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在耐性抑郁患者中,在成功的间歇性甲基突发刺激后,下丘脑-垂体-上腺轴的过度活动正常化

Fabrice Duval¹, Marie-Claude Mokrani¹, Vlad Danila¹

¹Pôle 8/9 Psychiatry, APF2R, Centre Hospitalier, Rouffach, France.

Psychoneuroendocrinology

|April 13, 2024

概括

间歇性甲基突破刺激 (iTBS) 在治疗耐药抑郁症 (TRD) 患者中使皮质醇水平正常化. 这种大脑刺激技术可以恢复正常的压力激素调节,改善TRD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.
内分泌学在内分泌学.

背景情况:

耐治疗性抑郁症 (TRD) 经常与HPA轴失调有关,特别是在德甲抑制试验 (DST) 上的皮质醇非抑制.
左背侧前额叶皮质在情绪调节和应激反应中发挥作用.
非侵入性脑刺激技术为TRD提供了潜在的治疗途径.

研究的目的:

调查多会期间歇性甲基突破刺激 (iTBS) 对TRD患者皮质醇水平的影响.
评估iTBS是否可以使基线皮质醇非抑制的TRD患者的甲抑制试验 (DST) 正常化.
探索皮质醇水平变化与抑郁症症状严重程度之间的关系.

主要方法:

一项试点研究涉及17名TRD住院患者,基线DST皮质醇非抑制 (CORmax>130nmol/L).
参与者接受了20次的iTBS,目标是左侧脊侧前额叶皮质.
干预后重复了DST,以测量DST后最大皮质醇水平 (CORmax) 的变化.

主要成果:

与健康对照组 (HCs) 相比,TRD患者的基线CORmax水平显著更高.
在20次iTBS会话后,CORmax水平显著下降,与HC相比.
康马克斯水平的降低与汉密尔顿抑郁评分表 (HAMD-17) 评分的降低相关.
在17名TRD患者中,10名TRD患者在iTBS后的DST正常化,其中7名被归类为响应者.

结论:

多会话iTBS可能会恢复TRD中垂体水平的正常葡萄糖皮质体受体反抑制.
成功的iTBS治疗与HPA轴功能正常化和抑郁症状减少有关.
作为TRD的治疗干预措施,iTBS显得有前途,特别是在HPA轴调节失调的患者中.

关键词:

皮质醇是一种皮质醇.在 DST 中使用 DST.在HPA轴上.在ITBS中,ITBS是ITBS.在RTMS中使用RTMS.抗性抑郁症是一种抗性抑郁症.

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