Extended-Interval Theta Burst Stimulation Enhances Glutamatergic Plasticity and Antidepressant Effects via Reduced GABAergic Recruitment

Kavli Affiliate: Dhakshin Ramanathan and Jyoti Mishra

| Authors: Morteza Salimi, Milad Nazari, Anna Linnik, Shruti Joshi, Jonathan Mishler, Ryan Golden, Maxim Bazhenov, Jennifer Rodger, Sahar Jomehpour, Miranda Francoeur Koloski, Jyoti Mishra and Dhakshin Ramanathan

| Summary:

Intermittent Theta Burst Stimulation (iTBS) is a patterned stimulation protocol FDA-cleared to treat depression, yet its outcomes are variable and mechanistically unclear. Here, using a combination of calcium imaging, histology, optogenetics and behavior, we show that one parameter of iTBS, the inter-train interval (ITI) between stimulation trains, plays a critical role in modulating GABAergic (and especially parvalbumin) neuronal activity, modulating subsequent neuronal plasticity and antidepressant effects. Shorter ITI stimulation protocols (4-10Ssinter-train intervals) activate GABA neurons, limiting resulting changes in cortical excitability and plasticity compared to extended interval TBS protocols (eTBS, with a 20s ITI). eTBS also drives the largest changes in synaptic / spine plasticity and leads to rapid and durable antidepressant-like effects after only a single stimulation session. Optogenetic activation of GABAergic neurons during eTBS blocks synaptic plasticity and rapid antidepressant effects. Together, these findings reveal a temporal control principle for TBS-induced cortical plasticity and provides a physiology-based strategy to improve TBS efficacy.

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