Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Department of Psychiatry, Monash University, Camberwell, Victoria, Australia; Monash Alfred Psychiatry Research Centre, Department of Psychiatry, Monash University, Melbourne, Victoria, Australia; Alfred Mental and Addiction Health, Alfred Health, Melbourne, Victoria, Australia.
Monash Alfred Psychiatry Research Centre, Department of Psychiatry, Monash University, Melbourne, Victoria, Australia.
Brain Stimul. 2021 Sep-Oct;14(5):1095-1105. doi: 10.1016/j.brs.2021.07.018. Epub 2021 Jul 29.
Theta burst pattern repetitive transcranial magnetic stimulation (TBS) is increasingly applied to treat depression. TBS's brevity is well-suited to application in accelerated schedules. Sizeable trials of accelerated TBS are lacking; and optimal TBS parameters such as stimulation intensity are not established.
We conducted a three arm, single blind, randomised, controlled, multi-site trial comparing accelerated bilateral TBS applied at 80 % or 120 % of the resting motor threshold and left unilateral 10 Hz rTMS. 300 patients with treatment-resistant depression (TRD) were recruited. TBS arms applied 20 bilateral prefrontal TBS sessions over 10 days, while the rTMS arm applied 20 daily sessions of 10 Hz rTMS to the left prefrontal cortex over 4 weeks. Primary outcome was depression treatment response at week 4.
The overall treatment response rate was 43.7 % and the remission rate was 28.2 %. There were no significant differences for response (p = 0.180) or remission (p = 0.316) across the three groups. Response rates between accelerated bilateral TBS applied at sub- and supra-threshold intensities were not significantly different (p = 0.319). Linear mixed model analysis showed a significant effect of time (p < 0.01), but not rTMS type (p = 0.680).
This is the largest accelerated bilateral TBS study to date and provides evidence that it is effective and safe in treating TRD. The accelerated application of TBS was not associated with more rapid antidepressant effects. Bilateral sequential TBS did not have superior antidepressant effect to unilateral 10 Hz rTMS. There was no significant difference in antidepressant efficacy between sub- and supra-threshold accelerated bilateral TBS.
θ爆发模式重复经颅磁刺激（TBS）越来越多地用于治疗抑郁症。TBS 的简短性使其非常适合加速治疗计划。缺乏加速 TBS 的大型试验；并且尚未确定最佳 TBS 参数，如刺激强度。
我们进行了一项三臂、单盲、随机、对照、多地点试验，比较了 80%或 120%静息运动阈值的双侧加速 TBS 和左单侧 10Hz rTMS。招募了 300 名治疗抵抗性抑郁症（TRD）患者。TBS 臂在 10 天内应用 20 次双侧前额叶 TBS，而 rTMS 臂在 4 周内每天应用 20 次 10Hz rTMS 到左前额叶皮质。主要结局是第 4 周时的抑郁治疗反应。
总体治疗反应率为 43.7%，缓解率为 28.2%。三组之间的反应（p=0.180）或缓解（p=0.316）没有显着差异。亚阈和超阈强度下加速双侧 TBS 的反应率无显着差异（p=0.319）。线性混合模型分析显示时间有显着影响（p<0.01），但 rTMS 类型无显着影响（p=0.680）。
这是迄今为止最大的加速双侧 TBS 研究，为 TBS 治疗 TRD 的有效性和安全性提供了证据。加速应用 TBS 与更快的抗抑郁作用无关。双侧序贯 TBS 与单侧 10Hz rTMS 相比没有更好的抗抑郁作用。亚阈和超阈加速双侧 TBS 的抗抑郁疗效无显着差异。
