TRANSCRANIAL MAGNETIC STIMULATION (TMS) FOR MAJOR DEPRESSION: A MULTISITE, NATURALISTIC, OBSERVATIONAL STUDY OF ACUTE TREATMENT OUTCOMES IN CLINICAL PRACTICE
TRANSCRANIAL MAGNETIC STIMULATION (TMS) FOR MAJOR DEPRESSION: A MULTISITE, NATURALISTIC, OBSERVATIONAL STUDY OF ACUTE TREATMENT OUTCOMES IN CLINICAL PRACTICE
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DOI：
10.1002/da.21969
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发表时间：
2012-07-01
影响因子：
7.4
通讯作者：
Demitrack, Mark A.
中科院分区：
文献类型：
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作者：
Carpenter, Linda L.;Janicak, Philip G.;Demitrack, Mark A.
很少有研究在现实世界的临床实践环境中检查经颅磁刺激（TMS）的有效性。方法42个美国临床TMS实践点治疗307例重度抑郁症（MDD）门诊患者，尽管抗抑郁药物治疗，症状持续。治疗基于获批TMS器械的标签程序。在基线、第2周、最大急性获益点和第6周（急性病程超过6周）进行评估。主要结局是临床医生总体印象-疾病严重程度从基线至急性期结束的变化。次要结局是自我报告抑郁量表（9项患者健康问卷[PHQ-9]和抑郁症状自评量表[IDS-SR]）的连续和分类结局的变化。结果患者的平均± SD年龄为48.6 ± 14.2岁，66.8%为女性。患者平均接受了2.5（+/- 2.4）次适当剂量和持续时间的抗抑郁药治疗，但该事件没有令人满意的改善。CGI-S从基线到治疗结束有显著变化（-1.9 +/-1.4，P < .0001）。临床医师评估有效率（CGI-S）为58.0%，缓解率为37.1%。患者报告的缓解率范围为56.4%至41.5%，缓解率范围为28.7%至26.5%（分别为PHQ-9和IDS-SR）。结论：结果表明，反应和依从率与研究人群相似。这些数据表明，TMS是一种有效的治疗那些无法受益于初始抗抑郁药物。
Background Few studies have examined the effectiveness of transcranial magnetic stimulation (TMS) in real-world clinical practice settings. Methods Forty-two US-based clinical TMS practice sites treated 307 outpatients with Major Depressive Disorder (MDD), and persistent symptoms despite antidepressant pharmacotherapy. Treatment was based on the labeled procedures of the approved TMS device. Assessments were performed at baseline, week 2, at the point of maximal acute benefit, and at week 6 when the acute course extended beyond 6 weeks. The primary outcome was change in the Clinician Global Impressions-Severity of Illness from baseline to end of acute phase. Secondary outcomes were change in continuous and categorical outcomes on self-report depression scales (9-Item Patient Health Questionnaire [PHQ-9], and Inventory of Depressive Symptoms-Self Report [IDS-SR]). Results Patients had a mean +/- SD age of 48.6 +/- 14.2 years and 66.8% were female. Patients received an average of 2.5 (+/- 2.4) antidepressant treatments of adequate dose and duration without satisfactory improvement in this episode. There was a significant change in CGI-S from baseline to end of treatment (-1.9 +/- 1.4, P < .0001). Clinician-assessed response rate (CGI-S) was 58.0% and remission rate was 37.1%. Patient-reported response rate ranged from 56.4 to 41.5% and remission rate ranged from 28.7 to 26.5%, (PHQ-9 and IDS-SR, respectively). Conclusion Outcomes demonstrated response and adherence rates similar to research populations. These data indicate that TMS is an effective treatment for those unable to benefit from initial antidepressant medication.