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Bilateral sequential theta burst stimulation for multiple-therapy-resistant depression: A naturalistic observation study.
Journal of Psychiatric Research ( IF 4.8 ) Pub Date : 2020-08-22 , DOI: 10.1016/j.jpsychires.2020.08.009
Amer M Burhan 1 , James A Patience 2 , Johannes G P Teselink 3 , Nicole M Marlatt 2 , Sahand Babapoor-Farrokhran 4 , Lena Palaniyappan 5
Affiliation  

Depression is a significant health issue with treatment resistance reported in about one third of patients. Treatment resistance results in significant disability, impaired quality of life, and increased healthcare costs. Repetitive transcranial magnetic stimulation (rTMS) is a treatment option for treatment resistant depression (TRD) with response and remission rates in open-label studies being as high as 58% and 37% respectively. Theta-burst is a faster and novel rTMS paradigm that has shown promise as a treatment for TRD in some preliminary studies. In a naturalistic design, we evaluated the response, remission and tolerability of bilateral sequential (right then left) prefrontal theta-burst rTMS (bsTBS) in 50 patients with TRD (600 pulses/session, 20 sessions, 100% of resting motor threshold (80% if intolerant to 100%, n = 2), F4/F3 of 10-20-20 EEG localization). Data was collected over 36 months from a specialized academic TMS clinic. Patients had multiple-treatment resistance with at least two failed trials of different antidepressants with 20% also having failed electroconvulsive therapy and 66% having received professional therapy. We found a 28% remission rate (HAMD-17 score of ≤7) and a 52% response rate (≥50% reduction in HAMD-17) with a 42% reduction in average HAMD-17 score. The treatment was well tolerated, with muscle contractions, mild pain or discomfort, headache, scalp irritation, and changes to vitals being captured as occasional adverse events with two instances of syncope (0.22% of treatments). This naturalistic study shows that bsTBS is a promising paradigm for a multiple-TRD patient population with approximately one-third of treatments achieving remission and over half achieving significant response.



中文翻译:

多重治疗抵抗性抑郁症的双侧连续θ爆发刺激:自然观察研究。

抑郁症是一个重要的健康问题,据报道约有三分之一的患者对治疗产生抗药性。治疗抵抗会导致严重的残疾、生活质量受损和医疗费用增加。重复经颅磁刺激 (rTMS) 是治疗难治性抑郁症 (TRD) 的一种治疗选择,在开放标签研究中的反应率和缓解率分别高达 58% 和 37%。Theta-burst 是一种更快、更新颖的 rTMS 范式,在一些初步研究中已显示出作为治疗 TRD 的前景。在自然主义设计中,我们评估了 50 名 TRD 患者(600 次脉冲/会话,20 次会话,100% 的静息运动阈值)双侧顺序(从右到左)前额叶 θ-burst rTMS (bsTBS) 的反应、缓解和耐受性。如果对 100% 不耐受,则为 80%,n = 2),10-20-20 EEG 定位的 F4/F3)。从专门的学术 TMS 诊所收集了超过 36 个月的数据。患者对多重治疗产生耐药性,至少有两次不同抗抑郁药的试验失败,其中 20% 的电休克疗法也失败了,66% 的患者接受了专业治疗。我们发现 28% 的缓解率(HAMD-17 评分≤7)和 52% 的缓解率(HAMD-17 降低 ≥50%),平均 HAMD-17 评分降低 42%。治疗耐受性良好,肌肉收缩、轻微疼痛或不适、头痛、头皮刺激和生命体征变化被捕获为偶发的不良事件,有两次晕厥(0.22% 的治疗)。

更新日期:2020-08-31
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