rTMS 作为抗抑郁药无反应者的下一步治疗：与当前抗抑郁药治疗方法的随机比较。
rTMS as a Next Step in Antidepressant Nonresponders: A Randomized Comparison With Current Antidepressant Treatment Approaches.
机构信息
Department of Psychiatry, Radboud University Medical Center, and Donders Institute for Brain, Cognition, and Behavior, Centre for Medical Neuroscience, Nijmegen, the Netherlands (Dalhuisen, Tendolkar, van Eijndhoven); Neurocare Clinics, Nijmegen, the Netherlands (van Oostrom); Depression Expertise Centre, Pro Persona Mental Health Care, and Behavioral Science Institute, Radboud University, Nijmegen, the Netherlands (Spijker); Center for Economic Evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands (Wijnen); GGZ inGeest Specialized Mental Health Care, and Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (van Exel); Department of Psychiatry and Psychology, St. Antonius Hospital, Utrecht/Nieuwegein, the Netherlands (van Mierlo); Department of Psychiatry, Elisabeth-TweeSteden Ziekenhuis Hospital, Tilburg, the Netherlands (de Waardt); Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands (Arns); Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Arns).
出版信息
Am J Psychiatry. 2024 Sep 1;181(9):806-814. doi: 10.1176/appi.ajp.20230556. Epub 2024 Aug 7.
OBJECTIVE
Although repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for depression, little is known about the comparative effectiveness of rTMS and other treatment options, such as antidepressants. In this multicenter randomized controlled trial, rTMS was compared with the next pharmacological treatment step in patients with treatment-resistant depression.
METHODS
Patients with unipolar nonpsychotic depression (N=89) with an inadequate response to at least two treatment trials were randomized to treatment with rTMS or to a switch of antidepressants, both in combination with psychotherapy. Treatment duration was 8 weeks and consisted of either 25 high-frequency rTMS sessions to the left dorsolateral prefrontal cortex or a switch of antidepressant medication following the Dutch treatment algorithm. The primary outcome was change in depression severity based on the Hamilton Depression Rating Scale (HAM-D). Secondary outcomes were response and remission rates as well as change in symptom dimensions (anhedonia, anxiety, sleep, rumination, and cognitive reactivity). Finally, expectations regarding treatment were assessed.
RESULTS
rTMS resulted in a significantly larger reduction in depressive symptoms than medication, which was also reflected in higher response (37.5% vs. 14.6%) and remission (27.1% vs. 4.9%) rates. A larger decrease in symptoms of anxiety and anhedonia was observed after rTMS compared with a switch in antidepressants, and no difference from the medication group was seen for symptom reductions in rumination, cognitive reactivity, and sleep disorders. Expectations regarding treatment correlated with changes in HAM-D scores.
CONCLUSIONS
In a sample of patients with moderately treatment-resistant depression, rTMS was more effective in reducing depressive symptoms than a switch of antidepressant medication. In addition, the findings suggest that the choice of treatment may be guided by specific symptom dimensions.
目的
尽管重复经颅磁刺激（rTMS）是治疗抑郁症的有效方法，但对于 rTMS 与其他治疗选择（如抗抑郁药）的相对疗效知之甚少。在这项多中心随机对照试验中，rTMS 与治疗抵抗性抑郁症患者的下一个药物治疗步骤进行了比较。
方法
将对至少两种治疗试验反应不足的单相非精神病性抑郁症（N=89）患者随机分为 rTMS 治疗组或抗抑郁药转换组，两组均结合心理治疗。治疗持续时间为 8 周，包括 25 次高频 rTMS 左外侧前额叶或根据荷兰治疗算法转换抗抑郁药物。主要结局是基于汉密尔顿抑郁评定量表（HAM-D）的抑郁严重程度变化。次要结局是反应和缓解率以及症状维度（快感缺失、焦虑、睡眠、沉思和认知反应性）的变化。最后，评估了对治疗的期望。
结果
rTMS 治疗组的抑郁症状缓解程度明显大于药物治疗组，这也反映在更高的反应率（37.5% vs. 14.6%）和缓解率（27.1% vs. 4.9%）。与抗抑郁药物转换相比，rTMS 治疗后观察到焦虑和快感缺失症状的较大减轻，而在沉思、认知反应性和睡眠障碍的症状减轻方面，rTMS 治疗组与药物治疗组无差异。对治疗的期望与 HAM-D 评分的变化相关。
结论
在中度治疗抵抗性抑郁症患者样本中，rTMS 降低抑郁症状的效果优于抗抑郁药物转换。此外，研究结果表明，治疗选择可能可以根据特定的症状维度来指导。
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