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MRI-guided dmPFC-rTMS as a Treatment for Treatment-resistant Major Depressive Disorder
Published on: August 11, 2015
Eficacia de la rTMS combinada con tDCS en pacientes con trastorno depresivo mayor con ansiedad: un estudio
Deyang Li1,2, Jiaxin Li1,3, Shuochi Wei1,4
1State Key Laboratory of Cognitive Science and Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
Background:
Major depressive disorder (MDD) with comorbid anxiety presents a greater treatment challenge and higher relapse risk. Non-invasive brain stimulation techniques such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) have shown efficacy individually, but their combined effect remains unclear.
Objective:
To assess the efficacy and acceptability of rTMS, tDCS and their combined therapy in alleviating depressive and anxiety symptoms in patients with MDD.
Methods:
In this double-blind, randomised, sham-controlled trial, 240 patients with MDD with anxiety symptoms were assigned to four groups: active rTMS+active tDCS, active rTMS+sham tDCS, sham rTMS+active tDCS and sham rTMS+sham tDCS. Participants received 10 sessions over 2 weeks and were followed for an additional 2 weeks. Primary outcomes were changes in Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Scale (HAMA) scores from baseline to post-treatment. χ² tests and mixed-design analysis of variance were used for group comparisons.
Findings:
After 2 weeks of treatment, the combined rTMS+tDCS group showed significantly greater reductions in HDRS scores than the other three groups. Reductions in HAMA scores were also larger compared with the sham-sham group and remained superior to that of the other groups at the 4-week follow-up. The combined group had the highest anxiety response rate (82.83%, p=0.014) and remission rate (26.17%, p=0.020) at post-treatment. No serious adverse events were reported across groups.
Conclusions:
Combined rTMS and tDCS were more effective than monotherapy or sham in alleviating depression and anxiety in MDD, with good tolerability and no significant side effects.
Clinical Implications:
This combined neuromodulation approach may serve as a promising and well-tolerated non-pharmacological option for patients with MDD with comorbid anxiety. It offers a clinically scalable intervention that could complement current first-line therapies.
Trial Registration Number:
ChiCTR2100052122.
