BACKGROUND To determine if an accelerated rTMS protocol results in distinct depressive symptom response trajectories, compared to a standard rTMS protocol. We also sought to validate previous analyses that identified distinct depressive symptom response trajectories with rTMS treatment using an external dataset. METHOD Data from two recent clinical trials comparing accelerated rTMS protocol delivered to the left dorsolateral prefrontal cortex (DLPFC) with standard once-daily rTMS protocol were used to identify depressive symptom response trajectories. The accelerated protocol in Trial 1 was conventional 10-Hz rTMS, while Trial 2 employed intermittent theta burst stimulation (iTBS). Participants were adult outpatients (18-70 years old) with bipolar or unipolar depression and moderate-severe depression (Montgomery Asberg Depression Rating Scale score >19) who had failed to respond to adequate courses of two different antidepressants. We used group-based trajectory modeling to identify MADRS response trajectories, and regression techniques adjusting for baseline depressive symptom severity to determine the association between treatment protocol and depressive symptom response trajectory. RESULTS Treatment outcomes of 189 participants were analysed. We identified four distinct response trajectories: "nonresponse" (N = 59; 30.7%), "minimal response" (N = 65; 34.1%), "higher symptoms, response" (N = 26; 14.6%), "lower symptoms, response" (N = 39; 20.6%). We failed to find an association between rTMS protocol (accelerated vs standard) with depressive symptom response trajectory even after adjusting for baseline depressive symptom severity. CONCLUSION The accelerated rTMS protocol in this study did not impact depressive symptom response trajectories. This work provides further confirmatory evidence that there are distinct depressive symptom response trajectories with rTMS delivered to the left DLPFC. AUSTRALIAN NEW ZEALAND CLINICAL TRIALS REGISTRY ACTRN12616000443493 and ACTRN12613000044729.

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与标准和加速 rTMS 相关的抑郁症状轨迹

背景确定与标准 rTMS 协议相比，加速 rTMS 协议是否会导致不同的抑郁症状反应轨迹。我们还试图验证先前的分析，这些分析使用外部数据集通过 rTMS 治疗确定了不同的抑郁症状反应轨迹。方法 最近的两项临床试验的数据比较了传递到左背外侧前额叶皮层 (DLPFC) 的加速 rTMS 协议与标准的每日一次 rTMS 协议，用于确定抑郁症状反应轨迹。试验 1 中的加速协议是传统的 10 Hz rTMS，而试验 2 采用间歇性 theta 脉冲刺激 (iTBS)。参与者是患有双相或单相抑郁症和中重度抑郁症（蒙哥马利阿斯伯格抑郁量表评分 >19）的成人门诊患者（18-70 岁），他们未能对两种不同抗抑郁药的足够疗程做出反应。我们使用基于组的轨迹建模来确定 MADRS 反应轨迹，并使用回归技术调整基线抑郁症状的严重程度，以确定治疗方案和抑郁症状反应轨迹之间的关联。结果 分析了 189 名参与者的治疗结果。我们确定了四种不同的反应轨迹：“无反应”（N = 59；30.7%）、“最小反应”（N = 65；34.1%）、“较高的症状，有反应”（N = 26；14.6%）、“较低的症状” ，响应”（N = 39；20.6%）。即使在调整基线抑郁症状严重程度后，我们也未能发现 rTMS 协议（加速与标准）与抑郁症状反应轨迹之间的关联。结论 本研究中的加速 rTMS 方案不影响抑郁症状反应轨迹。这项工作提供了进一步的证实性证据，表明将 rTMS 传递到左侧 DLPFC 存在明显的抑郁症状反应轨迹。澳大利亚新西兰临床试验注册处 ACTRN12616000443493 和 ACTRN12613000044729。这项工作提供了进一步的证实性证据，表明将 rTMS 传递到左侧 DLPFC 存在明显的抑郁症状反应轨迹。澳大利亚新西兰临床试验注册处 ACTRN12616000443493 和 ACTRN12613000044729。这项工作提供了进一步的证实性证据，表明将 rTMS 传递到左侧 DLPFC 存在明显的抑郁症状反应轨迹。澳大利亚新西兰临床试验注册处 ACTRN12616000443493 和 ACTRN12613000044729。