Jhanwar Venu Gopal, Bishnoi R J, Jhanwar M R
Department of Psychiatry, Deva Institute of Health Care & Research, Varanasi, Uttar Pradesh, India.
Indian J Psychol Med. 2011 Jan;33(1):92-6. doi: 10.4103/0253-7176.85406.
About 30 to 46% of patients with major depressive disorder (MDD) fail to fully respond to initial antidepressants. Treatment-resistant depression (TRD) is a severely disabling disorder with no proven treatment options; novel treatment methods like rTMS can be used as augmentation to ongoing pharmacotherapy or as a solitary method of treatment. To evaluate the utility of repetitive transcranial magnetic stimulation as an augmenting method in TRD. 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 intensity of 110% of 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-week 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 four 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 TRD. Adequately powered, randomized controlled trials are necessary to evaluate the role of rTMS in TRD.
约30%至46%的重度抑郁症（MDD）患者对初始抗抑郁药治疗反应不完全。难治性抑郁症（TRD）是一种严重致残的疾病，尚无经证实有效的治疗方案；重复经颅磁刺激（rTMS）等新的治疗方法可作为正在进行的药物治疗的辅助手段或单独的治疗方法。为评估重复经颅磁刺激作为TRD辅助治疗方法的效用。在一项开放标签研究中，对21例不符合精神分裂症特征、对至少2种抗抑郁药足量治疗无效的DSM-IV MDD患者给予rTMS治疗4周，同时保持原有抗抑郁药剂量不变。以患者运动阈值的110%为强度，在左侧背外侧前额叶皮质进行高频（10Hz）刺激。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）评分降低。次要疗效指标包括临床总体印象-改善和-严重程度量表评分。4周结束时，19例患者完成了为期4周的研究并接受评估。在意向性分析中，HAM-D17平均评分从30.80±5.00降至19.00±6.37（t=8.27，P<0.001）。只有4例患者报告有头痛，但未因不良反应而停药。该研究表明rTMS作为TRD辅助治疗药物的潜在效用。需要进行充分有力的随机对照试验来评估rTMS在TRD中的作用。
