University Department of Psychiatry, Centre d'Excellence Thérapeutique- Institut de Psychiatrie-Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France.
Rouen University Hospital, Rouen, France.
Psychol Med. 2023 Apr;53(5):2060-2071. doi: 10.1017/S0033291721003810. Epub 2021 Sep 28.
Electroconvulsive therapy (ECT) is one of the most effective treatments for treatment-resistant depression (TRD). However, due to response delay and cognitive impairment, ECT remains an imperfect treatment. Compared to ECT, repetitive transcranial magnetic stimulation (rTMS) is less effective at treating severe depression, but has the advantage of being quick, easy to use, and producing almost no side effects. In this study, our objective was to assess the priming effect of rTMS sessions before ECT on clinical response in patients with TRD.
In this multicenter, randomized, double-blind, sham-controlled trial, 56 patients with TRD were assigned to active or sham rTMS before ECT treatment. Five sessions of active/sham neuronavigated rTMS were administered over the left dorsolateral prefrontal cortex (20 Hz, 90% resting motor threshold, 20 2 s trains with 60-s intervals, 800 pulses/session) before ECT (which was active for all patients) started. Any relative improvements were then compared between both groups after five ECT sessions, in order to assess the early response to treatment.
After ECT, the active rTMS group exhibited a significantly greater relative improvement than the sham group [43.4% (28.6%) 25.4% (17.2%)]. The responder rate in the active group was at least three times higher. Cognitive complaints, which were assessed using the Cognitive Failures Questionnaire, were higher in the sham rTMS group compared to the active rTMS group, but this difference was not corroborated by cognitive tests.
rTMS could be used to enhance the efficacy of ECT in patients with TRD. ClinicalTrials.gov: NCT02830399.
电抽搐治疗（ECT）是治疗抵抗性抑郁症（TRD）最有效的治疗方法之一。然而，由于反应延迟和认知障碍，ECT 仍然不是一种完美的治疗方法。与 ECT 相比，重复经颅磁刺激（rTMS）在治疗重度抑郁症方面效果较差，但具有起效快、使用方便、几乎没有副作用的优点。在这项研究中，我们的目的是评估 rTMS 治疗前对 TRD 患者临床反应的启动效应。
在这项多中心、随机、双盲、假对照试验中，56 例 TRD 患者被分配到 ECT 治疗前接受 rTMS 治疗或假 rTMS 治疗。在 ECT（对所有患者均为有效治疗）开始前，对左背外侧前额叶皮层进行 5 次活性/假 rTMS 治疗（20 Hz，90%静息运动阈值，20 个 2 秒训练，间隔 60 秒，800 脉冲/次）。然后，在进行 5 次 ECT 治疗后，比较两组之间的任何相对改善情况，以评估对治疗的早期反应。
在 ECT 之后，活性 rTMS 组的相对改善程度明显大于假 rTMS 组[43.4%（28.6%）比 25.4%（17.2%）]。活性组的应答率至少是假 rTMS 组的三倍。使用认知失败问卷评估的认知抱怨在假 rTMS 组中高于活性 rTMS 组，但这一差异没有得到认知测试的证实。
rTMS 可用于增强 TRD 患者 ECT 的疗效。ClinicalTrials.gov：NCT02830399。
