Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; Centre for Advancing Health Outcomes, St Paul's Hospital, Vancouver, BC, Canada; School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada.
Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
J Affect Disord. 2024 Sep 1;360:108-113. doi: 10.1016/j.jad.2024.05.109. Epub 2024 May 22.
rTMS is a safe and effective intervention for treatment-resistant depression (TRD). However, there is limited data on its specific impact on suicidal ideation (SI), and the trajectory of SI over the treatment course.
This open-label clinical trial investigated SI outcomes and trajectories in patients with TRD receiving low-frequency rTMS (LFR) to the right dorsolateral prefrontal cortex (DLPFC; N = 55).
A latent class mixed-effect model was used to identify response trajectories for SI as well as core mood symptoms. Logistic regression analyses investigated risk factors associated with identified trajectories.
For each symptom domain, we identified two distinct trajectories during LFR, one tracking improvement (SI: n = 35, 60 %; mood: n = 29, 53 %) and the other tracking no improvement (SI: n = 20, 40 %; mood: n = 26, 47 %). Male sex, higher baseline anxiety, and higher baseline SI were risk factors for no improvement of SI; while higher baseline anxiety and benzodiazepine use were risk factors for no improvement of mood. Mediation analyses showed that anxiety was a risk factor for no improvement of SI and mood independent of benzodiazepine treatment.
This is the first study to investigate trajectories of response to LFR to the right DLPFC. SI and mood improved with LFR in most patients but the severity of anxiety symptoms was a factor of poor prognosis for both. Nuanced characterization of SI response to rTMS may lead to critical insights for individualized targeting strategies.
rTMS 是一种安全有效的治疗难治性抑郁症（TRD）的方法。然而，关于它对自杀意念（SI）的具体影响以及 SI 在治疗过程中的变化轨迹的数据有限。
本开放性临床试验研究了接受低频 rTMS（LFR）治疗右侧背外侧前额叶皮层（DLPFC）的 TRD 患者的 SI 结局和变化轨迹（N=55）。
使用潜在类别混合效应模型来识别 SI 以及核心情绪症状的反应轨迹。逻辑回归分析调查了与确定轨迹相关的风险因素。
对于每个症状领域，我们在 LFR 期间确定了两种不同的轨迹，一种跟踪改善（SI：n=35，60%；情绪：n=29，53%），另一种跟踪无改善（SI：n=20，40%；情绪：n=26，47%）。男性、较高的基线焦虑和较高的基线 SI 是 SI 无改善的风险因素；而较高的基线焦虑和苯二氮䓬类药物的使用是情绪无改善的风险因素。中介分析表明，焦虑是 SI 和情绪无改善的风险因素，独立于苯二氮䓬类药物治疗。
这是第一项研究右侧 DLPFC 的 LFR 反应轨迹的研究。大多数患者在接受 LFR 后 SI 和情绪都得到了改善，但焦虑症状的严重程度是两者预后不良的一个因素。对 rTMS 治疗 SI 反应的细致描述可能为个体化靶向策略提供关键见解。
