Shinjuku-Yoyogi Mental Lab Clinic, Tokyo, Japan.
Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
CNS Spectr. 2024 Aug;29(4):279-288. doi: 10.1017/S109285292400035X. Epub 2024 May 21.
Treatment and management for difficult-to-treat depression are challenging, especially in a subset of patients who are at high risk for relapse and recurrence. The conditions that represent this subset are recurrent depressive disorder (RDD) and bipolar disorder (BD). In this context, we aimed to examine the effectiveness of maintenance transcranial magnetic stimulation (TMS) on a real-world clinical basis by retrospectively extracting data from the TMS registry data in Tokyo, Japan.
Data on patients diagnosed with treatment-resistant RDD and BD who received maintenance intermittent theta burst stimulation (iTBS) weekly after successful treatment with acute iTBS between March 2020 and October 2023 were extracted from the registry.
All patients (21 cases: 10 cases with RDD and 11 cases with BD) could sustain response, and 19 of them further maintained remission. In this study, maintenance iTBS did not exacerbate depressive symptoms in any of the cases, but may rather have the effect of stabilizing the mental condition and preventing recurrence.
This case series is of great clinical significance because it is the first study to report on the effectiveness of maintenance iTBS for RDD and BD, with a follow-up of more than 2 years. Further validation with a randomized controlled trial design with a larger sample size is warranted.
治疗和管理难治性抑郁症具有挑战性，尤其是在一组复发和复发风险较高的患者中。代表这一组的情况是复发性抑郁障碍（RDD）和双相情感障碍（BD）。在这种情况下，我们旨在通过从日本东京的 TMS 注册数据中回顾性提取数据，从实际临床基础上检查维持性经颅磁刺激（TMS）的有效性。
从 2020 年 3 月至 2023 年 10 月期间，成功接受急性 iTBS 治疗后每周接受维持性间歇性 theta 爆发刺激（iTBS）治疗的难治性 RDD 和 BD 患者的 TMS 注册数据中提取出患有治疗抵抗性 RDD 和 BD 的患者的数据。
所有患者（21 例：10 例 RDD 和 11 例 BD）均能维持反应，其中 19 例进一步保持缓解。在这项研究中，维持 iTBS 没有使任何患者的抑郁症状恶化，反而可能具有稳定精神状态和预防复发的作用。
这项病例系列具有重要的临床意义，因为它是第一项报告维持 iTBS 对 RDD 和 BD 有效性的研究，随访时间超过 2 年。需要进行更大样本量的随机对照试验设计进一步验证。
