基于结构磁共振成像（sMRI）引导的个体化重复经颅磁刺激（rTMS）对减少青少年抑郁症患者抑郁症状及自杀观念的有效性：一项开放标签研究
Effectiveness of individualized rTMS under sMRI guidance in reducing depressive symptoms and suicidal ideation in adolescents with depressive disorders: an open-label study.
作者信息
Sun Yuyong, Liu Xiaoyan, Li Yi, Zhi Qianna, Xia Yong
机构信息
Department of Psychiatry, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
出版信息
Front Psychiatry. 2024 Dec 20;15:1485878. doi: 10.3389/fpsyt.2024.1485878. eCollection 2024.
BACKGROUND
Major Depressive Disorder (MDD) is occurring at a progressively younger age, and suicide is now the second leading cause of death among adolescents with MDD. Studies have shown that structural magnetic resonance imaging (sMRI) can improve the positioning accuracy and anti-depressant effects of repetitive transcranial magnetic stimulation (rTMS), thereby reducing suicidal ideation.
OBJECTIVE
To compare the efficacy of sMRI-guided rTMS combined with pharmacotherapy, surface 5-cm rTMS positioning combined with pharmacotherapy, and pharmacotherapy alone on reducing depressive symptoms and suicidal ideation (SI) in MDD adolescents.
METHODS
This was an open-label study of adjustable-dose pharmacotherapy combined with rTMS for the treatment of depressive symptoms and suicidal ideation in MDD adolescents. The three study groups were as follows: sMRI navigation for individualized rTMS coordinates targeting the dorsolateral prefrontal cortex (DLPFC) and in combination with pharmacotherapy for 10 rTMS sessions over two weeks; surface 5-cm positioning for DLPFC in combination with pharmacotherapy for 10 rTMS sessions over two weeks; pharmacotherapy. All patients received only one type of SSRIs anti-depressant. A total of 123 Chinese adolescents aged 13-18 with MDD were enrolled, and psychological parameters were evaluated in the first and second weeks of treatment.
RESULTS
Following treatment, the clinical symptoms improved in all three groups. The sMRI navigation group exhibited significantly more improvement in depressive symptoms and suicidal ideation, without severe adverse reactions.
CONCLUSION
Ten sessions of rTMS treatment are feasible and effective in improving depressive symptoms and reducing SI in MDD adolescents. The combination of sMRI navigation rTMS and pharmacotherapy was found to yield the best outcomes.
CLINICAL TRIAL REGISTRATION
https://www.medicalresearch.org.cn/index, identifier MR-33-24-030536.
背景
重度抑郁症（MDD）的发病年龄越来越小，自杀现已成为患有MDD的青少年的第二大死因。研究表明，结构磁共振成像（sMRI）可以提高重复经颅磁刺激（rTMS）的定位准确性和抗抑郁效果，从而减少自杀意念。
目的
比较sMRI引导下的rTMS联合药物治疗、表面5厘米rTMS定位联合药物治疗以及单纯药物治疗对降低MDD青少年抑郁症状和自杀意念（SI）的疗效。
方法
这是一项关于可调剂量药物治疗联合rTMS治疗MDD青少年抑郁症状和自杀意念的开放标签研究。三个研究组如下：通过sMRI导航针对背外侧前额叶皮质（DLPFC）进行个体化rTMS坐标定位，并联合药物治疗，在两周内进行10次rTMS治疗；对DLPFC进行表面5厘米定位并联合药物治疗，在两周内进行10次rTMS治疗；单纯药物治疗。所有患者仅接受一种类型的SSRI抗抑郁药。共纳入123名年龄在13 - 18岁的中国MDD青少年，并在治疗的第一周和第二周评估心理参数。
结果
治疗后，三组的临床症状均有改善。sMRI导航组在抑郁症状和自杀意念方面的改善更为显著，且无严重不良反应。
结论
10次rTMS治疗对改善MDD青少年的抑郁症状和降低SI是可行且有效的。发现sMRI导航rTMS与药物治疗相结合产生的效果最佳。
临床试验注册
https://www.medicalresearch.org.cn/index，标识符MR - 33 - 24 - 030536。
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