Low-frequency repetitive transcranial magnetic stimulation for adjuvant treatment of depression with different characteristics: a controlled study

doi:10.3877/cma.j.issn.1674-0785.2023.05.011

Abstract

Abstract:

Objective

To evaluate the efficacy and safety of low-frequency repetitive transcranial magnetic stimulation (rTMS) in the adjuvant treatment of depression with different characteristics.

Methods

A total of 80 depressed patients who visited the psychiatric department of Changshu Third People's Hospital from June 2018 to June 2022, met the diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5) with melancholic features, anxious distress, or atypical features, and had poor response to 8 weeks of antidepressant treatment were divided into three groups and treated with original antidepressants combined with low-frequency rTMS to the right dorsolateral prefrontal cortex (DLPFC) for 6 weeks. The 17-item Hamilton Depression Scale (HAMD-17), Self-rating Idea of Suicide Scale (SIOSS), and Treatment Emergent Symptoms Scale (TESS) were used to assess the efficacy and safety at baseline and the 2^nd, 4^th, and 6^th weekends after treatment.

Results

The main effects of time and group and the interaction of time and group were significant in the total score of HAMD-17, the scores of anxiety, block, and sleep disorder dimensions of HAMD-17, the scores of despair, optimism, and sleep disorder dimensions of SIOSS in the three groups (P＜0.05 or P＜0.01). The main effect of time and the interaction of time and group were significant in the total score of SIOSS in the three groups (P＜0.01). Findings from the single effect analysis showed that there were no significant differences in the scores of HAMD-17 and SIOSS at baseline among the three groups (P＞0.05). From the 2^nd weekend after treatment, the total scores of HAMD-17 and SIOSS in the anxious distress group decreased compared with those in the other groups (P＜0.05). There was no significant difference in the incidence rates of adverse reactions among the three groups (P＞0.05).

Conclusion

Low-frequency rTMS to the right DLPFC is effective and safe in treating depression with different characteristics, and it especially has faster onset and better efficacy for depression with anxiety distress.

Key words: Low-frequency repetitive transcranial magnetic stimulation, Depression with different characteristics, Antidepressant, Suboptimal response

Hui Pan, Ming Wang, Zhong Yang, Xiangdong Du. Low-frequency repetitive transcranial magnetic stimulation for adjuvant treatment of depression with different characteristics: a controlled study[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(05): 562-568.

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References 36

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	HAMD-17总分	焦虑/躯体化因子	阻滞因子	睡眠障碍因子
伴忧郁特征组（29例）
基线期	21.48±2.43	4.83±0.66	8.03±0.82	2.79±0.73
治疗第2周末	21.31±2.49	4.72±0.75	7.97±0.91	2.59±0.91
治疗第4周末	19.21±2.94	4.41±0.91	7.79±0.98	1.93±0.88
治疗第6周末	15.38±3.74	3.86±0.92	6.79±1.01	1.21±0.98
伴焦虑痛苦组（28例）
基线期	22.14±2.37	8.04±0.84	4.46±0.84	2.89±0.69
治疗第2周末	19.89±2.71	7.71±0.90	4.14±0.80	2.18±0.61
治疗第4周末	16.57±3.39	6.93±1.15	3.82±0.86	1.39±0.63
治疗第6周末	10.61±3.16	5.21±1.29	3.14±0.85	0.54±0.64
伴非典型特征（19例）
基线期	21.79±2.70	5.47±0.51	6.00±1.05	1.05±1.22
治疗第2周末	21.58±2.61	5.32±0.58	5.89±1.15	0.84±1.02
治疗第4周末	19.95±2.51	4.95±0.71	5.74±1.15	0.53±0.70
治疗第6周末	15.58±3.86	4.00±0.94	5.00±1.33	0.21±0.54
F值（时间）	383.58^b	187.20^b	133.62^b	152.24^b
F值（组别）	6.30^b	80.43^b	122.50^b	26.89^b
F值（交互）	19.02^b	21.25^b	2.19^a	10.80^b

	HAMD-17总分	焦虑/躯体化因子	阻滞因子	睡眠障碍因子
伴忧郁特征组（29例）
基线期	21.48±2.43	4.83±0.66	8.03±0.82	2.79±0.73
治疗第2周末	21.31±2.49	4.72±0.75	7.97±0.91	2.59±0.91
治疗第4周末	19.21±2.94	4.41±0.91	7.79±0.98	1.93±0.88
治疗第6周末	15.38±3.74	3.86±0.92	6.79±1.01	1.21±0.98
伴焦虑痛苦组（28例）
基线期	22.14±2.37	8.04±0.84	4.46±0.84	2.89±0.69
治疗第2周末	19.89±2.71	7.71±0.90	4.14±0.80	2.18±0.61
治疗第4周末	16.57±3.39	6.93±1.15	3.82±0.86	1.39±0.63
治疗第6周末	10.61±3.16	5.21±1.29	3.14±0.85	0.54±0.64
伴非典型特征（19例）
基线期	21.79±2.70	5.47±0.51	6.00±1.05	1.05±1.22
治疗第2周末	21.58±2.61	5.32±0.58	5.89±1.15	0.84±1.02
治疗第4周末	19.95±2.51	4.95±0.71	5.74±1.15	0.53±0.70
治疗第6周末	15.58±3.86	4.00±0.94	5.00±1.33	0.21±0.54
F值（时间）	383.58^b	187.20^b	133.62^b	152.24^b
F值（组别）	6.30^b	80.43^b	122.50^b	26.89^b
F值（交互）	19.02^b	21.25^b	2.19^a	10.80^b

	SIOSS总分	绝望因子	乐观因子	睡眠因子
伴忧郁特征组（29例）
基线期	14.93±4.34	8.00±2.80	3.38±0.73	2.76±0.79
治疗第2周末	14.72±4.37	7.86±2.80	3.28±0.75	2.55±0.99
治疗第4周末	13.97±4.38	7.31±2.83	3.17±0.76	1.93±0.92
治疗第6周末	11.79±3.68	6.66±2.57	2.69±0.76	1.24±0.95
伴焦虑痛苦组（28例）
基线期	15.36±3.67	9.68±3.51	2.32±0.77	2.93±0.54
治疗第2周末	12.64±3.52	7.25±2.88	2.04±0.84	2.29±0.71
治疗第4周末	11.71±3.64	6.82±2.97	1.93±0.77	1.46±0.64
治疗第6周末	8.79±2.82	5.32±2.28	1.54±0.79	0.54±0.69
伴非典型特征（19例）
基线期	16.05±3.60	10.58±3.10	3.32±0.67	1.00±1.20
治疗第2周末	15.63±3.69	10.37±3.22	3.21±0.79	0.74±0.99
治疗第4周末	14.84±3.98	9.63±3.47	3.05±0.91	0.58±0.77
治疗第6周末	11.74±3.53	7.89±2.94	2.26±0.73	0.26±0.65
F值（时间）	176.31^b	112.99^b	74.45^b	147.00^b
F值（组别）	2.91	4.59^a	22.01^b	25.29^b
F值（交互）	10.68^b	15.64^b	2.21^a	13.99^b

	SIOSS总分	绝望因子	乐观因子	睡眠因子
伴忧郁特征组（29例）
基线期	14.93±4.34	8.00±2.80	3.38±0.73	2.76±0.79
治疗第2周末	14.72±4.37	7.86±2.80	3.28±0.75	2.55±0.99
治疗第4周末	13.97±4.38	7.31±2.83	3.17±0.76	1.93±0.92
治疗第6周末	11.79±3.68	6.66±2.57	2.69±0.76	1.24±0.95
伴焦虑痛苦组（28例）
基线期	15.36±3.67	9.68±3.51	2.32±0.77	2.93±0.54
治疗第2周末	12.64±3.52	7.25±2.88	2.04±0.84	2.29±0.71
治疗第4周末	11.71±3.64	6.82±2.97	1.93±0.77	1.46±0.64
治疗第6周末	8.79±2.82	5.32±2.28	1.54±0.79	0.54±0.69
伴非典型特征（19例）
基线期	16.05±3.60	10.58±3.10	3.32±0.67	1.00±1.20
治疗第2周末	15.63±3.69	10.37±3.22	3.21±0.79	0.74±0.99
治疗第4周末	14.84±3.98	9.63±3.47	3.05±0.91	0.58±0.77
治疗第6周末	11.74±3.53	7.89±2.94	2.26±0.73	0.26±0.65
F值（时间）	176.31^b	112.99^b	74.45^b	147.00^b
F值（组别）	2.91	4.59^a	22.01^b	25.29^b
F值（交互）	10.68^b	15.64^b	2.21^a	13.99^b

不良反应	伴忧郁特征组（30例）	伴焦虑痛苦组（30例）	伴非典型特征组（20例）	χ²值	P值
头痛	2（6.67）	4（13.33）	2（10.00）	0.754	0.686
头昏	1（3.33）	3（13.33）	2（10.00）	1.345	0.511
恶心呕吐	1（3.33）	2（6.67）	2（10.00）	0.939	0.625
颈部酸痛	2（6.67）	3（10.00）	1（5.00）	0.480	0.787

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