MacMaster Frank P, Croarkin Paul E, Wilkes T Christopher, McLellan Quinn, Langevin Lisa Marie, Jaworska Natalia, Swansburg Rose M, Jasaui Yamile, Zewdie Ephrem, Ciechanski Patrick, Kirton Adam
Departments of Pediatrics and Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Strategic Clinical Network for Addictions and Mental Health, Alberta Health Services, Calgary, AB, Canada.
Front Psychiatry. 2019 Mar 29;10:170. doi: 10.3389/fpsyt.2019.00170. eCollection 2019.
Major depressive disorder (MDD) is common in youth and treatment options are limited. We evaluated the effectiveness and safety of repetitive transcranial magnetic stimulation (rTMS) in adolescents and transitional aged youth with treatment resistant MDD. Thirty-two outpatients with moderate to severe, treatment-resistant MDD, aged 13-21 years underwent a three-week, open-label, single center trial of rTMS (ClinicalTrials.gov identifier NCT01731678). rTMS was applied to the left dorsolateral prefrontal cortex (DLPFC) using neuronavigation and administered for 15 consecutive week days (120% rest motor threshold; 40 pulses over 4 s [10 Hz]; inter-train interval, 26 s; 75 trains; 3,000 pulses). The primary outcome measure was change in the Hamilton Depression Rating Scale (Ham-D). Treatment response was defined as a >50% reduction in Ham-D scores. Safety and tolerability were also examined. rTMS was effective in reducing MDD symptom severity ( = 8.94, = 31, < 0.00001). We observed 18 (56%) responders (≥ 50% reduction in Ham-D score) and 14 non-responders to rTMS. Fourteen subjects (44%) achieved remission (Ham-D score ≤ 7 post-rTMS). There were no serious adverse events (i.e., seizures). Mild to moderate, self-limiting headaches (19%) and mild neck pain (16%) were reported. Participants ranked rTMS as highly tolerable. The retention rate was 91% and compliance rate (completing all study events) was 99%. Our single center, open trial suggests that rTMS is a safe and effective treatment for youth with treatment resistant MDD. Larger randomized controlled trials are needed. www.ClinicalTrials.gov, identifier: NCT01731678.
重度抑郁症（MDD）在青少年中很常见，且治疗选择有限。我们评估了重复经颅磁刺激（rTMS）对患有难治性MDD的青少年及青年过渡期患者的有效性和安全性。32名年龄在13至21岁、患有中度至重度难治性MDD的门诊患者接受了为期三周的rTMS开放标签单中心试验（ClinicalTrials.gov标识符NCT01731678）。使用神经导航将rTMS应用于左侧背外侧前额叶皮质（DLPFC），连续15个工作日给药（120%静息运动阈值；4秒内40个脉冲[10赫兹]；串间间隔26秒；75串；3000个脉冲）。主要结局指标是汉密尔顿抑郁量表（Ham-D）的变化。治疗反应定义为Ham-D评分降低>50%。还检查了安全性和耐受性。rTMS在降低MDD症状严重程度方面有效（ = 8.94， = 31， < 0.00001）。我们观察到18名（56%）有反应者（Ham-D评分降低≥50%）和14名rTMS无反应者。14名受试者（44%）达到缓解（rTMS后Ham-D评分≤7）。没有严重不良事件（即癫痫发作）。报告了轻度至中度、自限性头痛（19%）和轻度颈部疼痛（16%）。参与者将rTMS评为耐受性良好。保留率为91%，依从率（完成所有研究事件）为99%。我们的单中心开放试验表明，rTMS是治疗难治性MDD青少年的一种安全有效的治疗方法。需要进行更大规模的随机对照试验。www.ClinicalTrials.gov，标识符：NCT01731678。
