■尽管重复经颅磁刺激(rTMS)是治疗抑郁症的有效方法,对rTMS和其他治疗方案的相对有效性知之甚少,比如抗抑郁药。在这项多中心随机对照试验中,在难治性抑郁症患者中,将rTMS与下一个药物治疗步骤进行了比较。
■对至少两项治疗试验反应不足的单相非精神病性抑郁症(N=89)患者被随机分配接受rTMS治疗或改用抗抑郁药,两者都与心理治疗相结合。治疗时间为8周,包括向左背外侧前额叶皮层进行25次高频rTMS治疗或按照荷兰治疗算法切换抗抑郁药。主要结果是基于汉密尔顿抑郁量表(HAM-D)的抑郁严重程度的变化。次要结果是反应和缓解率以及症状维度的变化(快感缺失,焦虑,睡眠,沉思,和认知反应性)。最后,评估了对治疗的期望.
■rTMS导致抑郁症状的减少明显大于药物治疗,这也反映在更高的反应(37.5%与14.6%)和缓解(27.1%vs.4.9%)率。与抗抑郁药的转换相比,rTMS后观察到焦虑和快感缺乏症状的减少幅度更大。与药物治疗组相比,反思性症状减轻没有差异,认知反应性,和睡眠障碍。对治疗的期望与HAM-D评分的变化相关。
■在患有中度治疗抵抗性抑郁症的患者样本中,rTMS在减轻抑郁症状方面比改用抗抑郁药物更有效。此外,研究结果表明,治疗的选择可能受特定症状维度的指导。
UNASSIGNED: Although repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for depression, little is known about the comparative effectiveness of rTMS and other treatment options, such as antidepressants. In this multicenter randomized controlled trial, rTMS was compared with the next pharmacological treatment step in patients with treatment-resistant depression.
UNASSIGNED: Patients with unipolar nonpsychotic depression (N=89) with an inadequate response to at least two treatment trials were randomized to treatment with rTMS or to a switch of antidepressants, both in combination with psychotherapy. Treatment duration was 8 weeks and consisted of either 25 high-frequency rTMS sessions to the left dorsolateral prefrontal cortex or a switch of antidepressant medication following the Dutch treatment algorithm. The primary outcome was change in depression severity based on the Hamilton Depression Rating Scale (HAM-D). Secondary outcomes were response and remission rates as well as change in symptom dimensions (anhedonia, anxiety, sleep, rumination, and cognitive reactivity). Finally, expectations regarding treatment were assessed.
UNASSIGNED: rTMS resulted in a significantly larger reduction in depressive symptoms than medication, which was also reflected in higher response (37.5% vs. 14.6%) and remission (27.1% vs. 4.9%) rates. A larger decrease in symptoms of anxiety and anhedonia was observed after rTMS compared with a switch in antidepressants, and no difference from the medication group was seen for symptom reductions in rumination, cognitive reactivity, and sleep disorders. Expectations regarding treatment correlated with changes in HAM-D scores.
UNASSIGNED: In a sample of patients with moderately treatment-resistant depression, rTMS was more effective in reducing depressive symptoms than a switch of antidepressant medication. In addition, the findings suggest that the choice of treatment may be guided by specific symptom dimensions.