Dalton Bethan, McClelland Jessica, Bartholdy Savani, Kekic Maria, Campbell Iain C, Schmidt Ulrike
Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK.
South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK.
J Eat Disord. 2021 Jan 28;9(1):16. doi: 10.1186/s40337-021-00370-3.
Repetitive transcranial magnetic stimulation (rTMS) is a promising treatment option for people with severe, enduring anorexia nervosa (SE-AN). As depression is often comorbid with AN, antidepressant medication is commonly prescribed to this patient group. Concurrent antidepressant medications may affect the rTMS treatment response. Therefore, in a secondary analysis of data from a feasibility trial, we explored the effect of antidepressant medication on responses to rTMS in people with SE-AN.
Twenty-six participants with SE-AN received 20 sessions (over 4 weeks) of neuronavigated high-frequency real rTMS to the left dorsolateral prefrontal cortex. Eating disorder (ED) and general psychopathology symptoms were assessed at baseline, post-treatment and at a 4-month follow-up.
Participants taking antidepressants (n = 16) for the duration of the rTMS treatment had a greater reduction in ED symptoms at the 4-month follow-up, compared to those not taking antidepressants (n = 10). Antidepressant status was not however associated with significant changes in mood outcomes.
In people with SE-AN receiving rTMS treatment, preliminary findings suggest a potential synergistic effect of antidepressant medication in reducing ED symptomatology. There was however no associated reduction in affective symptoms i.e., the effect does not seem to be related to changes in mood. The sample in this exploratory study was small and heterogenous. However, the preliminary results provide a basis for hypothesis generation for future studies.
重复经颅磁刺激（rTMS）是重度、持续性神经性厌食症（SE-AN）患者一种有前景的治疗选择。由于抑郁症常与神经性厌食症合并存在，因此常给该患者群体开具抗抑郁药物。同时使用抗抑郁药物可能会影响rTMS治疗反应。因此，在一项可行性试验数据的二次分析中，我们探讨了抗抑郁药物对SE-AN患者rTMS反应的影响。
26名SE-AN患者接受了20次（为期4周）经神经导航的高频真实rTMS，刺激左侧背外侧前额叶皮质。在基线、治疗后和4个月随访时评估饮食失调（ED）和一般精神病理学症状。
在rTMS治疗期间服用抗抑郁药的参与者（n = 16）在4个月随访时，与未服用抗抑郁药的参与者（n = 10）相比，ED症状有更大程度的减轻。然而，抗抑郁药使用情况与情绪结果的显著变化无关。
在接受rTMS治疗的SE-AN患者中，初步研究结果表明抗抑郁药物在减轻ED症状方面可能具有协同作用。然而，情感症状没有相应减轻，即这种作用似乎与情绪变化无关。这项探索性研究的样本量小且具有异质性。然而，初步结果为未来研究提出假设提供了依据。
