Li Cheng-Ta, Su Tung-Ping, Cheng Chih-Ming, Chen Mu-Hong, Bai Ya-Mei, Tsai Shih-Jen
Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.
Division of Psychiatry, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Front Neurosci. 2022 Dec 2;16:1046920. doi: 10.3389/fnins.2022.1046920. eCollection 2022.
A significant proportion of patients with major depressive disorder (MDD) failed to respond to antidepressant medications. Repetitive transcranial magnetic stimulation (rTMS) is an effective option for treating such treatment-resistant patients with MDD (TRD). Reliable clinical predictors for antidepressant responses to rTMS remain elusive.
In total, 212 patients with MDD who failed to respond to at least one adequate antidepressant trial and had a detailed evaluation before rTMS were recruited for chart review. Demographic data, clinical characteristics, psychiatric comorbidities, symptom ratings [e.g., objective and subjective depression, life stress, depression refractoriness by Maudsley Staging Method (MSM)], and antidepressant treatment responses were analyzed.
MSM-subitem1 (duration of current depressive episode; Beta = 0.209, = 0.004), MSM-subitem5 (a history of ECT treatment; Beta = -0.210, = 0.004), and psychiatric admissions (Beta = 0.241, = 0.001) predicted antidepressant response of rTMS treatment. ECT was underutilized (only 3.3%). Psychiatric admissions [Exp(B) = 1.382, = 0.021], a comorbidity of OCD [0.047, 0.005], and life stress level [0.984, 0.029] predicted the history of ECT treatment.
Several clinical variables (e.g., number of psychiatric admissions, OCD as a comorbidity, and life stress level) were reliable clinical factors associated with antidepressant responses of rTMS treatment and may be utilized in combination with MSM subitems to evaluate levels of TRD.
相当一部分重度抑郁症（MDD）患者对抗抑郁药物无反应。重复经颅磁刺激（rTMS）是治疗此类难治性MDD患者（TRD）的有效选择。rTMS抗抑郁反应的可靠临床预测指标仍然难以捉摸。
总共招募了212例对至少一次充分的抗抑郁试验无反应且在rTMS治疗前进行了详细评估的MDD患者进行病历回顾。分析了人口统计学数据、临床特征、精神共病、症状评分[例如，客观和主观抑郁、生活压力、用莫兹利分期法（MSM）评估的抑郁难治性]以及抗抑郁治疗反应。
MSM子项1（当前抑郁发作持续时间；β = 0.209，P = 0.004）、MSM子项5（有ECT治疗史；β = -0.210，P = 0.004）和精神科住院次数（β = 0.241，P = 0.001）可预测rTMS治疗的抗抑郁反应。ECT治疗的使用率较低（仅3.3%）。精神科住院次数[Exp（B） = 1.382，P = 0.021]、强迫症共病[P = 0.047，P = 0.005]和生活压力水平[P = 0.984，P = 0.029]可预测ECT治疗史。
几个临床变量（例如，精神科住院次数、强迫症共病和生活压力水平）是与rTMS治疗抗抑郁反应相关的可靠临床因素，可与MSM子项结合用于评估TRD水平。
