School of Medicine, University of California Davis Medical Center, Sacramento, California, USA.
Cingulum Health, Sydney, Australia.
Brain Behav. 2023 Nov;13(11):e3268. doi: 10.1002/brb3.3268. Epub 2023 Oct 5.
Not all patients with major depressive disorder (MDD) benefit from the US Food and Drug Administration-approved use of repetitive transcranial magnetic stimulation (rTMS) at the dorsolateral prefrontal cortex. We may be undertreating depression with this one-size-fits-all rTMS strategy.
We present a retrospective review of targeted and connectome-guided rTMS in 26 patients from Cingulum Health from 2020 to 2023 with MDD or MDD with associated symptoms. rTMS was conducted by identifying multiple cortical targets based on anomalies in individual functional connectivity networks as determined by machine learning connectomic software. Quality of life assessed by the EuroQol (EQ-5D) score and depression symptoms assessed by the Beck Depression Inventory (BDI) were administered prior to treatment, directly after, and at a follow-up consultation.
Of the 26 patients treated with rTMS, 16 (62%) attained remission after treatment. Of the 19 patients who completed follow-up assessments after an average interval of 2.6 months, 11 (58%) responded to treatment and 13 (68%) showed significant remission. Between patients classified with or without treatment-resistant depression, there was no difference in BDI improvement. Additionally, there was significant improvement in quality of life after treatment and during follow-up compared to baseline.
This review is retrospective in nature, so there is no control group to assess the placebo effect on patient outcomes.
The personalized, connectome-guided approach of rTMS is safe and may be effective for depression. This personalized rTMS treatment allows for co-treatment of multiple disorders, such as the comorbidity of depression and anxiety.
并非所有重度抑郁症（MDD）患者都能从美国食品和药物管理局批准的背外侧前额叶皮层重复经颅磁刺激（rTMS）中获益。我们可能在用这种一刀切的 rTMS 策略治疗抑郁症时做得不够。
我们回顾了 2020 年至 2023 年 Cingulum Health 对 26 名 MDD 或伴有相关症状的 MDD 患者进行的靶向和连接组学指导 rTMS 治疗。rTMS 是通过基于机器学习连接组学软件确定的个体功能连接网络中的异常，识别多个皮质靶点来进行的。治疗前、治疗后直接和随访咨询时，使用欧洲五维健康量表（EQ-5D）评分评估生活质量，使用贝克抑郁量表（BDI）评估抑郁症状。
在接受 rTMS 治疗的 26 名患者中，16 名（62%）在治疗后达到缓解。在完成平均 2.6 个月随访评估的 19 名患者中，11 名（58%）对治疗有反应，13 名（68%）显示明显缓解。在被分类为有或没有治疗抵抗性抑郁症的患者之间，BDI 改善没有差异。此外，与基线相比，治疗后和随访期间生活质量均有显著改善。
本回顾性研究没有对照组来评估患者结局的安慰剂效应。
rTMS 的个性化、连接组学指导方法是安全的，可能对抑郁症有效。这种个性化 rTMS 治疗允许同时治疗多种疾病，如抑郁症和焦虑症的共病。
