Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.
Research Institute Brainclinics, Nijmegen, The Netherlands.
Psychol Med. 2020 Jan;50(2):264-272. doi: 10.1017/S0033291718004191. Epub 2019 Jan 24.
Few studies focused on the relationship between psychological measures, major depressive disorder (MDD) and repetitive transcranial magnetic stimulation (rTMS) response. This study investigated several psychological measures as potential predictors for rTMS treatment response. Additionally, this study employed two approaches to evaluate the robustness of our findings by implementing immediate replication and full-sample exploration with strict p-thresholding.
This study is an open-label, multi-site study with a total of 196 MDD patients. The sample was subdivided in a Discovery (60% of total sample, n = 119) and Replication sample (40% of total sample, n = 77). Patients were treated with right low frequency (1 Hz) or left high frequency (10 Hz) rTMS at the dorsolateral prefrontal cortex. Clinical variables [Beck Depression Inventory (BDI), Neuroticism, Extraversion, Openness Five-Factor Inventory, and Depression, Anxiety, and Stress Scale, and BDI subscales] were obtained at baseline, post-treatment, and at follow-up. Predictors were analyzed in terms of statistical association, robustness (independent replication), as well as for their clinical relevance [positive predictive value (PPV) and negative predictive value (NPV)].
Univariate analyses revealed that non-responders had higher baseline anhedonia scores. Anhedonia scores at baseline correlated negatively with total BDI percentage change over time. This finding was replicated. However, anhedonia scores showed to be marginally predictive of rTMS response, and neither PPV nor NPV reached the levels of clinical relevance.
This study suggests that non-responders to rTMS treatment have higher baseline anhedonia scores. However, anhedonia was only marginally predictive of rTMS response. Since all other psychological measures did not show predictive value, it is concluded that psychological measures cannot be used as clinically relevant predictors to rTMS response in MDD.
很少有研究关注心理测量、重度抑郁症（MDD）和重复经颅磁刺激（rTMS）反应之间的关系。本研究调查了几种心理测量作为 rTMS 治疗反应的潜在预测因子。此外，本研究通过采用即时复制和全样本探索并使用严格的 p 值阈值，采用两种方法来评估我们发现的稳健性。
这是一项开放标签、多中心研究，共纳入 196 例 MDD 患者。该样本分为发现（总样本的 60%，n=119）和复制样本（总样本的 40%，n=77）。患者在背外侧前额叶皮质接受右低频（1Hz）或左高频（10Hz）rTMS 治疗。临床变量[贝克抑郁量表（BDI）、神经质、外向性、开放性五因素量表和抑郁、焦虑和压力量表以及 BDI 子量表]在基线、治疗后和随访时获得。预测因子根据统计学关联、稳健性（独立复制）以及临床相关性[阳性预测值（PPV）和阴性预测值（NPV）]进行分析。
单变量分析显示，无反应者的基线快感缺失评分较高。基线快感缺失评分与随时间变化的总 BDI 百分比变化呈负相关。这一发现得到了复制。然而，快感缺失评分对 rTMS 反应有边缘预测价值，PPV 和 NPV 均未达到临床相关水平。
本研究表明，rTMS 治疗无反应者的基线快感缺失评分较高。然而，快感缺失仅对 rTMS 反应有边缘预测价值。由于所有其他心理测量均未显示出预测价值，因此可以得出结论，心理测量不能作为 MDD 患者 rTMS 反应的临床相关预测因子。
