Epworth Centre for Innovation in Mental Health, Epworth Healthcare, The Epworth Clinic, Camberwell, Victoria, Australia; Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Victoria, Australia.
Epworth Centre for Innovation in Mental Health, Epworth Healthcare, The Epworth Clinic, Camberwell, Victoria, Australia; Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Victoria, Australia.
Brain Stimul. 2020 Jan-Feb;13(1):137-144. doi: 10.1016/j.brs.2019.08.013. Epub 2019 Aug 22.
Accelerated or intensive forms of repetitive transcranial magnetic stimulation (rTMS) are increasingly being explored for their potential to produce more efficient and rapid treatment benefits in major depressive disorder (MDD). However, accelerated or intensive protocols using standard forms of rTMS are still quite time-consuming to apply. Theta burst stimulation (TBS) is a novel form of magnetic stimulation with the potential to produce similar anti-depressant effects but in a much abbreviated period of time. The aim of this study was to investigate the comparative efficacy of an intensive TBS protocol compared to standard rTMS treatment.
74 outpatients (36 female, mean age 44.36 ± 12.1 years) with MDD received either intensive TBS (3 intermittent TBS treatments per day for 3 days in week 1, 3 treatments a day for 2 days in week 2, and 3 treatments in 1 day in week 3 and in week 4, or standard rTMS (5 daily sessions per week for 4 weeks). Patients were assessed weekly throughout the treatment course, and at 4 weeks after treatment end.
There were no significant differences in the degree of reduction in depressive symptoms, the rate of reduction in depressive symptoms, remission or response rates (response rates = 27.8% for intensive group, 26.3% for the standard group, p > 0.05 for all analyses) between the intensive TBS and standard rTMS treatment groups. However, the overall response and remission rates were limited in both groups. There was no difference in rates of side effects, no serious adverse events and no alterations in cognitive performance.
Intensively applied TBS appears to have similar efficacy to standard rTMS when these were applied as delivered in this study but does not produce more rapid clinical benefits. The overall response rates in both groups in this study were limited, most likely by the total doses provided in both study arms.
Australian New Zealand Clinical Trials Registry: ACTRN12616000443493.
重复经颅磁刺激（rTMS）的加速或强化形式越来越多地被探索用于治疗重度抑郁症（MDD），以期产生更高效、更快速的治疗效果。然而，使用标准 rTMS 形式的加速或强化方案仍然需要花费相当长的时间来实施。θ爆发刺激（TBS）是一种新的磁刺激形式，具有产生类似抗抑郁效果的潜力，但在更短的时间内。本研究的目的是研究强化 TBS 方案与标准 rTMS 治疗的比较疗效。
74 名门诊患者（36 名女性，平均年龄 44.36±12.1 岁）患有 MDD，他们接受了强化 TBS（第 1 周每天 3 次 TBS 治疗，第 2 周每天 3 次治疗，第 2 周每天 2 次治疗，第 3 周和第 4 周每天 3 次治疗）或标准 rTMS（每周 5 次治疗，持续 4 周）。患者在整个治疗过程中每周进行评估，并在治疗结束后 4 周进行评估。
强化 TBS 组和标准 rTMS 组在抑郁症状减轻程度、抑郁症状减轻率、缓解率或反应率（强化组反应率为 27.8%，标准组为 26.3%，所有分析均为 p>0.05）方面无显著差异。然而，两组的总体反应率和缓解率均有限。两组的副作用发生率、严重不良事件发生率和认知功能改变无差异。
在本研究中，当以相同的方式实施时，强化应用 TBS 似乎与标准 rTMS 具有相似的疗效，但不会产生更快的临床益处。本研究中两组的总体反应率均有限，这很可能是由于两个研究组提供的总剂量所致。
澳大利亚新西兰临床试验注册中心：ACTRN12616000443493。
