Effectiveness of transcranial magnetic stimulation in clinical practice post-FDA approval in the United States: results observed with the first 100 consecutive cases of depression at an academic medical center.
Effectiveness of transcranial magnetic stimulation in clinical practice post-FDA approval in the United States: results observed with the first 100 consecutive cases of depression at an academic medical center.
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DOI：
10.4088/jcp.11m07413
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发表时间：
2012-04-01
期刊：
影响因子：
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通讯作者：
O'Reardon, John P
中科院分区：
文献类型：
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作者：
Connolly, K Ryan;Helmer, Amanda;O'Reardon, John P
简介：经颅磁刺激（TMS）是美国食品和药物管理局批准的治疗重度抑郁症（MDD）的患者谁没有响应1充分的抗抑郁药试验在当前发作。在一项回顾性队列研究中，我们在前100名连续接受抑郁症治疗的患者中检查了TMS的有效性和安全性（完整的DSM-IV标准的重性抑郁症或双相情感障碍中的重性抑郁发作）在学术医疗中心在2008年7月21日和2011年3月25日之间。TMS在多达30个疗程中灵活给药，与当前药物不同，用于85例急性抑郁症患者。主要结局为治疗终点时的应答率和缓解率，通过6周时的临床疗效总评量表（CGI-I）进行测量。次要结局包括汉密尔顿抑郁评定量表（HDRS）、抑郁症状快速量表（QIDS-SR）、贝克抑郁量表（BDI）、贝克焦虑量表（BAI）和希恩残疾量表（SDS）的变化。在接受TMS维持治疗的患者中评估了6个月的持久获益。从12例接受TMS作为维持或继续治疗后，先前的电休克治疗（ECT）或TMS在临床试验setting.RESULTS：临床队列的数据也进行了审查，治疗耐药，平均3.4失败的充分的试验在当前的事件。31名患者在生前接受过ECT治疗，60%有精神病住院史。CGI-I有效率为50.6%，6周时缓解率为24.7%。HDRS评分的平均变化为-7.8分，QIDS-SR为-5.4分，BDI为-11.4分，BAI为-5.8分，SDS为-6.9分。HDRS有效率为41.2%，缓解率为35.3%。42例患者（49%）进入6个月的TMS维持治疗。62%（26/42例患者）在维持治疗期间的末次评估时维持其应答者状态。TMS治疗耐受性良好，急性治疗期的停药率为3%。急性或维持治疗过程中没有观察到严重的不良事件与TMS相关。结论：辅助TMS被发现是安全有效的，在急性和维持治疗难治性抑郁症患者。
INTRODUCTION: Transcranial magnetic stimulation (TMS) is a US Food and Drug Administration-approved treatment for major depressive disorder (MDD) in patients who have not responded to 1 adequate antidepressant trial in the current episode. In a retrospective cohort study, we examined the effectiveness and safety of TMS in the first 100 consecutive patients treated for depression (full DSM-IV criteria for major depressive episode in either major depressive disorder or bipolar disorder) at an academic medical center between July 21, 2008, and March 25, 2011.METHOD: TMS was flexibly dosed in a course of up to 30 sessions, adjunctive to current medications, for 85 patients treated for acute depression. The primary outcomes were response and remission rates at treatment end point as measured by the Clinical Global Impressions-Improvement scale (CGI-I) at 6 weeks. Secondary outcomes included change in the Hamilton Depression Rating Scale (HDRS); Quick Inventory of Depressive Symptomatology, self-report (QIDS-SR); Beck Depression Inventory (BDI); Beck Anxiety Inventory (BAI); and the Sheehan Disability Scale (SDS). Enduring benefit was assessed over 6 months in patients receiving maintenance TMS treatment. Data from 12 patients who received TMS as maintenance or continuation treatment after prior electroconvulsive therapy (ECT) or TMS given in a clinical trial setting were also reviewed.RESULTS: The clinical cohort was treatment resistant, with a mean of 3.4 failed adequate trials in the current episode. Thirty-one individuals had received prior lifetime ECT, and 60% had a history of psychiatric hospitalization. The CGI-I response rate was 50.6% and the remission rate was 24.7% at 6 weeks. The mean change was -7.8 points in HDRS score, -5.4 in QIDS-SR, -11.4 in BDI, -5.8 in BAI, and -6.9 in SDS. The HDRS response and remission rates were 41.2% and 35.3%, respectively. Forty-two patients (49%) entered 6 months of maintenance TMS treatment. Sixty-two percent (26/42 patients) maintained their responder status at the last assessment during the maintenance treatment. TMS treatment was well tolerated, with a discontinuation rate of 3% in the acute treatment phase. No serious adverse events related to TMS were observed during acute or maintenance treatment.CONCLUSIONS: Adjunctive TMS was found to be safe and effective in both acute and maintenance treatment of patients with treatment-resistant depression.