Abo Aoun Mohamed, Meek Benjamin P, Clair Luc, Wikstrom Sara, Prasad Benjamin, Modirrousta Mandana
BrainWave Clinic, Winnipeg, Canada.
Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Canada.
Psychiatry Clin Neurosci. 2023 Jan;77(1):38-47. doi: 10.1111/pcn.13488. Epub 2022 Nov 4.
Repetitive transcranial magnetic stimulation (rTMS) is widely utilized as an effective treatment for major depressive disorder (MDD) with varying response rates. Factors associated with better treatment outcome remain scarce. This naturalistic retrospective chart review hopes to shed light on easily obtainable and measurable predictive factors for patients referred to rTMS.
Protocol parameters, medication, rated scales, rTMS protocols, and treatment outcomes were reviewed for 196 patients with MDD who received rTMS at Saint Boniface Hospital between 2013 and 2019. Logistic regression and marginal effects were used to assess the different predictor variables for response (50% reduction or more on the Hamilton Depression Rating Scale (Ham-D)) and remission (Ham-D of ≤7 by the last session).
HamD at 10 sessions was predictive of remission, and Sheehan Disability Scale (SDS) at 10 sessions was predictive of response to rTMS. Ham-D, SDS, and Beck Anxiety Inventory were predictive of remission and response by Beck Anxiety Inventory 20 sessions. High frequency rTMS had a similar response and remission rate to low frequency, but higher response rate to intermittent Theta Burst Stimulation with no difference in remission rate. Positive predictive factors of response were lower age and bupropion use. Negative predictive factors were antipsychotics, anticonvulsants, or benzodiazepine use. For remission, antipsychotics or anticonvulsants use were negative predictors; bupropion use and higher resting motor threshold were positive predictors. Severity of depression as measured by baseline HamD was not associated with different probabilities of treatment success.
重复经颅磁刺激（rTMS）被广泛用作治疗重度抑郁症（MDD）的有效方法，但其有效率各不相同。与更好治疗效果相关的因素仍然很少。这项自然主义回顾性病历审查希望能揭示rTMS治疗患者易于获得和测量的预测因素。
回顾了2013年至2019年期间在圣博尼费斯医院接受rTMS治疗的196例MDD患者的方案参数、药物治疗、评定量表、rTMS方案和治疗结果。采用逻辑回归和边际效应评估不同预测变量对反应（汉密尔顿抑郁量表（Ham-D）降低50%或更多）和缓解（最后一次治疗时Ham-D≤7）的影响。
治疗10次时的HamD可预测缓解情况，治疗10次时的希恩残疾量表（SDS）可预测对rTMS的反应。Ham-D、SDS和贝克焦虑量表可预测治疗20次时的缓解和反应情况。高频rTMS与低频rTMS的反应和缓解率相似，但对间歇性theta爆发刺激的反应率更高，缓解率无差异。反应的积极预测因素是年龄较小和使用安非他酮。消极预测因素是使用抗精神病药物、抗惊厥药物或苯二氮䓬类药物。对于缓解情况，使用抗精神病药物或抗惊厥药物是消极预测因素；使用安非他酮和较高的静息运动阈值是积极预测因素。基线HamD测量的抑郁严重程度与治疗成功的不同概率无关。
