Pridmore, Discipline of Psychiatry, University of Tasmania, Hobart, Tasmania, Australia; TMS Unit, Saint Helens Private Hospital, Hobart, Tasmania, Australia.
O'Reilly, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.
Psychopharmacol Bull. 2022 Oct 27;52(4):61-68.
Major depressive disorder (MDD) which comes to transcranial magnetic stimulation (TMS) is prone to relapse. Cluster maintenance (CM) TMS is courses of 5 treatments delivered over 2.5-5 days, separated by monthly or greater non-treatment periods. Our aim was to characterize the outcomes of 100 courses of CM TMS.
This was a Quality Assurance/Clinical Audit study. We studied consecutive CM TMS courses provided to private hospital inpatients. Mood was rated (on admission and discharge) using the six-item Hamilton depression rating (HAMD6) and the Clinical Global Impression - Severity (CGI-S) scales. We also applied recent STAR*D criteria which are designed to measure the 'clinical change' expected to impact patient function [16].
For the total sample, using the HAMD6, 83% of courses featured relapse or partial relapse on admission, and 81% featured remission on discharge. Of 46 courses featuring HAMD6 relapse on admission, 74% featured remission on discharge. For the 100 courses the HAMD6 discharge scores were significantly lower than the admission scores (p = 2.0 × 10), as were the CGI-S scores (p = 1.8 × 10). Using STAR*D criteria for people in relapse or partial relapse on admission, CM TMS provided least a 'clinically meaningful' outcome in 82% of the cases.
For courses featuring relapse or partial relapse on admission, CM TMS converted greater than 70% to remission at discharge. It produced statistically significant reductions in HAMD6 and CGI-S scores, and using STAR*D criteria, at least 'clinically meaningful' change was extensively demonstrated. This evidence indicates CM TMS should be readily available to people living with relapsing MDD.
接受经颅磁刺激（TMS）治疗的重度抑郁症（MDD）容易复发。簇状维持（CM）TMS 是在 2.5-5 天内进行 5 次治疗的疗程，其间每月或更长时间不进行治疗。我们的目的是描述 100 个 CM TMS 疗程的结果。
这是一项质量保证/临床审计研究。我们研究了私立医院住院患者连续接受的 CM TMS 疗程。使用六项汉密尔顿抑郁评定量表（HAMD6）和临床总体印象-严重程度（CGI-S）量表在入院和出院时评估情绪。我们还应用了最近的 STAR*D 标准，该标准旨在衡量预计会影响患者功能的“临床变化”[16]。
对于总样本，使用 HAMD6，83%的疗程在入院时出现复发或部分复发，81%的疗程在出院时出现缓解。在 46 个入院时 HAMD6 复发的疗程中，74%的疗程在出院时缓解。对于 100 个疗程，HAMD6 的出院评分明显低于入院评分（p=2.0×10），CGI-S 评分也明显低于入院评分（p=1.8×10）。对于入院时出现复发或部分复发的患者，使用 STAR*D 标准，CM TMS 在 82%的情况下提供了至少“有临床意义”的结果。
对于入院时出现复发或部分复发的疗程，CM TMS 将超过 70%的患者转为缓解。它显著降低了 HAMD6 和 CGI-S 评分，并且使用 STAR*D 标准，广泛证明了至少“有临床意义”的变化。这些证据表明，CM TMS 应该为反复发作的 MDD 患者提供。
