背景:虽然theta爆发刺激(TBS)在重度抑郁症(MDD)中显示出希望,其治疗双相抑郁(BD-D)的有效性仍不确定.优化治疗参数对于寻求快速缓解症状至关重要。此外,与个性化治疗策略保持一致,并增加了对免疫心理学的兴趣,对最有可能从TBS获益的患者进行基于生物标志物的分层可能会提高缓解率.我们调查了与BD-D中的假手术相比,连续TBS(cTBS)的治疗效果,并评估血浆犬尿氨酸途径代谢物预测治疗结果的能力。
方法:37例BD-D患者接受多中心加速主动或假cTBS治疗,双盲,随机对照试验。治疗前(T0)采用17项汉密尔顿抑郁量表(HDRS-17)测量抑郁症状,治疗后3-4天(T1)和治疗后10-11天(T2)。血浆色氨酸,犬尿氨酸,用ELISA定量犬尿氨酸和喹啉酸的浓度。线性混合模型用于统计分析。
结果:尽管总样本显示抑郁症状改善,与假手术相比,活性cTBS未表现出更大的症状缓解.然而,较高的基线喹啉酸显着预测积极治疗组的症状改善,而不是假刺激的患者。
结论:适度的样本量限制了检测治疗效果显著差异的能力。此外,随访期为10-11天,而类似的研究通常随访至少一个月。
结论:需要更多的研究来优化BD-D的cTBS,并探索喹啉酸在治疗结果中的参与。
BACKGROUND: While theta burst stimulation (TBS) shows promise in Major Depressive Disorder (MDD), its effectiveness in bipolar depression (BD-D) remains uncertain. Optimizing treatment parameters is crucial in the pursuit of rapid symptom relief. Moreover, aligning with personalized treatment strategies and increased interest in immunopsychiatry, biomarker-based stratification of patients most likely to benefit from TBS might improve remission rates. We investigated treatment effectiveness of continuous TBS (cTBS) compared to sham in BD-D, and assessed the capacity of plasma kynurenine pathway metabolites to predict treatment outcome.
METHODS: Thirty-seven patients with BD-D underwent accelerated active or sham cTBS treatment in a multicenter, double-blind, randomized controlled trial. Depressive symptoms were measured with the 17-item Hamilton Depression Rating Scale (HDRS-17) before treatment (T0), 3-4 days posttreatment (T1) and 10-11 days posttreatment (T2). Plasma tryptophan, kynurenine, kynurenic acid and quinolinic acid concentrations were quantified with ELISA. Linear mixed models were used for statistical analyses.
RESULTS: Although the total sample showed depressive symptom improvement, active cTBS did not demonstrate greater symptom alleviation compared to sham. However, higher baseline quinolinic acid significantly predicted symptom improvement in the active treatment group, not in sham-stimulated patients.
CONCLUSIONS: The modest sample size limited the power to detect significant differences with regard to treatment effect. Also, the follow-up period was 10-11 days, whereas similar studies usually follow up for at least one month.
CONCLUSIONS: More research is required to optimize cTBS for BD-D and explore the involvement of quinolinic acid in treatment outcome.