Transcranial magnetic stimulation for treatment-resistant depression: Naturalistic treatment outcomes for younger versus older patients.
Transcranial magnetic stimulation for treatment-resistant depression: Naturalistic treatment outcomes for younger versus older patients.
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DOI：
10.1016/j.jad.2017.03.063
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发表时间：
2017-08-01
影响因子：
6.6
通讯作者：
Carpenter LL
中科院分区：
文献类型：
--
作者：
Conelea CA;Philip NS;Yip AG;Barnes JL;Niedzwiecki MJ;Greenberg BD;Tyrka AR;Carpenter LL
重复经颅磁刺激 (TMS) 已被证明对一般成年人群的难治性抑郁症 (TRD) 是安全有效的。与年轻患者相比，老年（≥60 岁）患者的认知、身体和功能障碍负担更大，其疗效仍不清楚。目前的研究旨在表征自然临床实践环境中年龄≥60岁的患者与<60岁的患者对TMS急性疗程的抗抑郁反应。回顾性收集并汇总了在两个门诊诊所接受急性门诊 TMS 治疗的 TRD 成人（n = 231；n = 75 岁 ≥ 60 岁，n = 156 < 60 岁）的数据。在基线和急性治疗结束时进行自我报告抑郁量表。比较了老年患者与年轻患者的连续测量和分类结果的变化。两个年龄段的抑郁症状都有显着改善。各组之间的缓解率和缓解率没有差异。在控制其他预测因素的模型中，年龄组不是抑郁症严重程度变化的显着预测因素，也不是临床反应或缓解的显着预测因素（所有 p>.05）。由于研究的自然性质，其局限性包括依赖自我报告的临床测量以及合并症和并发药物治疗的变异性。结果表明，TMS 对 TRD 的有效性不会因年龄而发生差异性改变。基于这些自然数据，年龄本身不应被视为 TMS 抗抑郁疗效的禁忌症或不良预后指标。
Repetitive transcranial magnetic stimulation (TMS) has been shown to be safe and effective for treatment-resistant depression (TRD) in the general adult population. Efficacy among older (≥60 years) patients, who have a greater burden of cognitive, physical, and functional impairment compared to their younger counterparts, remains unclear. The current study aimed to characterize antidepressant response to an acute course of TMS therapy among patients aged ≥60 years compared to those < 60 years in naturalistic clinical practice settings. Data were retrospectively collected and pooled for adults with TRD (N =231; n =75 aged ≥60 years and n = 156 < 60 years) who underwent an acute course of outpatient TMS therapy at two outpatient clinics. Self-report depression scales were administered at baseline and end of acute treatment. Change on continuous measures and categorical outcomes were compared across older vs. younger patients. Both age groups showed significant improvements in depression symptoms. Response and remission rates did not differ between groups. Age group was not a significant predictor of change in depression severity, nor of clinical response or remission, in a model controlling for other predictors (all p>.05). Limitations include reliance on self-report clinical measures and variability in comorbidity and concurrent pharmacotherapy due to the naturalistic nature of the study. Results suggest that effectiveness of TMS for TRD is not differentially modified by age. Based on these naturalistic data, age alone should not be considered a contraindication or poor prognostic indicator of the antidepressant efficacy of TMS.