Early symptom improvement and other clinical predictors of response to repetitive transcranial magnetic stimulation for depression.

Autor: Winninge M; Department of Medical Sciences, Uppsala University, Uppsala, Sweden., Cernvall M; Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Department of Psychology, Division of Clinical Psychology, Uppsala University, Uppsala, Sweden., Persson J; Department of Medical Sciences, Uppsala University, Uppsala, Sweden., Bodén R; Department of Medical Sciences, Uppsala University, Uppsala, Sweden. Electronic address: robert.boden@uu.se.
Jazyk: angličtina
Zdroj: Journal of affective disorders [J Affect Disord] 2024 Sep 15; Vol. 361, pp. 383-389. Date of Electronic Publication: 2024 Jun 17.
DOI: 10.1016/j.jad.2024.06.054
Abstrakt: Background: Repetitive transcranial magnetic stimulation (rTMS) is a rapidly emerging treatment for depression, but outcome prediction is still a challenge. This study aimed to identify predictors of response to rTMS among baseline clinical factors and early symptomatic improvements.
Methods: This cohort study comprised 136 patients with a unipolar or bipolar depressive episode referred for clinical intermittent theta-burst stimulation or right-sided 1 Hz rTMS at the Uppsala Brain Stimulation Unit. The co-primary outcomes used for logistic regression were response, defined as ≥50 % reduction of Montgomery and Åsberg Depression Rating Scale Self-assessment (MADRS-S) total score, and 1-2 points on the Clinical Global Impression Improvement (CGI-I) scale. Early improvement was defined as ≥20 % reduction in the MADRS-S total score, or ≥ 1 point reduction in each MADRS-S item, after two weeks of treatment.
Results: The response rates were 21 % for MADRS-S and 45 % for CGI-I. A depressive episode >24 months had lower odds for MADRS-S response compared to ≤12 months. Early improvement of the MADRS-S total score predicted CGI-I response (95 % CI = 1.35-9.47, p = 0.011), Initiative 6 predicted MADRS-S response (95 % CI = 1.08-9.05, p = 0.035), and Emotional involvement 7 predicted CGI-I response (95 % CI = 1.03-8.66, p = 0.044).
Limitations: No adjustment for concurrent medication.
Conclusions: A depressive episode ≤12 months and early improvement in overall depressive symptoms, as well as the individual items, Initiative 6 and Emotional involvement 7 , predicted subsequent rTMS response in a naturalistic sample of depressed patients. This could facilitate the early identification of patients who will benefit from further rTMS sessions.
Competing Interests: Declaration of competing interest None of the authors have anything to declare.
(Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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