Response to Letter to the Editor regarding "Transcranial magnetic stimulation for treatment-resistant depression: Naturalistic outcomes for younger versus older patients".
Response to Letter to the Editor regarding "Transcranial magnetic stimulation for treatment-resistant depression: Naturalistic outcomes for younger versus older patients".
复制标题
回复关于“经颅磁刺激治疗难治性抑郁症：年轻患者与老年患者的自然结果”的致编辑信。
DOI：
10.1016/j.jad.2017.08.033
复制
发表时间：
2018
影响因子：
6.6
通讯作者：
Carpenter,LindaL
中科院分区：
文献类型：
--
作者：
Conelea,ChristineA;Philip,NoahS;Yip,AugustinG;Barnes,JenniferL;Niedzwiecki,MatthewJ;Greenberg,BenjaminD;Tyrka,AudreyR;Carpenter,LindaL
我们感谢 Van den Noort 教授及其同事对我们最近的报告（Conelea 等人，2017）的评论。我们对患有难治性抑郁症 (TRD) 的成人 (N = 231) 进行了回顾性图表回顾，他们在自然临床实践环境中接受了急性门诊 TMS 治疗。我们发现年龄≥ 60 岁的患者与 < 60 岁的患者之间的抑郁症状有同等改善。我们的结论是，年龄较大不应被视为 TMS 治疗的禁忌症或不良预后指标，这一发现与之前的文献一致（参见 Sabesan 等人的评论，2015）。Van den Noort 教授及其同事对我们的研究提出了三点担忧。首先，他们以与之前写给期刊编辑的信件一致的方式（van den Noort 等，2014）表达了对 TMS 在衰老大脑中的安全性的担忧。我们指出，我们的数据来自对自然治疗结果的图表审查，因此这些数据没有系统捕获或足够详细，无法对所有安全结果进行严格测试。我们没有发现严重或非严重不良精神事件有任何差异，但没有使用标准化仪器评估副作用。此外，在大多数情况下，在 TMS 患者完成刺激过程并返回门诊精神科医生和治疗师接受维持护理后，我们与他们的接触有限。我们当然同意，仅靠我们的研究不足以全面证明 TMS 对所有老年 TRD 患者的安全性。然而，我们对所检查数据的安全性印象与已发表的研究结果一致，表明接受 TMS 的老年患者普遍具有良好的耐受性和至少短期安全性。例如，在对 TMS 治疗 TRD 的 4 项随机试验和 7 项非对照试验（总计 N = 136）的回顾中，Sabesan 等人（2015）没有发现与年龄相关的不良反应的明确证据，也没有发现与年龄相关的副作用的证据。
We appreciate the comments of Professor Van den Noort and colleagues regarding our recent report (Conelea et al., 2017). We described a retrospective chart review of adults (N= 231) with treatment resistant depression (TRD) who received an acute course of outpatient TMS therapy in a naturalistic clinical practice setting. We found equivalent improvements in depression symptoms between patients aged≥ 60 years vs. those< 60. We concluded that older age alone should not be considered a contraindication or poor prognostic indicator to TMS therapy, a finding that is consistent with the prior literature (see review by Sabesan et al., 2015).Professor Van den Noort and colleagues raised three concerns about our study. First, in a manner consistent with prior letters to journal editors (van den Noort et al., 2014), they expressed concern regarding the safety of TMS in the aging brain. We point out that our data were from a chart review of naturalistic treatment outcomes, and as such data were not systematically captured or available in sufficient detail to permit rigorous testing of all safety outcomes. We did not find any differences in serious or non-serious adverse psychiatric events, but side effects were not assessed with standardized instruments. Furthermore, in the majority of cases we have limited contact with our TMS patients after they finish the course of stimulation and return to their outpatient psychiatrists and therapists for maintenance care. We certainly agree that our study alone is insufficient to comprehensively demonstrate TMS safety for all older patients with TRD. However, our impressions of safety from the data we examined are consistent with published findings demonstrating generally good tolerability and at least short-term safety among older patients receiving TMS. For example, in a review of four randomized trials and seven uncontrolled trials of TMS for TRD (total N= 136), Sabesan et al.(2015) found no clear evidence of age-related adverse effects, no evidence of
登录
查看更多内容
认识到大脑刺激的风险。
影响因子：
56.9
作者：
M. van den Noort;Sabina Lim;P. Bosch
通讯作者：
P. Bosch
影响因子：
4.1
作者：
Vonloh M;Chen R;Kluger B
通讯作者：
Kluger B
影响因子：
10.6
作者：
Rush, AJ;Bernstein, IH;Fava, M
通讯作者：
Fava, M
影响因子：
5.3
作者：
McClintock, Shawn M.;Reti, Irving M.;Lisanby, Sarah H.
通讯作者：
Lisanby, Sarah H.
影响因子：
8.3
作者：
W. Ishak;J. Mirocha;Sarah Pi;Gabriel Tobia;Bret Becker;E. Peselow;R. Cohen
通讯作者：
R. Cohen