Department of Psychiatry, Deva Mental Health Care, Deva Institute of Health Care and Research Pvt. Ltd., Varanasi, Uttar Pradesh, India.
Indian J Psychiatry. 2011 Apr;53(2):145-8. doi: 10.4103/0019-5545.82543.
About 30-46% of patients with major depressive disorder (MDD) fail to fully respond to initial antidepressants. Treatment-resistant depression is a severely disabling disorder with no proven treatment options; novel treatment methods, such as repetitive transcranial magnetic stimulation (rTMS) can be used as augmentation to ongoing pharmacotherapy or as a solitary method of treatment.
To evaluate the utility of rTMS as an augmenting method in treatment-resistant depression.
In an open-label study, 21 patients with DSM-IV MDD without psychotic features who had failed to respond to an adequate trial of at least 2 antidepressants were given rTMS therapy for 4 weeks keeping the dose of pre-existing antidepressants unchanged. High-frequency (10 Hz) stimulations were delivered over left dorsolateral prefrontal cortex at an intensity of 110% of the patient's motor threshold. Treatment response was defined as a reduction in score on the Hamilton Rating Scale for Depression (HAM-D) from baseline to end of treatment. Secondary efficacy measures included scores on the Clinical Global Impressions-Change and -Severity scales.
At the end of 4 weeks, 19 patients completed the 4 weeks study and were assessed. In ITT analysis the mean HAM-D17 scores were reduced from 30.80±5.00 to 19.00±6.37 (t=8.27, P<0.001). Only 4 patients reported headache but there was no discontinuation due to adverse effects.
The study indicates the potential utility of rTMS as an augmenting agent in treatment-resistant depression. Adequately powered, randomized controlled trials are necessary to evaluate the role of rTMS in treatment-resistant depression.
约 30-46%的重性抑郁障碍（MDD）患者对初始抗抑郁药无充分反应。治疗抵抗性抑郁症是一种严重致残性疾病，目前尚无已证实的治疗方法；新的治疗方法，如重复经颅磁刺激（rTMS），可以作为正在进行的药物治疗的增强手段，或作为单一的治疗方法。
评估 rTMS 作为治疗抵抗性抑郁症增强手段的效用。
在一项开放标签研究中，21 名符合 DSM-IV MDD 标准且无精神病特征的患者，在至少 2 种抗抑郁药充分试验失败后，在不改变原有抗抑郁药剂量的情况下接受 rTMS 治疗 4 周。高频（10Hz）刺激以 110%的患者运动阈值强度施加于左侧背外侧前额叶皮质。治疗反应定义为从基线到治疗结束时汉密尔顿抑郁量表（HAM-D）评分的降低。次要疗效指标包括临床总体印象变化和严重程度量表评分。
4 周后，19 名患者完成了 4 周的研究并进行了评估。在 ITT 分析中，HAM-D17 平均评分从 30.80±5.00 降至 19.00±6.37（t=8.27，P<0.001）。仅有 4 名患者报告头痛，但无因不良反应而停药。
该研究表明 rTMS 作为治疗抵抗性抑郁症增强剂的潜在效用。需要进行充分的、随机对照试验来评估 rTMS 在治疗抵抗性抑郁症中的作用。
