经颅磁刺激治疗无反应抑郁症患者的扩展：一项自然研究的结果。
Extension of transcranial magnetic stimulation treatment for depression in non-responders: Results of a naturalistic study.
机构信息
Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Transcranial Magnetic Stimulation (TMS) Service, Psychiatric Neurotherapeutics Program, McLean Hospital, Harvard Medical School, Belmont, MA, USA.
Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Transcranial Magnetic Stimulation (TMS) Clinical Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
出版信息
J Psychiatr Res. 2023 Feb;158:314-318. doi: 10.1016/j.jpsychires.2022.12.038. Epub 2022 Dec 28.
BACKGROUND
Repetitive Transcranial Magnetic Stimulation (rTMS) shows efficacy in the treatment of major depressive disorder using a standard course of 20-36 treatment sessions. However, research efforts are being made to improve overall response and remission rates. Evidence from open-label extension studies of randomized control trials suggests that extending the rTMS treatment course beyond 36 treatments may improve outcomes, however, little has been published on the benefit of extended TMS treatment courses in clinical practice.
OBJECTIVE
In this retrospective naturalistic observational study, we studied response rates on continuation of rTMS following failure of the first round of 36 treatments.
METHODS
From 142 patients who received conventional rTMS and 29 who underwent theta-burst stimulation (TBS) at Massachusetts General Hospital TMS clinical service, 28 non-responders (23 to rTMS and 5 to TBS) opted to continue their treatment beyond session 36. The treatment protocol allowed personalization in target, TMS protocol, as well as number of pulses and sessions as clinically indicated. Sustained response and remission using Hamilton Rating Scale for Depression, 17-items (HAMD-17) was the primary outcome.
RESULTS
The average number of overall treatment sessions was 70.54 ± 16.73 for the sample. Overall, there was a 53.57% response rate and a 32.14% remission rate. Response and remission rates rose as the number of sessions increased and there did not appear to be a plateau in response over time.
CONCLUSION
Our results support the idea that subpopulation of TMS patients are late responders. Continuation of TMS up to 72 treatments among those patients who do not meet response criteria by session 36 may improve overall response rates. While the number of subjects and study design limit generalization, given the fact that these patients were medication refractory and had failed initial course of TMS, the result of this study is encouraging.
背景
重复经颅磁刺激（rTMS）在使用标准疗程 20-36 次治疗的情况下，对治疗重度抑郁症显示出疗效。然而，研究人员正在努力提高整体反应率和缓解率。随机对照试验的开放标签扩展研究的证据表明，将 rTMS 治疗疗程延长至 36 次以上可能会改善结果，但是，关于临床实践中延长 TMS 治疗疗程的益处，发表的内容很少。
目的
在这项回顾性自然观察研究中，我们研究了在第一轮 36 次治疗失败后继续 rTMS 治疗的反应率。
方法
在马萨诸塞州综合医院 TMS 临床服务中心接受常规 rTMS 治疗的 142 名患者和接受 theta 爆发刺激（TBS）治疗的 29 名患者中，有 28 名无反应者（23 名接受 rTMS 治疗，5 名接受 TBS 治疗）选择在第 36 次治疗后继续他们的治疗。治疗方案允许根据临床需要个性化选择目标、TMS 方案、脉冲数和治疗次数。使用汉密尔顿抑郁量表 17 项（HAMD-17）评估持续反应和缓解情况，这是主要结局。
结果
该样本的总治疗次数平均为 70.54 ± 16.73 次。总体而言，反应率为 53.57%，缓解率为 32.14%。随着治疗次数的增加，反应率和缓解率均有所上升，并且在治疗期间反应似乎没有达到平台期。
结论
我们的结果支持这样一种观点，即 TMS 患者的亚群是迟发性反应者。对于那些在第 36 次治疗时未达到反应标准的患者，在达到 72 次治疗后继续进行 TMS 治疗可能会提高总体反应率。虽然研究对象的数量和研究设计限制了结果的推广性，但鉴于这些患者对药物治疗有抗药性且已经失败了初始 TMS 疗程，本研究的结果令人鼓舞。
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