1 Monash Alfred Psychiatry Research Centre, Monash University and Alfred Health, Central Clinical School, Victoria, Australia.
2 Epworth Centre for Innovation in Mental Health, Epworth HealthCare, Camberwell, Victoria, Australia.
J Neurotrauma. 2019 Jul 1;36(13):2092-2098. doi: 10.1089/neu.2018.6097. Epub 2019 Mar 13.
Depression following a traumatic brain injury (TBI) is common and difficult to treat using standard approaches. The current study investigated, for the first time, transcranial magnetic stimulation (TMS) for the treatment of post TBI depression. We specifically assessed the safety, tolerability, and efficacy of TMS in this patient population. We also explored cognitive outcomes. Twenty-one patients with a current episode of major depression subsequent to a TBI participated in a randomized double-blind placebo-controlled trial of repetitive TMS (rTMS). Sequential bilateral rTMS (to the left and right dorsolateral prefrontal cortex) was provided in 20 treatments over a period of 4 weeks. Patients were randomly allocated to receive either active or sham stimulation. There were no adverse effects and treatment was well tolerated. There was no significant effect of rTMS on post-TBI depression, with all patients showing a significant improvement in depressive symptoms irrespective of their treatment group ( = 0.002). There were significant improvements in cognition following active rTMS in the areas of working memory ( = 0.021) and executive function ( = 0.029). rTMS was shown to be safe and well tolerated in patients who had developed depression after a TBI. We did not find a therapeutic effect for post-TBI depression; however, this approach may have some utility in improving cognitive function. Future research should focus on alternative rTMS treatment approaches for post-TBI depression and the direct investigation of rTMS as a treatment for cognitive impairment in TBI.
脑创伤（TBI）后抑郁很常见，且使用标准方法治疗较为困难。本研究首次探讨了经颅磁刺激（TMS）治疗 TBI 后抑郁。我们专门评估了 TMS 在该患者人群中的安全性、耐受性和疗效。我们还探讨了认知结果。21 名 TBI 后当前发作重性抑郁的患者参与了重复 TMS（rTMS）的随机双盲安慰剂对照试验。在 4 周的时间内，进行 20 次双侧顺序 rTMS（左、右背外侧前额叶皮层）。患者被随机分配接受活性或假刺激。无不良反应，治疗耐受性良好。rTMS 对 TBI 后抑郁无显著影响，所有患者的抑郁症状均显著改善，无论其治疗组如何（ = 0.002）。在接受活性 rTMS 治疗后，工作记忆（ = 0.021）和执行功能（ = 0.029）领域的认知能力有显著改善。rTMS 对 TBI 后出现抑郁的患者安全且耐受良好。我们未发现 rTMS 对 TBI 后抑郁有治疗作用；然而，这种方法可能对改善认知功能有一定的作用。未来的研究应侧重于针对 TBI 后抑郁的替代 rTMS 治疗方法，以及直接研究 rTMS 作为 TBI 认知障碍的治疗方法。
