Apostol Michael, Valles Thomas, Corlier Juliana, Leuchter Michael, Young Alexander, Artin Hewa, Koek Ralph, Einstein Evan, Wilke Scott, Tadayonnejad Reza, Oughli Hanadi, Strouse Thomas, Slan Aaron, Distler Margaret, DeYoung Dustin, Ginder Nathaniel, Krantz David, Leuchter Andrew
Res Sq. 2025 Aug 19:rs.3.rs-7377114. doi: 10.21203/rs.3.rs-7377114/v1.
Accelerated repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for Major Depressive Disorder (MDD), with an FDA-cleared protocol utilizing 10 sessions of prolonged intermittent Theta Burst Stimulation (piTBS) per day for five days. However, it remains unclear how many sessions and pulses are necessary to achieve benefit. We examined efficacy of five stimulation sessions per day for five days ("5x5") of either piTBS or individualized, electroencephalogram-based "resonant frequency" (RF) stimulation. We compared MDD symptom improvement (PHQ-9) between two groups: 1) accelerated patients (N = 40) undergoing 5x5 treatment (patients received piTBS or RF rTMS) and 2) conventional patients (N = 135) receiving standard once daily rTMS. Both protocols ameliorated MDD symptoms and there were no statistically significant differences in depression symptom changes (p = .07) between the accelerated 5x5 protocol (mean PHQ-9: pre-rTMS = 17.68, post-rTMS = 10.98) and conventional once-daily treatment (mean PHQ-9: pre-rTMS = 17.83, post-rTMS = 8.97). There was no significant difference in improvement between the piTBS and RF 5x5 protocols (p = 0.9). A PHQ-9 median split of 5x5 patients revealed that the top half of patients showed robust depression improvement (69%) while the bottom half received no significant benefit (8%) by day 5. However, the bottom half showed significant improvement (36%) at two-to-four-week follow up (p = 0.001). These results suggest 5x5 accelerated rTMS treatment is as effective as once daily rTMS treatment and that the efficacy of accelerated treatment may not be accurately assessed until weeks after treatment completion.
加速重复经颅磁刺激（rTMS）是治疗重度抑郁症（MDD）的一种有效方法，其美国食品药品监督管理局（FDA）批准的方案是每天进行10次延长间歇性θ波爆发刺激（piTBS），持续五天。然而，尚不清楚需要多少疗程和脉冲才能取得疗效。我们研究了每天进行五次刺激疗程、持续五天（“5x5”）的piTBS或基于脑电图的个体化“共振频率”（RF）刺激的疗效。我们比较了两组患者的MDD症状改善情况（PHQ-9）：1）接受5x5治疗的加速治疗患者（N = 40）（患者接受piTBS或RF rTMS）和2）接受标准每日一次rTMS的传统治疗患者（N = 135）。两种方案均改善了MDD症状，加速5x5方案（平均PHQ-9：rTMS治疗前 = 17.68，rTMS治疗后 = 10.98）与传统每日一次治疗（平均PHQ-9：rTMS治疗前 = 17.83，rTMS治疗后 = 8.97）之间的抑郁症状变化无统计学显著差异（p = 0.07）。piTBS和RF 5x5方案之间的改善情况无显著差异（p = 0.9）。对5x5患者进行PHQ-9中位数划分后发现，到第5天时，上半部分患者的抑郁症状有显著改善（69%），而下半部分患者未获得显著益处（8%）。然而，下半部分患者在随访两到四周时显示出显著改善（36%）（p = 0.001）。这些结果表明，5x5加速rTMS治疗与每日一次rTMS治疗同样有效，并且加速治疗的疗效可能直到治疗完成数周后才能准确评估。
