对抗抑郁药不完整和治疗耐药性抑郁症 (ASCERTAIN-TRD) 的非响应者进行比较有效性研究试验是一个随机临床试验
George I Papakostas1, Madhukar H Trivedi2, Richard C Shelton3
1Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. gpapakostas@mgb.org.
Molecular psychiatry
|March 7, 2024
概括
重复的横磁刺激增强证明比治疗耐药抑郁症的抗抑郁药更有效. 临床医生应尽早考虑这种非药理学方法,以改善患者的治疗结果.
科学领域:
- 神经科学是一个神经科学.
- 精神病学是一个精神病学.
- 临床研究 临床研究
背景情况:
- 耐治疗抑郁症 (TRD) 需要改善护理标准和患者的治疗结果.
- 在TRD中,关于药物/非药物增强与抗抑郁药物切换的比较疗效存在重大知识差距.
研究的目的:
- 为了比较与阿里皮普拉或重复性跨磁性刺激 (rTMS) 的增强疗法的有效性,而不是转换为TRD的venlafaxine XR/duloxetine.
主要方法:
- 多部位,8周,随机,开放的标签研究.
- 278名TRD患者随机 (1:1:1) 接受阿里皮普拉增强,rTMS增强或切换抗抑郁药.
- 蒙哥马利-阿斯伯格抑郁评分 (MADRS) 尺度被用作主要结果衡量标准.
主要成果:
- rTMS增强显示在MADRS切换上具有优势 (p=0.015).
- 增加阿里皮普拉的效果优于启动抑郁症症状问卷 (p=0.003).
- 根据主要测量,rTMS增强表现出更大的有效性,而不是基于TRD的抗抑郁药物切换.
结论:
- 重复的横磁刺激增强比治疗耐药抑郁症的抗抑郁药更有效.
- 临床医生应考虑为TRD患者早期实施rTMS增强.
- 需要进一步的研究来优化TRD管理策略.
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