每天一次与每天两次高频重复经颅磁刺激治疗难治性抑郁症：一项随机假刺激对照试验

Two Versus One High-Frequency Repetitive Transcranial Magnetic Stimulation Session per Day for Treatment-Resistant Depression: A Randomized Sham-Controlled Trial.

作者信息

Theleritis Christos, Sakkas Pavlos, Paparrigopoulos Thomas, Vitoratou Silia, Tzavara Chara, Bonaccorso Stefania, Politis Antonios, Soldatos Constantin R, Psarros Costantin

机构信息

From the *First Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece; Departments of †Psychosis Studies, and ‡Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; §University of Athens Medical School, Center for Health Services Research, Athens, Greece; and ∥The Johns Hopkins University, Baltimore, MD.

出版信息

J ECT. 2017 Sep;33(3):190-197. doi: 10.1097/YCT.0000000000000387.

DOI:10.1097/YCT.0000000000000387

PMID:28072660

Abstract

OBJECTIVES

High-frequency repetitive transcranial magnetic stimulation (HF-rTMS) has proven antidepressant effects, but the optimal frequency of sessions remains unclear.

METHODS

We conducted a 3-week, sham-controlled trial to assess the antidepressant efficacy of 1 active HF-rTMS session per day (A1 group) compared with 2 per day (A2 group) and equivalent sham sessions (once a day, S1 group; twice a day, S2 group) in patients with treatment-resistant major depression with a subsequent 2-week follow-up period. One hundred seventy-seven patients were screened, of whom 105 met eligibility criteria and 98 consented and were randomized. The HF-rTMS (20 Hz) was targeted to the left prefrontal cortex in sessions of approximately 40 trains (2 seconds each) at 100% resting motor threshold with an intertrain interval of 1 minute. Treatment response was defined as a 50% or greater decrease in the Hamilton Depression Rating Scale (HDRS) score and/or Clinician Global Impressions-Severity of Illness (CGI-S) score of 3 or less. Remission was defined as HDRS score less than 8 and/or CGI-S score of 2 or less.

RESULTS

Practically none of the subjects in either sham groups achieved remission. Increased odds of remission were present for CGI-S by stimulating twice rather than once per day (odds ratio [OR] = 1.5, P = 0.018), whereas there was a marginal result for HDRS (OR = 3.9, P = 0.066). Patients who had lower baseline HDRS (OR = 0.75, P = 0.014) and CGI-S scores (OR = 0.18, P = 0.001) were more likely to achieve remission.

CONCLUSIONS

Twice per day active HF-rTMS might be more effective than once per day active HF-rTMS or sham stimulation.

摘要

目的

高频重复经颅磁刺激（HF-rTMS）已被证明具有抗抑郁作用，但最佳治疗频率仍不明确。

方法

我们进行了一项为期3周的假刺激对照试验，以评估每天进行1次主动HF-rTMS治疗（A1组）与每天进行2次（A2组）以及等效假刺激治疗（每天1次，S1组；每天2次，S2组）对难治性重度抑郁症患者的抗抑郁疗效，并随后进行2周的随访。共筛查了177例患者，其中105例符合纳入标准，98例同意并被随机分组。HF-rTMS（20Hz）靶向左侧前额叶皮质，每次治疗约40串（每串2秒），强度为静息运动阈值的100%，串间间隔1分钟。治疗反应定义为汉密尔顿抑郁量表（HDRS）评分降低50%或更多和/或临床医师整体印象-疾病严重程度（CGI-S）评分降至3分或更低。缓解定义为HDRS评分低于8分和/或CGI-S评分2分或更低。

结果

两个假刺激组中几乎没有受试者达到缓解。每天刺激2次相比每天刺激1次，CGI-S评分达到缓解的几率增加（优势比[OR]=1.5，P=0.018），而HDRS评分有边缘性结果（OR=3.9，P=0.066）。基线HDRS评分较低（OR=0.75，P=0.014）和CGI-S评分较低（OR=0.18，P=0.001）的患者更有可能达到缓解。