解析非侵入性脑刺激和药物治疗的抗抑郁作用：基于经颅电刺激的症状聚类方法。
Parsing the antidepressant effects of non-invasive brain stimulation and pharmacotherapy: A symptom clustering approach on ELECT-TDCS.
作者信息
Goerigk Stephan A, Padberg Frank, Chekroud Adam, Kambeitz Joseph, Bühner Markus, Brunoni Andre R
机构信息
Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany; Department of Psychological Methodology and Assessment, Ludwig-Maximilians-University, Leopoldstraße 13, 80802, Munich, Germany; Hochschule Fresenius, University of Applied Sciences, Infanteriestraße 11A, 80797, Munich, Germany.
Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, 80336, Munich, Germany.
出版信息
Brain Stimul. 2021 Jul-Aug;14(4):906-912. doi: 10.1016/j.brs.2021.05.008. Epub 2021 May 26.
BACKGROUND
Transcranial direct current stimulation (tDCS) presents small antidepressant efficacy at group level and considerable inter-individual variability of response. Its heterogeneous effects bring the need to investigate whether specific groups of patients submitted to tDCS could present comparable or larger improvement compared to pharmacotherapy. Aggregate measurements might be insufficient to address its effects.
OBJECTIVE
/Hypothesis: To determine the efficacy of tDCS, compared to pharmacotherapy and placebo, in depressive symptom clusters.
METHODS
Data from ELECT-TDCS (Escitalopram versus Electrical Direct-Current Therapy for Treating Depression Clinical Study, ClinicalTrials.gov, NCT01894815), in which antidepressant-free, depressed patients were randomized to receive 22 bifrontal tDCS (2 mA, 30 min) sessions (n = 94), escitalopram 20 mg/day (n = 91), or placebo (n = 60) over 10 weeks. Agglomerative hierarchical clustering identified "sleep/insomnia", "core depressive", "guilt/anxiety", and "atypical" clusters that were the dependent measure. Trajectories were estimated using linear mixed regression models. Effect sizes are expressed in raw HAM-D units. P-values were adjusted for multiple comparisons.
RESULTS
For core depressive symptoms, escitalopram was superior to tDCS (ES = -0.56; CI = -0.94 to -0.17, p = .009), which was superior to placebo (ES = 0.49; CI = 0.06 to 0.92, p = .042). TDCS but not escitalopram was superior to placebo in sleep/insomnia symptoms (ES = 0.87; CI = 0.22 to 1.52, p = .015). Escitalopram but not tDCS was superior to placebo in guilt/anxiety symptoms (ES = 1.66; CI = 0.58 to 2.75, p = .006). No active intervention was superior to placebo for atypical symptoms.
CONCLUSIONS
Pharmacotherapy and non-invasive brain stimulation produce distinct effects in depressive symptoms. TDCS or escitalopram could be chosen according to specific clusters of symptoms for a bigger response.
TRIAL REGISTRATION
ClinicalTrials.gov, NCT01894815.
背景
经颅直流电刺激（tDCS）在群体水平上显示出较小的抗抑郁疗效，且个体间反应存在较大差异。其效果的异质性使得有必要研究接受tDCS治疗的特定患者群体与药物治疗相比是否能有相当或更大程度的改善。总体测量可能不足以阐明其效果。
目的/假设：确定与药物治疗和安慰剂相比，tDCS对抑郁症状群的疗效。
方法
来自ELECT - tDCS（艾司西酞普兰与电直流疗法治疗抑郁症临床研究，ClinicalTrials.gov，NCT01894815）的数据，其中未服用抗抑郁药的抑郁症患者被随机分配接受22次双额叶tDCS（2毫安，30分钟）治疗（n = 94）、艾司西酞普兰20毫克/天（n = 91）或安慰剂（n = 60），为期10周。凝聚层次聚类确定了“睡眠/失眠”、“核心抑郁”、“内疚/焦虑”和“非典型”症状群作为相关测量指标。使用线性混合回归模型估计轨迹。效应大小以原始汉密尔顿抑郁量表（HAM - D）单位表示。P值经多重比较校正。
结果
对于核心抑郁症状，艾司西酞普兰优于tDCS（效应大小ES = -0.56；置信区间CI = -0.94至 -0.17，p = 0.009），tDCS优于安慰剂（ES = 0.49；CI = 0.06至0.92，p = 0.042）。在睡眠/失眠症状方面，tDCS优于安慰剂，而艾司西酞普兰则不然（ES = 0.87；CI = 0.22至1.52，p = 0.015）。在内疚/焦虑症状方面，艾司西酞普兰优于安慰剂，而tDCS则不然（ES = 1.66；CI = 0.58至2.75，p = 0.006）。对于非典型症状，没有任何一种积极干预措施优于安慰剂。
结论
药物治疗和非侵入性脑刺激在抑郁症状上产生不同的效果。可根据特定症状群选择tDCS或艾司西酞普兰以获得更大的反应。
试验注册
ClinicalTrials.gov，NCT01894815。
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