rTMS作为抗抑郁药不响应患者的下一步:随机比较与当前抗抑郁药治疗方法
Iris Dalhuisen1, Iris van Oostrom1, Jan Spijker1
1Department of Psychiatry, Radboud University Medical Center, and Donders Institute for Brain, Cognition, and Behavior, Centre for Medical Neuroscience, Nijmegen, the Netherlands (Dalhuisen, Tendolkar, van Eijndhoven); Neurocare Clinics, Nijmegen, the Netherlands (van Oostrom); Depression Expertise Centre, Pro Persona Mental Health Care, and Behavioral Science Institute, Radboud University, Nijmegen, the Netherlands (Spijker); Center for Economic Evaluation, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands (Wijnen); GGZ inGeest Specialized Mental Health Care, and Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (van Exel); Department of Psychiatry and Psychology, St. Antonius Hospital, Utrecht/Nieuwegein, the Netherlands (van Mierlo); Department of Psychiatry, Elisabeth-TweeSteden Ziekenhuis Hospital, Tilburg, the Netherlands (de Waardt); Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands (Arns); Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Arns).
重复的横磁刺激 (rTMS) 显著优于治疗耐药抑郁症的抗抑郁药物,显示出更高的反应和缓解率. 这表明rTMS可能是某些患者更有效的选择.
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.
- 临床医学 临床医学
背景情况:
- 重复性横磁刺激 (rTMS) 是一种成熟的抑郁症治疗方法,但其与抗抑郁药等其他选择的比较有效性尚不清楚.
- 治疗耐药性抑郁症 (TRD) 构成了重大挑战,需要对既有和新的治疗干预措施进行比较.
研究的目的:
- 为了比较rTMS的有效性与在治疗耐药抑郁症患者中切换抗抑郁药物的有效性.
- 评估rTMS和抗抑郁药物对特定抑郁症症状尺寸的影响.
主要方法:
- 一个多中心随机对照试验,涉及89名单极性非精神病性抑郁症患者,他们对至少两种先前的治疗反应不充分.
- 患者被随机分配为为期8周的高频rTMS,针对左侧脊侧前额叶皮层或由荷兰治疗算法指导的抗抑郁药物的切换,两者与心理治疗相结合.
- 主要结局是抑郁症严重程度的变化 (汉密尔顿抑郁症评分表);次要结局包括反应/缓解率和症状尺寸变化.
主要成果:
- 与转换抗抑郁药物相比,rTMS显著减少了抑郁症状,反应率 (37.5%与14.6%) 和缓解率 (27.1%与4.9%) 较高.
- rTMS导致焦虑和无情症的症状得到更大的改善.
- 在rTMS和用于反,认知反应或睡眠障碍症状减少的药物之间没有发现显著差异.
结论:
- 对于中度耐治疗抑郁症,rTMS在减少抑郁症状方面比切换抗抑郁药物更有效.
- 治疗选择可能会受到治疗耐药抑郁症患者存在的特定症状尺寸的影响.
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