Jorge Ricardo E, Moser David J, Acion Laura, Robinson Robert G
Department of Psychiatry, The University of Iowa, Room W278 General Hospital, 200 Hawkins Dr, Iowa City, IA 52242-1000, USA.
Arch Gen Psychiatry. 2008 Mar;65(3):268-76. doi: 10.1001/archgenpsychiatry.2007.45.
The term vascular depression (VD) has been used to describe late-life depressive disorders in patients with clinical evidence of cerebrovascular disease. Preliminary data on poststroke depression suggest that repetitive transcranial magnetic stimulation (rTMS) might also be effective among patients with VD.
To examine the efficacy and safety of rTMS to treat VD.
Prospective, randomized, sham-controlled study.
University hospital.
After discontinuation of antidepressant therapy, 92 patients with clinically defined VD were randomly assigned to receive active or sham rTMS of the left dorsolateral prefrontal cortex. Approximately half of the patients met criteria for magnetic resonance imaging-defined VD. In experiment 1, we administered a total cumulative dose (TCD) of 12 000 pulses (TCD-12K); in experiment 2, 18,000 pulses (TCD-18K). Sham stimulation was performed using a sham coil.
In experiment 1, the sham group showed a 13.6% decrease in the 17-item Hamilton Depression Rating Scale (HAMD-17) scores compared with a 33.1% decrease in the TCD-12K group (P = .04). Response rates were 6.7% in the sham group and 33.3% in the active-stimulation group (P = .08); remission rates were 6.7% and 13.3%, respectively (P = .50). In experiment 2, the sham group showed a 17.5% decrease in the 17-item Hamilton Depression Rating Scale scores compared with a 42.4% decrease observed in the TCD-18K group (P < .001). Response rates were 6.9% in the sham group and 39.4% in the active-stimulation group (P = .003); remission rates were 3.5% and 27.3%, respectively (P = .01). Response rates to rTMS were negatively correlated with age and positively correlated with higher frontal gray matter volumes.
To our knowledge, this is the first controlled trial that demonstrates the efficacy of rTMS among geriatric patients with VD. Older age and smaller frontal gray matter volumes were associated with a poorer response to rTMS.
血管性抑郁（VD）这一术语已被用于描述有脑血管疾病临床证据的老年期抑郁症患者。关于卒中后抑郁的初步数据表明，重复经颅磁刺激（rTMS）可能对VD患者也有效。
研究rTMS治疗VD的疗效和安全性。
前瞻性、随机、假刺激对照研究。
大学医院。
在停用抗抑郁药治疗后，92例临床诊断为VD的患者被随机分配接受左侧背外侧前额叶皮质的主动或假rTMS治疗。约一半患者符合磁共振成像定义的VD标准。在实验1中，我们给予12000次脉冲的总累积剂量（TCD-12K）；在实验2中，给予18000次脉冲（TCD-18K）。使用假线圈进行假刺激。
在实验1中，假刺激组17项汉密尔顿抑郁量表（HAMD-17）评分下降了13.6%，而TCD-12K组下降了33.1%（P = 0.04）。假刺激组的有效率为6.7%，主动刺激组为33.3%（P = 0.08）；缓解率分别为6.7%和13.3%（P = 0.50）。在实验2中，假刺激组17项汉密尔顿抑郁量表评分下降了17.5%，而TCD-18K组下降了42.4%（P < 0.001）。假刺激组的有效率为6.9%，主动刺激组为39.4%（P = 0.003）；缓解率分别为3.5%和27.3%（P = 0.01）。rTMS的有效率与年龄呈负相关，与较高的额叶灰质体积呈正相关。
据我们所知，这是第一项证明rTMS对老年VD患者有效的对照试验。年龄较大和额叶灰质体积较小与rTMS反应较差有关。
