Harquail Centre for Neuromodulation and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Harquail Centre for Neuromodulation and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Brain Stimul. 2024 Jul-Aug;17(4):752-759. doi: 10.1016/j.brs.2024.06.006. Epub 2024 Jun 18.
Patient expectations, including both positive (placebo) and negative (nocebo) effects, influence treatment outcomes, yet their impact on acute repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant depression (TRD) is unclear.
In this single-center retrospective chart review, 208 TRD patients completed the Stanford Expectation of Treatment Scale (SETS) before starting open-label rTMS treatment. Patients were offered two excitatory rTMS protocols (deep TMS or intermittent theta-burst stimulation), which stimulated the left dorsolateral prefrontal cortex. A minimum of 20 once daily treatments were provided, delivered over 4-6 weeks. Primary outcomes were 1) remission, measured by a post-treatment score of <8 on the Hamilton Depression Rating Scale (HAMD-17), and 2) premature discontinuation. The change in HAMD-17 scores over time was used as a secondary outcome. Physicians were blinded to SETS scores. Logistic and linear regression, adjusting for covariates, assessed SETS and HAMD-17 relationships.
Of 208 patients, 177 had baseline and covariate data available. The mean positivity bias score (positive expectancy minus negative expectancy subscale averages) was 0.48 ± 2.21, indicating the cohort was neutral regarding the expectations of their treatment on average. Higher positive expectancy scores were significantly associated with greater odds of remission (OR = 1.90, p = 0.003) and greater reduction in HAMD-17 scores (β = 1.30, p = 0.005) at the end of acute treatment, after adjusting for covariates. Negative expectancy was not associated with decreased odds of remission (p = 0.2) or treatment discontinuation (p = 0.8).
Higher pre-treatment positive expectations were associated with greater remission rates with open-label rTMS in a naturalistic cohort of patients with TRD.
患者的期望，包括积极的（安慰剂）和消极的（反安慰剂）效应，会影响治疗结果，但它们对治疗抵抗性抑郁症（TRD）的急性重复经颅磁刺激（rTMS）的影响尚不清楚。
在这项单中心回顾性图表研究中，208 名 TRD 患者在开始开放标签 rTMS 治疗前完成了斯坦福治疗期望量表（SETS）。患者接受了两种兴奋性 rTMS 方案（深度 TMS 或间歇性 theta 爆发刺激），刺激左背外侧前额叶皮质。提供至少 20 次每日一次的治疗，在 4-6 周内完成。主要结局是 1）缓解，以治疗后汉密尔顿抑郁评定量表（HAMD-17）评分<8 来衡量，2）提前停药。随着时间的推移，HAMD-17 评分的变化作为次要结局。医生对 SETS 评分不知情。调整协变量后，进行逻辑和线性回归，以评估 SETS 和 HAMD-17 之间的关系。
在 208 名患者中，有 177 名患者具有基线和协变量数据。平均正性偏差评分（正性期望减去负性期望子量表平均值）为 0.48±2.21，表明该队列在平均水平上对其治疗的期望是中立的。较高的正性期望评分与缓解的可能性更大显著相关（OR=1.90，p=0.003），以及急性治疗结束时 HAMD-17 评分的更大降低（β=1.30，p=0.005），在调整协变量后。负性期望与缓解的可能性降低无关（p=0.2）或治疗中断（p=0.8）。
在自然队列中，TRD 患者接受开放标签 rTMS 治疗前的较高正性期望与更高的缓解率相关。
