High-frequency repetitive TMS for suicidal ideation in adolescents with depression
High-frequency repetitive TMS for suicidal ideation in adolescents with depression
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DOI：
10.1016/j.jad.2018.06.048
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发表时间：
2018-10-15
影响因子：
6.6
通讯作者：
Lewis, Charles P.
中科院分区：
文献类型：
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作者：
Croarkin, Paul E.;Nakonezny, Paul A.;Lewis, Charles P.
工作背景：本探索性研究旨在探讨高频率重复TMS自杀ideationinadolescent.Methods的急性过程中的效果：数据汇总从3个先前的协议提供了30个会议的开放标签TMS治疗过程中的青少年与难治性抑郁症。所有参与者（n = 19）均为门诊患者，服用抗抑郁药物，并提供TMS作为后续治疗。在基线、10次治疗后、20次治疗后和30次治疗后评估自杀倾向。自杀意念的结果测量包括哥伦比亚自杀严重程度评定量表（C-SSRS）“意念强度”子量表和儿童抑郁评定量表修订版（CDRS-R）第13项“自杀倾向”。自杀意念的预测几率（CDRS-R项目13和C-SSRS思维强度子量表）在6周的急性TMS治疗中显著降低，而未对疾病进行调整（抑郁症）严重程度。然而，在6周的治疗中，自杀意念的预测几率下降的幅度被减弱，并在随后的分析中调整了疾病（抑郁症）的严重程度。局限性：这是一项探索性研究，样本量小，没有假对照。监管和道德的障碍限制严重suicidality.Conclusions的青少年入学：目前的研究结果表明，开放标签TMS减轻自杀意念在青少年通过治疗和改善抑郁症状的严重程度。虽然在解释这些结果时需要谨慎，但这些发现可以为未来针对青少年自杀意念的干预性试验的设计和执行提供信息。
Background: This exploratory study sought to examine the effect of an acute course of high-frequency repetitive TMS on suicidal ideation in adolescents.Methods: Data were pooled from 3 prior protocols providing a 30-session course of open-label TMS treatment for adolescents with treatment-resistant depression. All participants (n = 19) were outpatients taking antidepressant medication, with TMS provided as adjunctive treatment. Suicidality was assessed at baseline, after 10 treatments, after 20 treatments, and after 30 treatments. Outcome measures of suicidal ideation included the Columbia Suicide Severity Rating Scale (C-SSRS) "Intensity of Ideation" subscale and Item 13 "Suicidality" on the Children's Depression Rating Scale, Revised (CDRS-R).Results: The predicted odds of suicidal ideation (CDRS-R Item 13 and C-SSRS Intensity of Ideation subscale) significantly decreased over 6 weeks of acute TMS treatment without adjustments for illness (depression) severity. However, the magnitude of the decrease in the predicted odds of suicidal ideation across 6 weeks of treatment was attenuated and rendered non-significant in subsequent analyses that adjusted for illness (depression) severity.Limitations: This was an exploratory study with a small sample size and no sham control. Regulatory and ethical barriers constrained enrollment of adolescents with severe suicidality.Conclusions: The present findings suggest that open-label TMS mitigated suicidal ideation in adolescents through the treatment and improvement of depressive symptom severity. Although caution is warranted in the interpretation of these results, the findings can inform the design and execution of future interventional trials targeting suicidal ideation in adolescents.