Lawson Health Research Institute, London, ON, Canada.
Dept of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
J Psychiatr Res. 2024 Dec;180:387-393. doi: 10.1016/j.jpsychires.2024.10.031. Epub 2024 Nov 1.
Theta burst stimulation (TBS) is a novel and faster modality of transcranial magnetic stimulation, which is showing promise as a treatment-resistant depression (TRD) treatment. Though TBS can be applied unilaterally or bilaterally, few studies have compared the effectiveness of both approaches in a naturalistic clinical sample. In this retrospective chart review, we aimed to: (1) replicate previous bilateral sequential TBS effectiveness in a larger cohort of patients at a single centre, (2) present treatment outcome data between unilateral and bilateral TBS approaches, (3) investigate baseline factors associated with our observed outcomes, and (4) examine the sustainability of response, with follow-up data up to 6 months from patients.
We included 161 patients who received TBS (unilateral: n = 64 (40%), 45.55 ± 14.25 years old, 55% females; bilateral: n = 97 (60%), 47.67 ± 15.11 years old, 58% females).
Firstly, we observed 47% response and 34% remission in the bilateral group, replicating findings from a smaller naturalistic study from our group; patients receiving unilateral TBS displayed 36% response and 26% remission, with no significant differences found between unilateral and bilateral TBS in remission and response rates. Secondly, bilaterally stimulated patients needed fewer treatments than those stimulated unilaterally (27 vs 29 on average respectively, t [159] = 3.31, p = .001), and had significantly lower anxiety symptoms post treatment (GAD-7) relative to patients receiving unilateral stimulation, F (1,148) = 3.95, p = .049. Thirdly, no baseline factors were found to predict treatment outcomes. Lastly, after six months, 69% of patients who met the response criteria did not require additional treatment or a change in medication.
Our findings support the efficacy and tolerability of TBS in TRD and indicate that bilateral TBS may have a superior anxiolytic effect and offer a slightly faster time to response.
θ爆发刺激（TBS）是一种新型、更快的经颅磁刺激模式，作为一种治疗抵抗性抑郁症（TRD）的治疗方法显示出了前景。尽管 TBS 可以单侧或双侧应用，但很少有研究在自然临床样本中比较这两种方法的有效性。在这项回顾性图表研究中，我们旨在：（1）在单个中心的更大患者队列中复制先前双侧序贯 TBS 的有效性，（2）呈现单侧和双侧 TBS 方法之间的治疗结果数据，（3）研究与我们观察到的结果相关的基线因素，以及（4）通过患者随访数据检查反应的可持续性，随访时间最长可达 6 个月。
我们纳入了 161 名接受 TBS（单侧：n=64（40%），45.55±14.25 岁，55%为女性；双侧：n=97（60%），47.67±15.11 岁，58%为女性）的患者。
首先，我们观察到双侧组的反应率为 47%，缓解率为 34%，复制了我们小组的一项较小的自然研究结果；接受单侧 TBS 的患者的反应率为 36%，缓解率为 26%，在缓解率和反应率方面，单侧和双侧 TBS 之间没有发现显著差异。其次，双侧刺激的患者需要的治疗次数少于单侧刺激的患者（分别平均为 27 次和 29 次，t[159]=3.31，p=.001），并且治疗后焦虑症状（GAD-7）明显低于接受单侧刺激的患者，F（1,148）=3.95，p=.049。第三，没有发现基线因素可以预测治疗结果。最后，六个月后，符合反应标准的 69%的患者不需要额外的治疗或药物改变。
我们的研究结果支持 TBS 在 TRD 中的疗效和耐受性，并表明双侧 TBS 可能具有更好的抗焦虑作用，并提供稍快的反应时间。
