治疗耐药性抑郁症的快速起作用方法:内鼻素与加速rTMS的实际比较有效性
Michele Prato1, Matteo Carminati2, Filippo Frizzi1
1Department of Clinical Neurosciences, Vita-Salute San Raffaele University, Milan, Italy.
International journal of psychiatry in clinical practice
|March 12, 2026
概括
加速重复的跨磁性刺激 (aTMS) 显示,与治疗耐药性抑郁症的鼻内素相比,早期抗抑郁药效果优越. 然而,随着时间的推移,这种优势逐渐减少,六个月后没有观察到任何显著差异.
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:
- 治疗耐药性抑郁症 (TRD) 是一个重大挑战,通常是标准药物治疗不够解决的.
- 鼻腔内注射的埃斯凯特胺和加速重复的跨磁性刺激 (aTMS) 为TRD提供了快速起作用的干预措施.
- 对于这些先进的TRD治疗方法,只有有限的对比性研究存在.
研究的目的:
- 在患有TRD的患者中,比较aTMS与鼻内素的疗效.
- 在多个时间点评估治疗反应和缓解率.
- 为了确定治疗结果的潜在调节者.
主要方法:
- 一项涉及TRD患者的回顾性研究,这些患者接受了aTMS (n=18) 或鼻内胺 (n=22) 的治疗.
- 在基线和1,3,6个月使用蒙哥马利-阿斯伯格抑郁评分表 (MADRS) 评估抑郁症严重程度.
- 主要结局包括响应 (≥50%的MADRS减少) 和缓解 (MADRS<10);使用线性混合效应模型分析的纵向变化.
主要成果:
- 在1个月后,aTMS的响应率 (72.2%对20%) 和缓解率 (66.6%对10%) 与埃斯凯坦胺相比显著更高 (p<0.001).
- 虽然aTMS在1个月和3个月显示出更大的MADRS减少,但在6个月后,这些差异并不显著.
- 在3个月和6个月的Esketamine亚组中,精神病并发症与更好的结果有关,但在aTMS亚组中并非如此.
结论:
- 对于TRD,aTMS表现出比Esketamine更强大的初始抗抑郁作用.
- 在6个月的时间里,aTMS的早期优势逐渐减少,与Esketamine相比,没有持续的显著差异.
- 需要进一步的前性,充足的比较试验来证实这些发现并指导临床实践.
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