Chen Xing, Jiang Fei, Yang Qun, Zhang Peiyun, Zhu Haijiao, Liu Chao, Zhang Tongtong, Li Weijun, Xu Jian, Shen Hongmei
Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China.
Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong, China.
Front Psychiatry. 2022 Aug 25;13:951595. doi: 10.3389/fpsyt.2022.951595. eCollection 2022.
In this study, we sought to explore the effectiveness of bilateral repetitive transcranial magnetic stimulation (rTMS) over the dorsolateral prefrontal cortex (DLPFC) on depressive symptoms and dysfunction of hypothalamic-pituitary-adrenal (HPA) axis in patients with major depressive disorder (MDD).
One hundred and thirty-six adults with MDD were administrated drugs combined with 3 weeks of active rTMS ( = 68) or sham ( = 68) treatment. The 17-item Hamilton Depression Rating Scale for Depression (HAMD-17) was to elevate depression severity at baseline and weeks 4. To test the influence of rTMS on the HPA axis, plasma adrenocorticotropic hormone (ACTH) and serum cortisol (COR) were detected in pre- and post-treatment.
No statistical significance was found for the baseline of sociodemographic, characteristics of depression, and psychopharmaceutical dosages between sham and rTMS groups ( > 0.05). There was a significant difference in the HAMD-17 total score between the two groups at end of 4 weeks after treatment ( < 0.05). Compared to the sham group, the rTMS group demonstrated a more significant score reduction of HAMD-17 and sleep disorder factor (HAMD-SLD) including sleep onset latency, middle awakening, and early awakening items at end of 4-week after treatment ( < 0.05). Furthermore, total score reduction of HAMD-17 was correlated with a decrease in plasma ACTH, not in COR, by rTMS stimulation ( < 0.05).
Bilateral rTMS for 3 weeks palliated depression improvement of sleep disorder, and plasma ACTH is a predictor for the efficacy of rTMS, especially in male patients with MDD.
在本研究中，我们试图探讨对重度抑郁症（MDD）患者双侧背外侧前额叶皮质（DLPFC）进行重复经颅磁刺激（rTMS）对抑郁症状及下丘脑 - 垂体 - 肾上腺（HPA）轴功能障碍的有效性。
136名成年MDD患者接受药物治疗并结合为期3周的主动rTMS治疗（n = 68）或假刺激治疗（n = 68）。采用17项汉密尔顿抑郁量表（HAMD - 17）评估基线及第4周时的抑郁严重程度。为测试rTMS对HPA轴的影响，在治疗前后检测血浆促肾上腺皮质激素（ACTH）和血清皮质醇（COR）。
假刺激组和rTMS组在社会人口统计学基线、抑郁特征及精神药物剂量方面无统计学差异（P > 0.05）。治疗4周后两组HAMD - 17总分有显著差异（P < 0.05）。与假刺激组相比，rTMS组在治疗4周后HAMD - 17总分及睡眠障碍因子（HAMD - SLD，包括入睡潜伏期、中途觉醒和早醒项目）得分降低更显著（P < 0.05）。此外，rTMS刺激使HAMD - 17总分降低与血浆ACTH降低相关，而非与COR降低相关（P < 0.05）。
双侧rTMS治疗3周可缓解抑郁并改善睡眠障碍，血浆ACTH是rTMS疗效的预测指标，尤其在男性MDD患者中。
