Neuromodulation Research Clinic, Douglas Mental Health University Institute and McGill University, Montréal, Québec, Canada.
Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
J Affect Disord. 2017 Aug 1;217:112-117. doi: 10.1016/j.jad.2017.03.075. Epub 2017 Apr 6.
This open-label pilot study explored the effects of a course of accelerated high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) on two neurocognitive domains (decision-making and impulse control) in patients with major depressive disorder (MDD).
Participants with MDD and a treatment resistant major depressive episode (n=24) underwent twice-daily HF-rTMS targeted at the left dorsolateral prefrontal cortex (lDLPFC) over two weeks. Psychopathology was assessed by clinician-administered and self-reported measures of depression and anxiety; decision-making was assessed by the Iowa Gambling Task, the Balloon Analog Risk Task and the Game of Dice Task; impulse control was assessed by the Stroop Color-Word Task, the Continuous Performance Task and the Stop-Signal Task.
Depression and anxiety scores significantly improved from pre-post HF-rTMS treatment. However, none of the decision-making or impulse control variables of interest changed significantly from pre-post HF-rTMS. Moreover, there was no correlation between changes in psychopathological symptoms and in neurocognition.
This is a moderately sized open label trial, and the confounds of ongoing psychotropics and illness chronicity can not be excluded in this treatment resistant sample.
There is dissociation between acute symptomatic benefit after a course of accelerated HF-rTMS applied to the lDLPFC in treatment resistant MDD and performance on tests of decision making and impulse control. Though rTMS appears cognitively safe, additional research is warranted to understand this potential dissociation and its putative clinical implications.
本开放性先导研究探讨了一疗程加速高频重复经颅磁刺激（HF-rTMS）对伴有治疗抵抗性重度抑郁障碍（MDD）患者的两个神经认知领域（决策和冲动控制）的影响。
MDD 患者和伴有治疗抵抗性重度抑郁发作的患者（n=24）接受了为期两周、每天两次的针对左侧背外侧前额叶皮层（lDLPFC）的 HF-rTMS 治疗。通过临床医生和患者自评的抑郁和焦虑量表评估精神病理学；通过 Iowa 赌博任务、气球模拟风险任务和骰子游戏任务评估决策能力；通过 Stroop 颜色-文字任务、连续作业任务和停止信号任务评估冲动控制。
HF-rTMS 治疗后抑郁和焦虑评分显著改善。然而，HF-rTMS 治疗前后，感兴趣的决策和冲动控制变量均无显著变化。此外，精神病理症状和神经认知的变化之间没有相关性。
这是一个中等规模的开放性试验，不能排除在治疗抵抗性样本中，正在进行的精神药物治疗和疾病慢性化的混杂因素。
在伴有治疗抵抗性 MDD 的患者中，加速 HF-rTMS 应用于 lDLPFC 后急性症状改善与决策和冲动控制测试的表现之间存在分离。尽管 rTMS 在认知上是安全的，但需要进一步的研究来理解这种潜在的分离及其可能的临床意义。
