Do bipolar disorder soft signs impact outcomes following Transcranial Magnetic Stimulation (TMS) therapy for depression?
Do bipolar disorder soft signs impact outcomes following Transcranial Magnetic Stimulation (TMS) therapy for depression?
复制标题
双相情感障碍的软体征会影响经颅磁刺激 (TMS) 治疗抑郁症的结果吗？
DOI：
10.1016/j.jad.2018.10.367
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发表时间：
2019
影响因子：
6.6
通讯作者：
Carpenter,LindaL
中科院分区：
文献类型：
--
作者：
Bennett,Emily;Almeida,JorgeRC;Carpenter,LindaL
背景：经颅磁刺激（TMS）目前尚未被FDA批准用于双相情感障碍（BD）抑郁症患者，但许多单极抑郁症患者在接受TMS治疗时都有双相情感障碍的软症状。目前尚不清楚这些软信号是否预示着不同的结果。目的探讨自然治疗条件下双相软体征与经颅磁刺激治疗效果的关系。方法对经颅磁刺激治疗的MDD患者（n= 105）进行回顾性图表分析。双相障碍的素质是通过对修改后的情绪障碍问卷和家族史的回答来确定的。结果采用两种自我报告抑郁严重程度量表，有双相障碍素质组和无双相障碍素质组的stms反应率相等。双相软症状组的缓解率明显较低（13.5% vs 30.2%;p= 0.04）。当针对多个比较进行修正时，此结果不成立。我们没有观察到躁狂的转变。局限性：这些数据仅限于被诊断为单极抑郁症的患者，这些患者具有阈下症状定义的“软”双相特征。结果不能外推到完全双相诊断的患者。结论重度抑郁症患者的双相人格不存在安全问题，但在考虑经颅磁刺激治疗时可能导致缓解率降低。
BackgroundTranscranial Magnetic Stimulation (TMS) is not currently FDA approved for depressed patients with bipolar disorder (BD), but many unipolar depressed patients presenting for TMS have soft signs of bipolarity. It is not known whether or not these soft signs portend differential outcomes.ObjectiveTo investigate the relationship between BD soft signs and TMS treatment outcomes in a naturalistic treatment setting.MethodsWe conducted a retrospective chart review of MDD patients (n= 105) treated with TMS. BD diathesis was defined by responses to a modified version of the Mood Disorder Questionnaire and family history.ResultsTMS response rates for the group with BD diathesis and the group without were equivalent using two self-report depression severity scales. Remission rate was significantly lower for the bipolar soft signs group (13.5% versus 30.2%;p= 0.04) on one scale. This result does not hold when corrected for multiple comparisons. We did not observe switch to mania.LimitationsThese data are limited to patients diagnosed with unipolar depression with “soft” bipolar features defined by subthreshold symptoms. The results cannot be extrapolated to patients with a full bipolar diagnosis.ConclusionBipolar diathesis in MDD is not a safety concern but may lead to somewhat lower remission rates when considering TMS treatment.