Transcranial magnetic stimulation (TMS) is increasingly being used to treat posttraumatic stress disorder (PTSD) comorbid with major depressive disorder (MDD). Yet, identifying the most effective stimulation parameters remains an active area of research. We recently reported on the use of 5 Hz TMS to reduce PTSD and MDD symptoms. A recently developed form of TMS, intermittent theta burst stimulation (iTBS), appears noninferior for treating MDD. Because iTBS can be delivered in a fraction of the time, it provides significant logistical advantages; however, evaluations of whether iTBS provides comparable PTSD and MDD symptom reductions are lacking. We performed a retrospective chart review comparing clinical outcomes in veterans with PTSD and MDD who received iTBS (n = 10) with a matched cohort that received 5-Hz TMS (n = 10). Symptoms were evaluated using self-reported rating scales at baseline and every five treatments for up to 30 sessions. Both protocols were safe and reduced symptoms, ps < .001, but veterans who received iTBS reported poorer outcomes. These results were observed using mixed-model analyses, Group x Time interaction: p = .011, and effect sizes, where 5 Hz TMS demonstrated superior PTSD and MDD symptom improvement, ds = 1.81 and 1.51, respectively, versus iTBS, ds = 0.63 and 0.88, respectively. Data from prior controlled trials of iTBS, with increased stimulation exposure, have appeared to provide comparable clinical outcomes compared with 5 Hz TMS. Prospective and controlled comparisons are required; however, the present findings provide important information for clinicians using TMS to treat these commonly comorbid disorders.

中文翻译：

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经颅磁刺激治疗创伤后应激障碍和重度抑郁症：比较常用的临床方案

经颅磁刺激 (TMS) 越来越多地用于治疗合并重度抑郁症 (MDD) 的创伤后应激障碍 (PTSD)。然而，确定最有效的刺激参数仍然是一个活跃的研究领域。我们最近报道了使用 5 Hz TMS 来减轻 PTSD 和 MDD 症状。最近开发的一种 TMS 形式，即间歇性 theta 爆发刺激 (iTBS)，在治疗 MDD 方面似乎不逊色。因为 iTBS 可以在很短的时间内交付，它提供了显着的后勤优势；然而，缺乏对 iTBS 是否提供可比的 PTSD 和 MDD 症状减轻的评估。我们对接受 iTBS 的 PTSD 和 MDD 退伍军人的临床结果进行了回顾性图表审查（n= 10) 与接受 5-Hz TMS ( n = 10) 的匹配队列。使用基线时的自我报告评分量表评估症状，每 5 次治疗最多 30 次。两种方案均安全且症状减轻，p s < .001，但接受 iTBS 的退伍军人报告的结果较差。这些结果是使用混合模型分析、组 x 时间交互：p = .011 和效应大小观察到的，其中 5 Hz TMS 表现出优异的 PTSD 和 MDD 症状改善，ds = 1.81 和 1.51，分别与 iTBS ，ds =分别为 0.63 和 0.88。与 5 Hz TMS 相比，来自先前 iTBS 对照试验的数据，随着刺激暴露的增加，似乎提供了可比的临床结果。需要进行前瞻性和对照比较；然而，目前的研究结果为使用 TMS 治疗这些常见合并症的临床医生提供了重要信息。