Hejzlar Martin, Novak Tomas, Bares Martin
NIMH Clinical Center, National Institute of Mental Health Czech Republic, Klecany, Czech Republic.
Department of Psychiatry and Medical Psychology, Third Medical Faculty, Charles University, Prague, Czech Republic.
Neuropsychiatr Dis Treat. 2021 May 28;17:1713-1722. doi: 10.2147/NDT.S303226. eCollection 2021.
There are no head-to-head studies comparing the antidepressant effect of transcranial direct current stimulation (tDCS) with repetitive transcranial magnetic stimulation (rTMS). This pooled analysis compared indirectly the antidepressant efficacy and acceptability of rTMS, tDCS, and the antidepressant venlafaxine (VNF) extended-release.
The analysis (n=117, both patients with treatment-resistant depression (TRD) and non-TRD were included) examined pooled data from two 4-week, single-centered, two-armed, double-blind, randomized studies (EUDRACT n. 2005-000826-22 and EUDRACT n. 2015-001639-19). The antidepressant efficacy of right-sided low-frequency rTMS (n=29) vs VNF (n=31) and left-sided anodal tDCS (n=29) vs VNF (n=28) was evaluated. The primary outcome was a change in the Montgomery-Åsberg Depression Rating Scale (MADRS) score from baseline to the treatment endpoint at week 4. The response was defined as a ≥50% reduction in the MADRS score and remission as the MADRS score ≤10 points, both were calculated for the primary treatment endpoint at week 4.
Mean change in total MADRS scores from baseline to week 4 was 7.0 (95% CI, 4.8-9.1) points in the rTMS group, 7.6 (95% CI, 5.5-9.8) in the tDCS group, and 8.9 (95% CI, 7.4-10.4) among patients in the VNF group, a non-significant difference (F(2111)=0.62, p=0.54). Similarly, neither the response rates nor remission rates for rTMS (response 31%; remission 17%), tDCS (24%, 17%), or VNF (41%; 27%) significantly differed among treatment groups ( =2.59, p=0.28; =1.66, p=0.44). Twenty patients (17%) dropped out of the studies in a similar proportion across groups (rTMS 3/29, tDCS 6/29, VNF 11/59, =1.41, p=0.52).
Our current analysis found a comparable efficacy and acceptability in all three treatment modalities (rTMS, tDCS, and VNF) and clinical relevance for the acute treatment of major depressive disorder.
尚无直接比较经颅直流电刺激（tDCS）与重复经颅磁刺激（rTMS）抗抑郁效果的研究。本汇总分析间接比较了rTMS、tDCS及抗抑郁药文拉法辛缓释剂（VNF）的抗抑郁疗效和可接受性。
该分析（n = 117，纳入了难治性抑郁症（TRD）患者和非TRD患者）检查了两项为期4周、单中心、双臂、双盲、随机研究（欧盟临床试验注册号2005 - 000826 - 22和欧盟临床试验注册号2015 - 001639 - 19）的汇总数据。评估了右侧低频rTMS（n = 29）与VNF（n = 31）以及左侧阳极tDCS（n = 29）与VNF（n = 28）的抗抑郁疗效。主要结局是蒙哥马利 - 阿斯伯格抑郁评定量表（MADRS）评分从基线到第4周治疗终点的变化。缓解定义为MADRS评分降低≥50%，痊愈定义为MADRS评分≤10分，两者均针对第4周的主要治疗终点计算。
rTMS组从基线到第4周MADRS总分的平均变化为7.0（95%CI，4.8 - 9.1）分，tDCS组为7.6（95%CI，5.5 - 9.8）分，VNF组患者为8.9（95%CI，7.4 - 10.4）分，差异无统计学意义（F(2,111)=0.62，p = 0.54）。同样，rTMS（缓解率31%；痊愈率17%）、tDCS（24%，17%）或VNF（41%；27%）的缓解率和痊愈率在各治疗组间均无显著差异（χ² = 2.59，p = 0.28；χ² = 1.66，p = 0.44）。20名患者（17%）退出研究，各组退出比例相似（rTMS组3/29，tDCS组6/29，VNF组11/59，χ² = 1.41，p = 0.52）。
我们目前的分析发现，在所有三种治疗方式（rTMS、tDCS和VNF）中，抗抑郁疗效和可接受性具有可比性，且对重度抑郁症的急性治疗具有临床意义。
