndromischen Surveillance von Suizidversuchen und psychiatrischen Notfällen und bieten damit einen Ausgangspunkt für weitere Validierung und Analyse. Die Abbildung von Veränderungen in Echtzeit erweitert die bisherigen Forschungsmöglichkeiten zu psychiatrischen Notfällen in Deutschland. Eine systematische Surveillance von Suizidversuchen kann zu einer evidenzbasierten Suizidprävention beitragen.