Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
BMJ Ment Health. 2024 Oct 23;27(1):e301290. doi: 10.1136/bmjment-2024-301290.
Intermittent theta burst stimulation (iTBS) is a form of repetitive transcranial magnetic stimulation (rTMS) that can be administered in a fraction of the time of standard rTMS. Applying multiple daily iTBS sessions (ie, accelerated iTBS) may enable patients to achieve remission more rapidly. However, questions remain regarding the optimal time interval between treatment sessions.
The overall aim of this study was to compare the efficacy and tolerability of two accelerated bilateral iTBS protocols (ie, 30-min or 60-min intervals) and a once-daily bilateral iTBS protocol (ie, 0-min interval) while the number of pulses was held constant, in patients with treatment-resistant depression (TRD).
182 patients with TRD were randomised to receive two sessions per day of bilateral iTBS of the dorsomedial prefrontal cortex (DMPFC) at 60-min, 30-min or 0-min intervals. Sham treatments were delivered using a shielded 'sham coil' which produced the auditory and tactile sensations of stimulation. The primary outcome measure was a change in depression scores on the 17-item Hamilton Rating Scale for Depression (HRSD-17) after 20 days of treatment.
HRSD-17 scores improved across all groups; however, these improvements did not significantly differ between the three groups after 20 days of treatment. Similarly, response and remission rates did not differ between the treatment groups.
These results suggest that contrary to our original hypothesis, implementing a 30-min or 60-min interval between two treatment sessions of DMPFC-iTBS does not lead to a more rapid improvement in symptoms, than once-daily iTBS administration.
NCT02778035.
间歇性 theta 爆发刺激（iTBS）是一种重复经颅磁刺激（rTMS）的形式，可以在标准 rTMS 的一小部分时间内进行。应用多次每日 iTBS 疗程（即加速 iTBS）可能使患者更快达到缓解。然而，关于治疗间隔的最佳时间间隔仍存在疑问。
本研究的总体目的是比较两种加速双侧 iTBS 方案（即 30 分钟或 60 分钟间隔）和每日一次双侧 iTBS 方案（即 0 分钟间隔）的疗效和耐受性，同时保持脉冲数不变，治疗抵抗性抑郁症（TRD）患者。
182 例 TRD 患者随机分为两组，每天接受两次双侧背内侧前额叶皮质（DMPFC）iTBS 治疗，间隔 60 分钟、30 分钟或 0 分钟。假治疗使用屏蔽的“假线圈”进行，产生刺激的听觉和触觉感觉。主要观察指标是治疗 20 天后汉密尔顿抑郁量表（HRSD-17）的抑郁评分变化。
所有组的 HRSD-17 评分均有所改善；然而，治疗 20 天后，三组之间的这些改善没有显著差异。同样，反应率和缓解率在治疗组之间也没有差异。
这些结果表明，与我们最初的假设相反，在 DMPFC-iTBS 的两次治疗之间实施 30 分钟或 60 分钟的间隔不会导致症状更快改善，而不是每日一次的 iTBS 给药。
NCT02778035。
