Kweon Jamie, Fukuda Andrew M, Gobin Asi P, Haq Lamaan, Carpenter Linda L, Brown Joshua C
Brain Stimulation Mechanisms Laboratory, Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, United States.
Department of Psychiatry, Harvard Medical School, Boston, MA, United States.
Front Psychiatry. 2024 Sep 23;15:1458696. doi: 10.3389/fpsyt.2024.1458696. eCollection 2024.
While repetitive transcranial magnetic stimulation (rTMS) is effective for 50-60% of those treatment-resistant depression, it is critical to identify predictors of response for optimal patient selection to improve therapy. Insomnia is a known symptom of depression that is both correlated with depression severity and associated with poor antidepressant response. Therefore, understanding this relationship may open new opportunities for the optimization of rTMS treatment. We aimed to explore whether baseline sleep quality, specifically insomnia, is associated with rTMS outcomes in a naturalistic sample of 975 patients (age 18-90; 63.9% F) receiving a standard course of rTMS treatment from two outpatient TMS clinics located within psychiatric hospitals in the United States. One site additionally collected information on concurrent medication use on 350 patients; among these, we examined whether pharmacological treatment of insomnia affected TMS treatment response.
Depression was measured using the 30-item Inventory of Depressive Symptomology Self Report (IDS-SR) in site one and an abbreviated 16-item Quick Inventory of Depressive Symptomology (QIDS) derived from the IDS-SR in site two. Sleep disturbances were measured using three insomnia-related questions. Multilevel logistic regression was used to determine whether baseline insomnia scores were associated with TMS treatment outcome. Upon dichotomous categorization of the sample by insomnia and sleep-medication use, depression and sleep scores were analyzed across time using mixed repeated measures ANOVA.
We found that sleep quality improves after TMS (p<.001) and correlates with improvement in non-insomnia related depression symptoms (r= .318, p<.001). We found that among those who had significant insomnia at baseline, those not using sleep medications had significantly worse post-treatment IDS-SR scores compared to those using sleep medications (p=. 021) despite no difference in final insomnia score.
Together, our results suggest that while baseline insomnia is not associated with TMS effectiveness, treating insomnia may affect the trajectory of TMS therapy. Future prospective studies are needed to examine the effect of insomnia treatment alongside TMS for depression.
虽然重复经颅磁刺激（rTMS）对50%-60%的难治性抑郁症患者有效，但识别反应预测因素对于优化患者选择以改善治疗至关重要。失眠是抑郁症的一种已知症状，它既与抑郁严重程度相关，又与抗抑郁反应不佳有关。因此，了解这种关系可能为优化rTMS治疗带来新的机会。我们旨在探讨基线睡眠质量，特别是失眠，是否与来自美国两家精神病医院门诊TMS诊所接受标准疗程rTMS治疗的975名患者（年龄18-90岁；63.9%为女性）的rTMS治疗结果相关。其中一个站点还收集了350名患者同时使用药物的信息；在这些患者中，我们研究了失眠的药物治疗是否会影响TMS治疗反应。
在第一个站点使用30项抑郁症状自评量表（IDS-SR）测量抑郁，在第二个站点使用从IDS-SR衍生而来的16项简化抑郁症状快速量表（QIDS）测量抑郁。使用三个与失眠相关的问题测量睡眠障碍。采用多水平逻辑回归来确定基线失眠评分是否与TMS治疗结果相关。在按失眠和睡眠药物使用对样本进行二分分类后，使用混合重复测量方差分析对抑郁和睡眠评分随时间进行分析。
我们发现TMS治疗后睡眠质量有所改善（p<.001），并且与非失眠相关抑郁症状的改善相关（r=.318，p<.001）。我们发现，在基线时有严重失眠的患者中，未使用睡眠药物的患者与使用睡眠药物的患者相比，治疗后IDS-SR评分显著更差（p=.021），尽管最终失眠评分没有差异。
总之，我们的结果表明，虽然基线失眠与TMS疗效无关，但治疗失眠可能会影响TMS治疗的进程。未来需要进行前瞻性研究，以检验失眠治疗与TMS联合治疗抑郁症的效果。
