经颅磁刺激治疗抵抗性双相抑郁的疗效和安全性。

The Efficacy and Safety of Transcranial Magnetic Stimulation in Treatment-Resistant Bipolar Depression.

机构信息

Pamukkale University, Department of Psychiatry, Kınıklı Campus Pamukkale, Denizli, Turkey.

出版信息

Psychiatr Danub. 2022 Summer;34(2):236-244. doi: 10.24869/psyd.2022.236.

DOI:10.24869/psyd.2022.236

PMID:35772133

Abstract

BACKGROUND

The aim of the current study is to investigate the efficacy and safety of Transcranial magnetic stimulation (TMS) treatment, a non-invasive brain stimulation technique, on depressive symptoms in treatment-resistant bipolar depression (TRBD).

SUBJECTS AND METHODS

The study included 29 patients between the ages of 18-65, with bipolar disorder depressive episode according to DSM-5 and with the decision of non-response to treatment according to the Canadian Mood and Anxiety Treatment Network (CANMAT). Patients were divided into two groups double-blind-randomly, 20 sessions of TMS and 20 sessions of sham TMS were applied crossover. Hamilton Depression Rating Scale (HAM-D), Beck Depression Inventory (BDI), Young Mania Rating Scale (YMRS) and TMS Side Effect Questionnaire were applied to the patients before the treatment, at the 2nd week which is the crossover phase, and at the end of the treatment at 4th week.

RESULTS

In both groups, the severity of depression was decreased significantly according to HAM-D and BDI scores after the procedure. As well as active stimulation, some positive placebo effects were observed with sham stimulation. But the decreases seen in HAM-D and BDI scores and response to the treatment were higher during the weeks when the groups received active stimulation (respectively p=0.000, p=0.001, p=0.005). At the end of the study, according to HAM-D, 55.7% of the patients showed response to the treatment, 24.13% partial response. According to BDI, 41.37% of the patients showed response to the treatment, and 31.03% partial response. No associations were found between TMS response and sociodemographic - clinical features, or type of the disease (p>0.05). During the study, no serious adverse effects such as seizures or manic / hypomanic switches were observed.

CONCLUSIONS

The results of our study showed that TMS treatment is an effective and safe treatment for patients with treatment-resistant bipolar depression.

摘要

背景

本研究旨在探讨经颅磁刺激（TMS）治疗对治疗抵抗性双相抑郁（TRBD）患者抑郁症状的疗效和安全性，TMS 是一种非侵入性脑刺激技术。

受试者和方法

该研究纳入了 29 名年龄在 18-65 岁之间的患者，这些患者符合 DSM-5 中双相障碍抑郁发作的诊断标准，且根据加拿大情绪和焦虑治疗网络（CANMAT）的标准被判定为治疗无反应。患者被随机分为两组，进行双盲交叉研究，每组接受 20 次 TMS 治疗和 20 次假 TMS 治疗。在治疗前、第 2 周（交叉阶段）和第 4 周治疗结束时，使用汉密尔顿抑郁量表（HAM-D）、贝克抑郁量表（BDI）、杨氏躁狂量表（YMRS）和 TMS 副作用问卷对患者进行评估。

结果

在两组患者中，HAM-D 和 BDI 评分均显示治疗后抑郁严重程度显著降低。除了积极的刺激外，假刺激也观察到了一些积极的安慰剂效应。但在接受积极刺激的几周内，HAM-D 和 BDI 评分的降低以及对治疗的反应更高（分别为 p=0.000、p=0.001、p=0.005）。研究结束时，根据 HAM-D，55.7%的患者对治疗有反应，24.13%部分反应。根据 BDI，41.37%的患者对治疗有反应，31.03%部分反应。TMS 反应与社会人口统计学-临床特征或疾病类型之间没有关联（p＞0.05）。在研究过程中，没有观察到癫痫或躁狂/轻躁狂转换等严重不良事件。