性别和年龄在 10Hz 和间歇性 theta 爆发（iTBS）重复经颅磁刺激（rTMS）治疗重性抑郁障碍（MDD）的疗效差异中的作用。

The role of sex and age in the differential efficacy of 10 Hz and intermittent theta-burst (iTBS) repetitive transcranial magnetic stimulation (rTMS) treatment of major depressive disorder (MDD).

机构信息

TMS Clinical and Research Service, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

出版信息

J Affect Disord. 2024 Dec 1;366:106-112. doi: 10.1016/j.jad.2024.08.129. Epub 2024 Aug 24.

DOI:10.1016/j.jad.2024.08.129

PMID:39187197

Abstract

BACKGROUND

Sex- and age-dependent outcome differences have been observed in treatment of Major Depressive Disorder (MDD), including 10 Hz repetitive Transcranial Magnetic Stimulation (rTMS). We examined whether there are sex- and age-dependent differences in outcome with intermittent Theta Burst Stimulation (iTBS), another rTMS protocol.

METHODS

The relationship between biological sex, age, and treatment outcome was retrospectively examined among 414 patients with MDD treated with 10 Hz or iTBS rTMS. Linear mixed-effects modeling was used to examine the association between treatment and change in the 30-item Inventory of Depressive Symptomatology Self-Report (IDS-SR30) score from baseline to treatments 10 and 30, with biological sex (M/F), protocol (iTBS/10 Hz), age (≥/<50 years old), and time (treatment 1/10/30) included as fixed effects. The three-way sex-protocol-time and age-protocol-time interactions were used to determine any differential relationships between protocol and outcome dependent on sex and age. Post-hoc t-tests were conducted to examine differences in improvement.

RESULTS

There was a significant three-way sex-protocol-time interaction at treatments 10 (p = 0.016) and 30 (p = 0.031). Males showed significantly greater improvement with iTBS than females at treatments 10 (p = 0.041) and 30 (p = 0.035), while females showed numerically greater improvement with 10 Hz treatment. While there was not a significant three-way age-protocol-time interaction, there was a significant interaction between age (≥50 years old) and time at treatments 10 (p = 0.007) and 30 (p = 0.042), and among age, sex, and time at treatment 30 (p = 0.028).

LIMITATIONS

Retrospective naturalistic treatment protocol.

CONCLUSIONS

iTBS appeared less efficacious in females than in males, and rTMS overall was more efficacious in patients over fifty, particularly females.

摘要

背景

在治疗重度抑郁症（MDD）方面，已经观察到性别和年龄相关的疗效差异，包括 10 Hz 重复经颅磁刺激（rTMS）。我们研究了另一种 rTMS 方案——间歇性 theta 爆发刺激（iTBS）是否存在性别和年龄相关的疗效差异。

方法

回顾性分析了 414 例接受 10 Hz 或 iTBS rTMS 治疗的 MDD 患者的生物学性别、年龄与治疗结果之间的关系。采用线性混合效应模型，考察从基线到治疗 10 次和 30 次期间，治疗与 30 项抑郁症状自评量表自我报告（IDS-SR30）评分变化之间的相关性，其中固定效应包括生物学性别（M/F）、方案（iTBS/10 Hz）、年龄（≥/＜50 岁）和时间（治疗 1/10/30）。采用三因素性别-方案-时间和年龄-方案-时间交互作用，确定方案和结局是否因性别和年龄而异。进行事后 t 检验，以检验改善程度的差异。

结果

在治疗 10 次（p=0.016）和 30 次（p=0.031）时，存在显著的三因素性别-方案-时间交互作用。与女性相比，男性接受 iTBS 治疗的改善程度显著更大，在治疗 10 次（p=0.041）和 30 次（p=0.035）时，而女性接受 10 Hz 治疗的改善程度则更高。虽然没有显著的三因素年龄-方案-时间交互作用，但在治疗 10 次（p=0.007）和 30 次（p=0.042）时，年龄（≥50 岁）和时间之间存在显著的交互作用，以及在年龄、性别和治疗 30 次时（p=0.028）之间存在显著的交互作用。