Simultaneous rTMS and psychotherapy in major depressive disorder: Clinical outcomes and predictors from a large naturalistic study
Simultaneous rTMS and psychotherapy in major depressive disorder: Clinical outcomes and predictors from a large naturalistic study
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DOI：
10.1016/j.brs.2017.11.004
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发表时间：
2018-03-01
影响因子：
7.7
通讯作者：
Arns, Martijn
中科院分区：
文献类型：
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作者：
Donse, Lana;Padberg, Frank;Arns, Martijn
背景资料：重复经颅磁刺激（rTMS）被认为是一种有效的非侵入性神经调节治疗抑郁症（MDD）。然而，很少有人知道的临床结果相结合的rTMS和心理治疗（rTMS刺PT）。通过共同的神经生物学脑机制，rTMS刺PT可能会发挥增强抗抑郁作用相比，各自monotherapies.Objective：目前的自然主义研究的目的是评估的可行性和临床结果rTMS刺PT在一个大组的MDD患者。第二个目的是确定临床预测的反应和remission.Methods：共196例MDD患者进行了治疗，至少10个会议的同时rTMS和PT。在DLPFC上应用rTMS，左侧10 Hz或右侧1 Hz。心理治疗是基于认知行为疗法（CBT）的原则。每五次治疗使用BDI测量症状，直至治疗结束和6个月随访。对应答者和无应答者以及10 Hz和1 Hz方案进行了比较。主要结果和结论：1）rTMS和PT联合治疗的有效率为66%，治疗结束时的缓解率为56%，随访时的持续缓解率为60%。与之前的RCT结果相比，这些比率相对较高; 2）在10 Hz和1 Hz TMS之间未发现临床结局差异; 3）临床基线变量不能预测治疗结局; 4）早期症状改善（在第10次会议上）高度预测反应，因此可用于指导rTMS thorn PT继续; 5）基于目前在一项大型自然主义研究中的发现，未来的研究需要采用更标准化的方法来得出关于rTMS刺PT独特作用的可靠结论。(C)2017作者（S）爱思唯尔公司出版
Background: Repetitive transcranial magnetic stimulation (rTMS) is considered an efficacious non-invasive neuromodulation treatment for major depressive disorder (MDD). However, little is known about the clinical outcome of combined rTMS and psychotherapy (rTMS thorn PT). Through common neurobiological brain mechanisms, rTMS thorn PT may exert enhanced antidepressant effects compared to the respective monotherapies.Objective: The current naturalistic study aimed to evaluate feasibility and clinical outcome of rTMS thorn PT in a large group of MDD patients. The second aim was to identify clinical predictors of response and remission.Methods: A total of 196 patients with MDD were treated with at least 10 sessions of simultaneous rTMS and PT. rTMS was applied over the DLPFC, either 10 Hz left or 1 Hz right. Psychotherapy was based on principles of cognitive behavioral therapy (CBT). Symptoms were measured using the BDI each fifth session until end of treatment and at 6-month follow-up. Comparisons were made between responders and non-responders, as well as between the 10 Hz and 1 Hz protocol. Additionally, baseline variables and early BDI change were evaluated as predictors of response/remission.Major findings and conclusions: 1) Combining rTMS and PT resulted in a 66% response and a 56% remission rate at the end of treatment with 60% sustained remission at follow-up. Compared to previous findings in RCTs, these rates are relatively high; 2) No differences were found between the 10 Hz and 1 Hz TMS regarding clinical outcome; 3) Clinical baseline variables were not predictive of treatment outcomes; 4) Early symptom improvement (at session 10) was highly predictive of response, and may therefore be used to guide rTMS thorn PT continuation; 5) Based on the current findings in a large naturalistic study, future studies employing a more standardized method are warranted to draw solid conclusions on the unique effect of rTMS thorn PT. (C) 2017 The Author(s). Published by Elsevier Inc.