Mudunuru Aswin K, Reddy M S, Valipay Kartik, A Balaji S, M Madhiha, N Chandresh, K Chandrasekhar, Gundugurti Prasad R
Non-Invasive Brain Stimulation, Asha Neuromodulation Clinics, Hyderabad, IND.
Psychiatry, Asha Hospital, Hyderabad, IND.
Cureus. 2024 May 23;16(5):e60895. doi: 10.7759/cureus.60895. eCollection 2024 May.
Background Of late, the interest in accelerated treatment protocols in repetitive transcranial magnetic stimulation (TMS) for the treatment of depression and obsessive-compulsive disorder (OCD) has been gaining momentum. Studies have already found that the patterned theta burst stimulation is non-inferior to the standard high-frequency stimulation in treating depression. The objective of the present study was to evaluate the clinical efficacy of a customized accelerated combination TMS naturalistic setting. Methods Retrospective analysis of pre and post-deep repetitive TMS responses in depression and OCD patients was performed. About 391 Depression and 239 OCD patients' data was analyzed. Customized treatment protocols consisted of twice daily high-frequency stimulations intervened by one theta burst stimulation. The outcome measures were a day six score in depression and a day 10 score in OCD, compared to day one baseline scores. Results The overall response rate in depression was 60.86%, estimated as a >50% reduction in the Hamilton Depression Rating Scale (HAM-D) 21 items score, and 62.76% in OCD, estimated as a >35% reduction in the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score. The mean reduction of YBOCS and HAM-D was statistically significant at p<0.0001 (Mann-Whitney U test statistic=9442.5, z=12.66 for YBOCS and 16673.5, z=18.92 for HAM-D). Corresponding effect size estimations revealed Cohen's d value of 1.40 and 1.59, respectively. Conclusions The response rates achieved at day six and day 10 in depression and OCD, respectively, were comparable to previous studies employing standard treatment protocols. The accelerated protocol produced satisfactory short-term clinical outcomes that were effective in the early management of the illness without any serious adverse effects.
背景 最近，重复经颅磁刺激（TMS）加速治疗方案在抑郁症和强迫症（OCD）治疗中的应用受到越来越多的关注。研究已经发现，模式化θ波爆发刺激在治疗抑郁症方面不劣于标准高频刺激。本研究的目的是评估定制的加速联合TMS自然环境下的临床疗效。方法 对抑郁症和强迫症患者深部重复TMS治疗前后的反应进行回顾性分析。分析了约391例抑郁症患者和239例强迫症患者的数据。定制治疗方案包括每日两次高频刺激，中间穿插一次θ波爆发刺激。结果指标为与第1天基线评分相比，抑郁症患者第6天的评分和强迫症患者第10天的评分。结果 抑郁症的总体缓解率为60.86%，以汉密尔顿抑郁量表（HAM-D）21项评分降低>50%来评估；强迫症的总体缓解率为62.76%，以耶鲁-布朗强迫症量表（Y-BOCS）评分降低>35%来评估。YBOCS和HAM-D的平均降低在p<0.0001时具有统计学意义（曼-惠特尼U检验统计量=9442.5，YBOCS的z=12.66，HAM-D的z=16673.5，z=18.92）。相应的效应量估计显示，Cohen's d值分别为1.40和1.59。结论 抑郁症和强迫症分别在第6天和第10天达到的缓解率与以往采用标准治疗方案的研究相当。加速方案产生了令人满意的短期临床结果，在疾病的早期管理中有效，且无任何严重不良反应。
