NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant׳Andrea Hospital, Rome, Italy; Alcohology Service, Villa Rosa, Suore Ospedaliere of the Sacred Heart of Jesus, Viterbo, Italy.
NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant׳Andrea Hospital, Rome, Italy; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Bipolar & Psychotic Disorders Program, McLean Hospital, Belmont, MA, USA.
J Affect Disord. 2015 Mar 15;174:57-63. doi: 10.1016/j.jad.2014.11.015. Epub 2014 Nov 20.
Co-occurrence of Major Depressive (MDD) and Alcohol Use Disorders (AUDs) is frequent, causing more burden than each disorder separately. Since the dorsolateral prefrontal cortex (DLPFC) is critically involved in both mood and reward and dysfunctional in both conditions, we aimed to evaluate the effects of dTMS stimulation of bilateral DLPFC with left prevalence in patients with MDD with or without concomitant AUD.
Twelve MDD patients and 11 with concomitant MDD and AUD (MDD+AUD) received 20 dTMS sessions. Clinical status was assessed through the Hamilton Depression Rating Scale (HDRS) and the Clinical Global Impressions severity scale (CGIs), craving through the Obsessive Compulsive Drinking Scale (OCDS) in MDD+AUD, and functioning with the Global Assessment of Functioning (GAF).
There were no significant differences between the two groups in sociodemographic (age, sex, years of education and duration of illness) and baseline clinical characteristics, including scores on assessment scales. Per cent drops on HDRS and CGIs scores at the end of the sessions were respectively 62.6% and 78.2% for MDD+AUD, and 55.2% and 67.1% for MDD (p<0.001). HDRS, CGIs and GAF scores remained significantly improved after the 6-month follow-up. HDRS scores dropped significantly earlier in MDD+AUD than in MDD LIMITATIONS: The small sample size and factors inherent to site and background treatment may have affected results.
High frequency bilateral DLPFC dTMS with left preference was well tolerated and effective in patients with MDD, with or without AUD. The antidepressant effect of dTMS is not affected by alcohol abuse in patients with depressive episodes. The potential use of dTMS for mood modulation as an adjunct to treatment in patients with a depressive episode, with or without alcohol abuse, deserves further investigation.
重度抑郁症（MDD）和酒精使用障碍（AUD）共病的情况很常见，其造成的负担比每种疾病单独存在时都要大。由于背外侧前额叶皮层（DLPFC）在情绪和奖励方面都有重要作用，并且在这两种情况下都存在功能障碍，我们旨在评估左侧优势的双侧 DLPFC 的 dTMS 刺激对伴有或不伴有共病 AUD 的 MDD 患者的影响。
12 名 MDD 患者和 11 名伴有共病 MDD 和 AUD（MDD+AUD）的患者接受了 20 次 dTMS 治疗。临床状况通过汉密尔顿抑郁评定量表（HDRS）和临床总体印象严重程度量表（CGIs）进行评估，在 MDD+AUD 中通过强迫性饮酒量表（OCDS）评估渴求，通过总体功能评估量表（GAF）评估功能。
两组在人口统计学（年龄、性别、受教育年限和病程）和基线临床特征方面（包括评估量表的评分）没有显著差异。在治疗结束时，HDRS 和 CGI 评分的百分比下降分别为 MDD+AUD 组的 62.6%和 78.2%，MDD 组的 55.2%和 67.1%（p<0.001）。在 6 个月的随访后，HDRS、CGIs 和 GAF 评分仍显著改善。在 MDD+AUD 中，HDRS 评分下降的时间明显早于 MDD 组。
样本量小以及治疗地点和背景治疗固有的因素可能影响了结果。
高频双侧 DLPFC 的 dTMS 刺激，左优势，耐受性良好，对伴有或不伴有 AUD 的 MDD 患者有效。在伴有抑郁发作的患者中，dTMS 的抗抑郁作用不受酒精滥用的影响。dTMS 作为一种辅助治疗方法，用于调节情绪，值得进一步研究，适用于伴有或不伴有酒精滥用的抑郁发作患者。
