Butler Hospital, Department of Psychiatry and Human Behavior, the Warren Alpert Medical School of Brown University, 345 Blackstone Blvd, Providence, RI 02906, United States.
Butler Hospital, Department of Psychiatry and Human Behavior, the Warren Alpert Medical School of Brown University, 345 Blackstone Blvd, Providence, RI 02906, United States; Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin, TX 78712, United States.
J Affect Disord. 2019 Feb 15;245:237-240. doi: 10.1016/j.jad.2018.10.367. Epub 2018 Nov 2.
Transcranial Magnetic Stimulation (TMS) is not currently FDA approved for depressed patients with bipolar disorder (BD), but many unipolar depressed patients presenting for TMS have soft signs of bipolarity. It is not known whether or not these soft signs portend differential outcomes.
To investigate the relationship between BD soft signs and TMS treatment outcomes in a naturalistic treatment setting.
We conducted a retrospective chart review of MDD patients (n = 105) treated with TMS. BD diathesis was defined by responses to a modified version of the Mood Disorder Questionnaire and family history.
TMS response rates for the group with BD diathesis and the group without were equivalent using two self-report depression severity scales. Remission rate was significantly lower for the bipolar soft signs group (13.5% versus 30.2%; p = 0.04) on one scale. This result does not hold when corrected for multiple comparisons. We did not observe switch to mania.
These data are limited to patients diagnosed with unipolar depression with "soft" bipolar features defined by subthreshold symptoms. The results cannot be extrapolated to patients with a full bipolar diagnosis.
Bipolar diathesis in MDD is not a safety concern but may lead to somewhat lower remission rates when considering TMS treatment.
经颅磁刺激（TMS）目前尚未获得 FDA 批准用于双相障碍（BD）的抑郁患者，但许多单相抑郁患者在接受 TMS 治疗时存在双相障碍的软性体征。目前尚不清楚这些软性体征是否预示着不同的结果。
在自然治疗环境中研究 BD 软性体征与 TMS 治疗结果之间的关系。
我们对接受 TMS 治疗的 MDD 患者（n=105）进行了回顾性图表审查。BD 素质由对心境障碍问卷的修改版本和家族史的反应来定义。
使用两种自我报告的抑郁严重程度量表，BD 素质组和无 BD 素质组的 TMS 反应率相当。在一种量表上，双相软性体征组的缓解率明显较低（13.5%比 30.2%；p=0.04）。当校正多次比较时，该结果并不成立。我们没有观察到躁狂发作的转变。
这些数据仅限于被诊断为单相抑郁的患者，其“软性”双相特征由亚阈值症状定义。结果不能外推至具有完整双相诊断的患者。
MDD 中的双相素质不是安全问题，但在考虑 TMS 治疗时，可能会导致缓解率略低。
