Dalhuisen Iris, Biemans Tom, Vos Cornelis F, Hark Sophie Ter, van Oostrom Iris, Spijker Jan, Wijnen Ben, van Exel Eric, van Mierlo Hans, de Waardt Dieuwertje, Arns Martijn, Tendolkar Indira, Janzing Joost, van Eijndhoven Philip
Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands.
Donders Institute for Brain Cognition and Behavior, Centre for Medical Neuroscience, Nijmegen, The Netherlands.
Eur Arch Psychiatry Clin Neurosci. 2025 Apr 23. doi: 10.1007/s00406-025-02012-0.
Antidepressive treatment outcomes can be assessed using sum scores from measurement scales, but symptom clusters may better capture the multidimensional structure of depression. Little is known about the comparative effectiveness of different treatment modalities on these clusters. We sought to evaluate the effects of rTMS and antidepressant medication on four symptom clusters and the extent to which these differ between treatments. In addition, we assessed whether baseline cluster scores predicted (non)response.
Data were obtained from two clinical trials (DETECT: rTMS vs. medication; PITA: tricyclic antidepressants). Primary outcomes were symptom cluster scores: 'General Depression', 'Anxiety', 'Somatic Symptoms' and 'Insomnia'. In the primary analysis based on DETECT, a MANCOVA comparing rTMS with medication was performed. For validation, a MANCOVA was performed replacing medication data from DETECT with data from PITA. Baseline symptom cluster scores were compared between responders and non-responders, as well as treatment groups.
In both the primary and validation analyses, no difference was seen between rTMS and medication on the symptom clusters. Similar patterns of response were observed in all groups, with 'Insomnia' showing the greatest effect of treatment. Baseline cluster scores did not predict treatment response.
We did not find a differential effect of rTMS or antidepressant medication on depressive symptom clusters. Both treatments demonstrated comparable response patterns for all clusters, and baseline cluster scores did not differ between responders and non-responders. Future studies with larger samples or more homogeneous treatments may elucidate the role of symptom clusters as a tool for more individualized treatment.
PITA NCT03548675 DETECT The Netherlands Trial Register NL7628.
抗抑郁治疗效果可通过测量量表的总分来评估，但症状群可能更能体现抑郁症的多维结构。关于不同治疗方式对这些症状群的相对有效性知之甚少。我们试图评估重复经颅磁刺激（rTMS）和抗抑郁药物对四个症状群的影响，以及这些影响在不同治疗方法之间的差异程度。此外，我们还评估了基线症状群评分是否能预测治疗反应。
数据来自两项临床试验（DETECT：rTMS与药物治疗对比；PITA：三环类抗抑郁药）。主要结局为症状群评分：“总体抑郁”、“焦虑”、“躯体症状”和“失眠”。在基于DETECT的主要分析中，进行了一项比较rTMS与药物治疗的多变量协方差分析（MANCOVA）。为进行验证，用PITA的数据替换DETECT中的药物治疗数据后进行了一项MANCOVA。比较了反应者与无反应者以及治疗组之间的基线症状群评分。
在主要分析和验证分析中，rTMS与药物治疗在症状群方面均未发现差异。所有组均观察到相似的反应模式，其中“失眠”显示出最大的治疗效果。基线症状群评分不能预测治疗反应。
我们未发现rTMS或抗抑郁药物对抑郁症状群有不同影响。两种治疗方法在所有症状群中均表现出可比的反应模式，反应者与无反应者之间的基线症状群评分无差异。未来样本量更大或治疗更同质化的研究可能会阐明症状群作为更个体化治疗工具的作用。
PITA NCT03548675 DETECT 荷兰试验注册编号NL7628
