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Yin BW, Yang L. Comparative Efficacy of Augmenting Escitalopram with Modified Electroconvulsive Therapy or High-Frequency Repetitive Transcranial Magnetic Stimulation on Depressive Symptoms, Quality of Life, and Cognitive Function in Treatment-Resistant Depression. TOHOKU J EXP MED 2024; 262:191-199. [PMID: 38171724 DOI: 10.1620/tjem.2023.j103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Treatment-resistant depression (TRD) poses significant therapeutic challenges despite available interventions. Escitalopram (ESC) is a highly selective antidepressant. This study aimed to compare ESC alone and ESC combined with modified electroconvulsive therapy (MECT) or high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) in TRD patients. Ninety participants were randomized into ESC alone, ESC + MECT, and ESC + HF-rTMS groups. Notable differences were observed in Hamilton Depression Rating Scale (HDRS-17) scores at 12 weeks among ESC (14.37), ESC + MECT (10.27), and ESC + HF-rTMS (10.77) groups (P = 0.006). In terms of overall quality of life (QoL) evaluated using the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) at 12 weeks, the ESC, ESC + MECT, and ESC + HF-rTMS groups scored 2, 3, and 3.5, respectively. ESC + MECT/HF-rTMS groups showed reduced depressive symptoms compared to the ESC group, accompanied by higher overall QoL scores and increased satisfaction with health. Patients receiving ESC + MECT demonstrated no significant alterations in short-term memory and orientation, as measured by the Montreal Cognitive Assessment (MoCA), before and after treatment. Moreover, a decline in language was observed compared to baseline (12 weeks: median 2, IQR 2-3; baseline: median 1, IQR 1-3; P = 0.022). The positive impact of ESC with HF-rTMS on cognitive function was evidenced by improvements in all domines MoCA.Combining ESC with MECT or HF-rTMS exhibited enhanced effectiveness in alleviating depressive symptoms and enhancing QoL compared to ESC monotherapy. Specifically, the ESC + HF-rTMS combination displayed potential as a comprehensive treatment strategy for TRD, addressing both emotional and cognitive aspects.
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Affiliation(s)
- Bo-Wen Yin
- Department of Psychiatry, Wenzhou Seventh People's Hospital
| | - Liu Yang
- Department of Psychiatry, Wenzhou Seventh People's Hospital
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Liu Z, Yu S, Hu Y, Wang D, Wang S, Tang Z, Li W. Efficacy and safety of repeated transcranial magnetic stimulation combined with escitalopram in the treatment of major depressive disorder: a meta-analysis. Front Psychiatry 2024; 14:1275839. [PMID: 38234362 PMCID: PMC10791764 DOI: 10.3389/fpsyt.2023.1275839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/14/2023] [Indexed: 01/19/2024] Open
Abstract
Objective This study was designed to systematically review the efficacy and safety of repeated transcranial magnetic stimulation (rTMS) combined with escitalopram in treating major depressive disorder (MDD). Methods Databases including PubMed, Embase, Cochrane, Web of Science, CNKI, Wanfang, VIP Journal, and China Biomedical Literature databases were electronically searched for randomized controlled trials of rTMS combined with escitalopram intervention for MDD treatment from the inception of these databases to 27 May 2023. Two reviewers independently screened the studies, extracted the data, and assessed the quality of the included studies. R 4.2.2 was then used for a meta-analysis. Results In total, 19 articles involving 1,032 patients were included. The results of the meta-analysis showed that Hamilton Depression Rating Scale (HAMD) scores were significantly lower in the group receiving rTMS combined with escitalopram (experimental group) than that in the control group [weighted mean difference (WMD) = -5.30, 95% confidence interval (95% CI): -6.44 to -4.17, p < 0.01]. The response rate of the experimental group was significantly higher than that of the control group [odds ratio (OR): 5.48; 95% CI: 3.72 to 8.07; p < 0.01]. No significant difference in the adverse reaction rate was observed between the two groups (OR: 1.04, 95% CI: 0.71 to 1.52, p = 0.82). Conclusion Our findings suggest that rTMS combined with escitalopram can benefit patients with MDD in a safe manner, which may help in guiding clinical practice. Systematic review registration DOI number: 10.37766/inplasy2023.11.0114, INPLASY2023110114.
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Affiliation(s)
| | | | | | | | | | - Zhaohui Tang
- Basic Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Weihong Li
- Basic Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Kong Y, Zhou J, Zhao M, Zhang Y, Tan T, Xu Z, Hou Z, Yuan Y, Tan L, Song R, Shi Y, Feng H, Wu W, Zhao Y, Zhang Z. Non-inferiority of intermittent theta burst stimulation over the left V 1 vs. classical target for depression: A randomized, double-blind trial. J Affect Disord 2023; 343:59-70. [PMID: 37751801 DOI: 10.1016/j.jad.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/27/2023] [Accepted: 09/18/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) targeting the visual cortex (VC) has shown antidepressant effects for major depressive disorder (MDD) in sham-controlled trials, but comparisons with rTMS targeting the left dorsolateral prefrontal cortex (DLPFC) are lacking. We aimed to determine the non-inferiority of intermittent theta-burst stimulation (iTBS) over VC vs DLPFC for MDD. METHODS Participants randomly received navigated iTBS over the left V1 or the left DLPFC twice daily for 14 days with a 3-month follow-up. The primary outcome was change in Hamilton Depression Rating Scale (HAMD-17) score from baseline to treatment end, with 2.5 points as the non-inferiority margin. Secondary outcomes included: improvement in Montgomery-Asberg Depression Rating Scale (MADRS), Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA); response and remission rates; suicidal ideation and adverse events. RESULTS Of 75 randomized patients, 67 completed full treatment, including 52 first-episode patients and 15 relapsers. The primary outcome indicated the non-inferiority of VC (adjusted difference 1.14, lower 97.5 % CI -1.24; p = .002), confirmed by improvements in objective cognitive task and protein levels, as did most secondary outcomes. Reduced suicidal ideation after treatment, incidence of eye discomfort and pain score were lower in the VC group. CONCLUSIONS Left VC iTBS has the potential to be non-inferior to DLPFC iTBS in most first-episode MDD in improving depressive symptoms and cognitive function, with less suicidal ideation and adverse events. LIMITATIONS Given the limited sample size, the lack of a sham control and the use of antidepressants, the findings should be interpreted with caution.
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Affiliation(s)
- Yan Kong
- Department of Neurology, Affiliated Zhongda Hospital, School of Medicine, Institution of Neuropsychiatry, Key Laboratory of Developmental Genes and Human Disease, Southeast University, Nanjing 210009, China; Department of Clinical Psychology, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, China
| | - Jiawei Zhou
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Mingge Zhao
- Department of Nursing, Affiliated Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
| | - Yuhua Zhang
- Department of Psychosomatics and Psychiatry, Affiliated of Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
| | - Tingting Tan
- Department of Psychosomatics and Psychiatry, Affiliated of Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
| | - Zhi Xu
- Department of Psychosomatics and Psychiatry, Affiliated of Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
| | - Zhenghua Hou
- Department of Psychosomatics and Psychiatry, Affiliated of Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
| | - Yonggui Yuan
- Department of Psychosomatics and Psychiatry, Affiliated of Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
| | - Liangliang Tan
- Department of Psychosomatics and Psychiatry, Affiliated of Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
| | - Ruize Song
- Department of Neurology, Affiliated Zhongda Hospital, School of Medicine, Institution of Neuropsychiatry, Key Laboratory of Developmental Genes and Human Disease, Southeast University, Nanjing 210009, China
| | - Yachen Shi
- Department of Neurology, Affiliated Zhongda Hospital, School of Medicine, Institution of Neuropsychiatry, Key Laboratory of Developmental Genes and Human Disease, Southeast University, Nanjing 210009, China
| | - Haixia Feng
- Department of Nursing, Affiliated Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
| | - Wei Wu
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford 94305, USA
| | - Yang Zhao
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China.
| | - Zhijun Zhang
- Department of Neurology, Affiliated Zhongda Hospital, School of Medicine, Institution of Neuropsychiatry, Key Laboratory of Developmental Genes and Human Disease, Southeast University, Nanjing 210009, China; Department of Mental Health and Public Health, Faculty of Life and Health Sciences, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China; Research Center for Brain Health, Pazhou Lab, Guangzhou 510330, China.
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Sun Y, Lei F, Zou K, Zheng Z. Rapid improvements and subsequent effects in major depressive disorder patients with somatic pain using rTMS combined with sertraline. Sci Rep 2023; 13:17973. [PMID: 37863972 PMCID: PMC10589316 DOI: 10.1038/s41598-023-44887-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 10/13/2023] [Indexed: 10/22/2023] Open
Abstract
This study aims to explore changes in depression and pain for major depressive disorder (MDD) patients with somatic pain after repetitive transcranial magnetic stimulation (rTMS) using the event-related potentials (ERPs) technique. Eighty MDD patients with somatic pain were randomly assigned to drug therapy (DT) and combined therapy (CT) groups. CT group underwent intermittent theta burst stimulation over the left dorsolateral prefrontal cortex (DLPFC) with 800 pulses and 1 Hz over the right DLPFC with 800 pulses, 5 times a week for 3 weeks. All patients were given sertraline at 50-100 mg per day. All subjects were evaluated at baseline and at weeks three and six of therapy using the Hamilton Rating Scale for Depression (HAMD), Hamilton Anxiety Scale (HAMA), and Numerical Rating Scales (NRS), and the latency and amplitude of P300 and mismatch negativity (MMN) were measured. There were no significant differences in all indices between groups at baseline. At 3 weeks, HAMD subscale scores of Cognitive Impairment and NRS scores were significantly lower in the CT group than in the DT group. At 6 weeks, NRS and HAMD total scores in the CT group decreased significantly in the CT group compared with the DT group, especially for anxiety and pain, and the MMN and P300 latencies and P300 amplitude showed greater improvements. Our findings highlight that rTMS in combination with antidepressants is a rapid method of symptom improvement in patients with somatic pain with MDD and is helpful for cognitive impairment and anxiety.
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Affiliation(s)
- Yuanfeng Sun
- Neurobiological Detection Center, West China Hospital, Sichuan University, Chengdu, China
| | - Fei Lei
- Neurobiological Detection Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ke Zou
- Neurobiological Detection Center, West China Hospital, Sichuan University, Chengdu, China.
| | - Zhong Zheng
- Neurobiological Detection Center, West China Hospital, Sichuan University, Chengdu, China.
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Sun N, Liu M, Liu P, Zhang A, Yang C, Liu Z, Li J, Li G, Wang Y, Zhang K. Abnormal cortical-striatal-thalamic-cortical circuit centered on the thalamus in MDD patients with somatic symptoms: Evidence from the REST-meta-MDD project. J Affect Disord 2023; 323:71-84. [PMID: 36395992 DOI: 10.1016/j.jad.2022.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/21/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Somatic symptoms are common comorbidities of major depressive disorder (MDD), and negatively impact the course and severity of the disease. In order to enrich the understanding of the pathological mechanism and clarify the neurobiological basis of somatic symptoms in depression, we attempted to explore the changes of brain structure and function in a large sample between depression with and without somatic symptoms. METHODS Structure magnetic resonance imaging (MRI) data were collected from 342 patients with somatic symptoms (SD), 208 patients without somatic symptoms (NSD), and 510 healthy controls (HCs) based on the REST-meta-MDD project. We analyzed the whole brain VBM maps of the three groups, and combined with weight degree centrality (DC) index, we investigated whether the brain regions with gray matter volume (GMV) and gray matter density (GMD) abnormalities in MDD patients with somatic symptoms had corresponding brain functional abnormalities. RESULTS Between depression with and without somatic symptoms, we found that there are extensive GMV and GMD differences involving cortical regions such as the temporal lobe, occipital lobe, and insula, as well as subcortical brain regions such as thalamus and striatum. The comparison results of weight DC signals of GMV and GMD abnormal clusters between the SD and NSD groups were basically consistent with the GMV and GMD abnormal clusters. CONCLUSION The results indicate that the structure and function of cortical-striatal-thalamic-cortical (CSTC) circuit centered on the thalamus were abnormal in MDD patients with somatic symptoms. This may be the neurobiological basis of somatic symptoms in MDD.
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Affiliation(s)
- Ning Sun
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China; Department of Mental Health, Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Min Liu
- Department of Psychosomatic, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi 710032, China
| | - Penghong Liu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Aixia Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Chunxia Yang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Zhifen Liu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China; Department of Mental Health, Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Jianying Li
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Gaizhi Li
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Yanfang Wang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Kerang Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China.
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