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Norred MA, Zuschlag ZD, Madore MR, Philip NS, Kozel FA. Sleep as a predictor of improved response to transcranial magnetic stimulation for depression (SPIRiTeD). J Affect Disord 2024; 362:9-13. [PMID: 38944289 DOI: 10.1016/j.jad.2024.06.077] [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: 02/27/2024] [Revised: 06/05/2024] [Accepted: 06/22/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) is an evidence-based approach to treatment- resistant Major Depressive Disorder (TRD). Sleep dysfunction is associated with poor outcomes in TRD, however, the impacts of sleep dysfunction on TMS treatment has yet to be defined. This study examined the association between sleep dysfunction and improvement in depression symptoms with TMS treatment for TRD. METHODS A retrospective observational cohort study was conducted examining all Veterans receiving TMS treatments through the "VA TMS Clinical Pilot Program" over a three-year period. The Patient Health Questionnaire (PHQ-9) sleep item was utilized to assess sleep dysfunction. The association between sleep dysfunction improvements during TMS treatment with depression outcomes was analyzed. RESULTS 94.3 % (N = 778) of Veterans reported baseline sleep dysfunction. Chi-square analysis demonstrated higher rates of depression remission at the completion of TMS treatment for those with sleep improvement at weeks 1, 3 and 6 (all p < .001). ANOVA comparing sleep improvements and end of treatment PHQ-8 score (modified to remove sleep item) found a statistically significant difference in mean improvements of depression scores at all 3 time points. LIMITATIONS Limitations include those that are inherent to retrospective studies, as well as limitations in using the PHQ-9 sleep item as the primary means to assess sleep dysfunction. CONCLUSION This study reports on the largest sample size to date examining the relationship between sleep dysfunction and TMS treatment outcomes for MDD, and found that improvement in sleep dysfunction was associated with greater reductions in end of treatment depression symptoms including higher depression remission rates.
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Affiliation(s)
- Michael A Norred
- James A. Haley Veterans Hospital, Mental Health and Behavioral Sciences Service, Tampa, FL, United States; University of South Florida, Department of Psychiatry and Behavioral Neurosciences, Tampa, FL, United States.
| | - Zachary D Zuschlag
- James A. Haley Veterans Hospital, Mental Health and Behavioral Sciences Service, Tampa, FL, United States; University of South Florida, Department of Psychiatry and Behavioral Neurosciences, Tampa, FL, United States
| | - Michelle R Madore
- VA Palo Alto Health Care System, Mental Illness Research Education and Clinical Center, Palo Alto, CA, United States; Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Stanford, CA, United States
| | - Noah S Philip
- Veterans Affairs Providence Health Care System, Center for Neurorestoration and Neurotechnology, Providence, RI, United States; Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, United States
| | - F Andrew Kozel
- Florida State University, College of Medicine, Department of Behavioral Sciences and Social Medicine, Tallahassee, FL, United States
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Dong L, Bogart LM, Mutchler MG, Klein DJ, Ghosh-Dastidar MB, Lawrence SJ, Goggin K, Wagner GJ. Sleep Disturbance Mediates the Associations Between HIV Stigma and Mental and Physical Health Among Black Adults with HIV. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02083-0. [PMID: 38990469 DOI: 10.1007/s40615-024-02083-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 06/28/2024] [Accepted: 06/30/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVES Black Americans have been disproportionally affected by the HIV epidemic, and experience significant disparities in sleep health, mental health, and physical health domains. Using longitudinal data from a sample of Black adults with HIV, the current study examined the associations between stigma and mental and physical health outcomes and how sleep disturbance may play a mediating role. METHODS Data were drawn from a recent randomized controlled trial. Questionnaires were used to examine internalized and anticipated HIV stigma, perceived discrimination (enacted stigma) based on multiple social identities (i.e., HIV-serostatus, race, sexual orientation), sleep disturbance, mental health problems (depressive and posttraumatic stress disorder [PTSD] symptoms), and mental and physical health-related quality of life (HRQOL) at baseline, 7-month follow-up, and 13-month follow-up assessments. Linear mixed modeling was used to examine main effects of stigma on health outcomes; causal mediation analysis was used to estimate indirect paths through sleep disturbance. RESULTS Internalized and anticipated HIV stigma and multiple discrimination were associated with more sleep disturbance, more depressive and PTSD symptoms, and poorer mental and physical HRQOL. Results also indicated significant indirect paths (i.e., mediation) through greater sleep disturbance between HIV-related stigma and discrimination and mental health and health-related quality of life. CONCLUSIONS Results support that sleep disturbance is a mediating pathway through which different forms of stigmas impact health outcomes. Sleep may be an intervention target to help improve mental and physical well-being and reduce health disparities among racial and ethnic minority people with HIV.
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Affiliation(s)
- Lu Dong
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA.
| | - Laura M Bogart
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA
- Department of Psychiatry, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Matt G Mutchler
- APLA Health, Los Angeles, CA, USA
- School of Public Health and Health Sciences, California State University, Dominguez Hills, Carson, CA, USA
| | - David J Klein
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA
| | | | | | - Kathy Goggin
- Children's Mercy Kansas City and University of Missouri-Kansas City Schools of Medicine and Pharmacy, Kansas City, MO, USA
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Glenn J Wagner
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA
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Sadeghniiat K, Zebardast J, Parsaei M, Seyedmirzaei H, Arbabi M, Noorbala AA, Ansari S. Effects of routine repetitive transcranial magnetic stimulation on the sleep duration of patients with treatment-resistant depression: A prospective cohort study. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2024; 3:e187. [PMID: 38868089 PMCID: PMC11114370 DOI: 10.1002/pcn5.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/25/2024] [Accepted: 02/29/2024] [Indexed: 06/14/2024]
Abstract
Aim The aim of this study was to evaluate the short-term and long-term effects of routine repetitive transcranial magnetic stimulation (rTMS) on the sleep duration, depressive symptoms, and quality of life of patients with treatment-resistant depression (TRD). Methods In this prospective cohort study, 25 participants with TRD were assessed using the Insomnia Severity Index (ISI) and four sleep duration components of the Pittsburgh Sleep Quality Index (PSQI). Depression severity was measured with Hamilton's Depression Rating Scale (HDRS) and Beck's Depression Inventory (BDI-II), and patient-perceived quality of life with the 36-Item Short-Form Survey (SF-36). All of these measures were evaluated at baseline (T0), and immediately (T1), 6 weeks (T2), and 12 weeks (T3) after the end of intervention. Results At T1 endpoint, HDRS, BDI, SF-36, ISI, and three PSQI items (time to wake up, time taken to fall asleep, and Real Sleep Time) significantly improved, though these gains were reduced at follow-up endpoints (T2 and T3). Adjusting for confounders (age, sex, occupational status, BMI, and hypnotic medication) revealed that only improvements in HDRS, BDI, and time taken to fall asleep at T1 remained statistically significant. Linear regression analyses showed no significant association between reduced time taken to fall asleep and depression symptoms, suggesting rTMS can independently enhance this parameter, irrespective of depression resolution. Conclusion Routine rTMS therapy can potentially enhance sleep duration in TRD individuals, alongside improved depressive symptoms and quality of life. However, these benefits tend to decrease over long-term follow-up, emphasizing a more pronounced short-term efficacy of rTMS.
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Affiliation(s)
- Khosro Sadeghniiat
- Psychosomatic Medicine Research CenterTehran University of Medical ScienceTehranIran
| | - Jayran Zebardast
- Departments of Cognitive LinguisticsInstitute for Cognitive Science Studies (ICSS)TehranIran
| | - Mohammadamin Parsaei
- Maternal, Fetal, and Neonatal Research Center, Family Health Research Institute, Vali‐E‐Asr HospitalTehran University of Medical SciencesTehranIran
| | - Homa Seyedmirzaei
- Maternal, Fetal, and Neonatal Research Center, Family Health Research Institute, Vali‐E‐Asr HospitalTehran University of Medical SciencesTehranIran
- Sports Medicine Research Center, Neuroscience InstituteTehran University of Medical SciencesTehranIran
| | - Mohammad Arbabi
- Psychosomatic Medicine Research CenterTehran University of Medical ScienceTehranIran
| | - Ahmad Ali Noorbala
- Psychosomatic Medicine Research CenterTehran University of Medical ScienceTehranIran
| | - Sahar Ansari
- Psychosomatic Medicine Research CenterTehran University of Medical ScienceTehranIran
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Chopra A, Singal P, Kodya S. Impact of deep transcranial magnetic stimulation on insomnia outcomes in patients with treatment-resistant depression: a retrospective study. J Clin Sleep Med 2024; 20:813-815. [PMID: 38152858 PMCID: PMC11063691 DOI: 10.5664/jcsm.10954] [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] [Received: 08/14/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/29/2023]
Abstract
Deep transcranial magnetic stimulation (dTMS) is an Food and Drug Administration-approved treatment for treatment-resistant depression (TRD). Our study aims to examine the impact of baseline insomnia severity on mood outcomes of dTMS and the impact of dTMS on comorbid insomnia in patients with treatment-resistant depression using a retrospective analysis. Twenty-five patients with treatment-resistant depression who underwent dTMS were divided into two groups: "low insomnia" and "high insomnia," depending on Insomnia Severity Index scores at baseline. Significant improvements in depression and anxiety from baseline to final dTMS session were noted in both groups. Baseline insomnia severity was not associated with poorer treatment outcomes after dTMS. Final insomnia scores of the two groups were not significantly different, suggesting dTMS alleviated insomnia symptoms in patients with treatment-resistant depression. Further research incorporating a prospective study design in a multicenter setting is warranted to replicate these findings and elucidate the mechanistic action of dTMS on insomnia outcomes. CITATION Chopra A, Singal P, Kodya S. Impact of deep transcranial magnetic stimulation on insomnia outcomes in patients with treatment-resistant depression: a retrospective study. J Clin Sleep Med. 2024;20(5):813-815.
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Affiliation(s)
- Amit Chopra
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Prakamya Singal
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Suzanne Kodya
- Psychiatry & Behavioral Health Institute, Allegheny Health Network, Pittsburgh, Pennsylvania
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Kaster TS, Downar J, Vila-Rodriguez F, Baribeau DA, Thorpe KE, Daskalakis ZJ, Blumberger DM. Differential symptom cluster responses to repetitive transcranial magnetic stimulation treatment in depression. EClinicalMedicine 2023; 55:101765. [PMID: 36483268 PMCID: PMC9722479 DOI: 10.1016/j.eclinm.2022.101765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/16/2022] [Accepted: 11/16/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) can target specific neural circuits, which may allow for personalized treatment of depression. Treatment outcome is typically determined using sum scores from validated measurement scales; however, this may obscure differential improvements within distinct symptom domains. The objectives for this work were to determine: (1) whether a standard depression measure can be represented using a four symptom cluster model and (2) whether these symptom clusters had a differential response to rTMS treatment. METHODS Data were obtained from two multi-centre randomized controlled trials of rTMS delivered to the left dorsolateral prefrontal cortex (DLPFC) for participants with treatment-resistant depression (TRD) conducted in Canada (THREE-D [Conducted between Sept 2013, and Oct 2016] and CARTBIND [Conducted between Apr 2016 and Feb 2018]). The first objective used confirmatory factor analytic techniques, and the second objective used a linear mixed effects model. Trial Registration: NCT01887782, NCT02729792. FINDINGS In the total sample of 596 participants with TRD, we found a model consisting of four symptom clusters adequately fit the data. The primary analysis using the THREE-D treatment trial found that symptom clusters demonstrated a differential response to rTMS treatment (F(3,5984) = 31.92, p < 0.001). The anxiety symptom cluster was significantly less responsive to treatment than other symptom clusters (t(6001) = -8.02, p < 0.001). These findings were replicated using data from the CARTBIND trial. INTERPRETATION There are distinct symptom clusters experienced by individuals with TRD that have a differential response to rTMS. Future work will determine whether differing rTMS treatment targets have distinct patterns of symptom cluster responses with the eventual goal of personalizing rTMS protocols based on an individual's clinical presentation. FUNDING Canadian Institutes of Health Research, Brain Canada.
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Key Words
- CFA, Confirmatory factor analysis
- CFI, Comparative fit index
- Cluster analysis
- DLPFC, Dorsolateral prefrontal cortex
- Depressive disorders
- HDRS-17, 17-item Hamilton Depression Rating Scale
- HFL, High-frequency left stimulation
- MDD, Major depressive disorder
- MINI, Mini International Neuropsychiatric Interview
- RMSEA, Root mean square error of approximation
- Repetitive transcranial magnetic stimulation
- SRMR, Standardized root mean squared residual
- TRD, Treatment-resistant depression
- Treatment outcomes
- iTBS, Intermittent theta-burst stimulation
- rTMS, Repetitive transcranial magnetic stimulation
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Affiliation(s)
- Tyler S. Kaster
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Corresponding author. 1025 Queen St. W., Toronto, ON, M6J 1H4, Canada.
| | - Jonathan Downar
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Fidel Vila-Rodriguez
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, University of British Columbia, Vancouver, BC, Canada
| | - Danielle A. Baribeau
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, Toronto, ON, Canada
| | - Kevin E. Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Zafiris J. Daskalakis
- Department of Psychiatry, University of California, San Diego Health, CA, United States
| | - Daniel M. Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
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Zhou Q, Liu Z, Zhao S, Yu J, Zhou D, Xu W, Zhang Y. Transcranial magnetic stimulation combined with transcranial direct current stimulation in patients with chronic insomnia: a case report. J Clin Sleep Med 2022; 18:2871-2874. [PMID: 36453603 PMCID: PMC9713920 DOI: 10.5664/jcsm.10272] [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] [Received: 05/16/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 12/14/2022]
Abstract
Long-term insomnia affects the normal life and work of individuals and increases the risk of various health problems, including mental illness. Therefore, there is an urgent need for an efficient and safe treatment for improving sleep. In this study, we report the case a 52-year-old woman who received repetitive transcranial magnetic stimulation (rTMS) combined with transcranial direct current stimulation (tDCS) after agreeing to publish her case. In order to evaluate the quality of sleep and the stability of emotional symptoms, clinical evaluations were conducted at baseline, after 10 treatment sessions, after 20 treatment sessions, and 1 month after the end of treatment. After completing rTMS combined with tDCS, the patient showed an overall clinical improvement, with clinical changes mainly observed in the Pittsburgh Sleep Quality Index, Hamilton Depression Scale, Hamilton Anxiety Scale scores and polysomnography, and this improvement was maintained 1 month after the intervention. This case provides the first evidence for the feasibility, tolerability, and safety of combined rTMS and tDCS in a patient with chronic insomnia. CLINICAL TRIAL REGISTRATION Registry: Chinese Clinical Trial Registry; Name: Clinical study of repetitive transcranial magnetic stimulation combined with transcranial direct current stimulation in the treatment of chronic insomnia; URL: http://www.chictr.org.cn/edit.aspx?pid=57440&htm=4; Identifier: ChiCTR ChiCTR2100052681. CITATION Zhou Q, Liu Z, Zhao S, et al. Transcranial magnetic stimulation combined with transcranial direct current stimulation in patients with chronic insomnia: a case report. J Clin Sleep Med. 2022;18(12):2871-2873.
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Affiliation(s)
- Qi Zhou
- Department of Psychiatry, Ningbo Kangning Hospital, Affiliated Mental Health Center of Ningbo University, Ningbo, Zhejiang, China
| | - Zhiwang Liu
- Department of Psychiatry, Ningbo Kangning Hospital, Affiliated Mental Health Center of Ningbo University, Ningbo, Zhejiang, China
| | - Shengnan Zhao
- Department of Psychiatry, Ningbo Kangning Hospital, Affiliated Mental Health Center of Ningbo University, Ningbo, Zhejiang, China
| | - Jia Yu
- Department of Psychiatry, Ningbo Kangning Hospital, Affiliated Mental Health Center of Ningbo University, Ningbo, Zhejiang, China
| | - Dongsheng Zhou
- Department of Psychiatry, Ningbo Kangning Hospital, Affiliated Mental Health Center of Ningbo University, Ningbo, Zhejiang, China
| | - Weiqian Xu
- Taizhou Second People's Hospital, Taizhou, Zhejiang, China
| | - Yuanyuan Zhang
- Department of Psychiatry, Ningbo Kangning Hospital, Affiliated Mental Health Center of Ningbo University, Ningbo, Zhejiang, China
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Mbous YPV, Nili M, Mohamed R, Dwibedi N. Psychosocial Correlates of Insomnia Among College Students. Prev Chronic Dis 2022; 19:E60. [PMID: 36108290 PMCID: PMC9480843 DOI: 10.5888/pcd19.220060] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Methods Results Conclusion
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Affiliation(s)
- Yves Paul Vincent Mbous
- School of Pharmacy, Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, West Virginia
| | - Mona Nili
- School of Pharmacy, Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, West Virginia
| | - Rowida Mohamed
- School of Pharmacy, Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, West Virginia
| | - Nilanjana Dwibedi
- School of Pharmacy, Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, West Virginia
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Chen X, Jiang F, Yang Q, Zhang P, Zhu H, Liu C, Zhang T, Li W, Xu J, Shen H. Bilateral repetitive transcranial magnetic stimulation ameliorated sleep disorder and hypothalamic-pituitary-adrenal axis dysfunction in subjects with major depression. Front Psychiatry 2022; 13:951595. [PMID: 36090377 PMCID: PMC9452697 DOI: 10.3389/fpsyt.2022.951595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/04/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE In this study, we sought to explore the effectiveness of bilateral repetitive transcranial magnetic stimulation (rTMS) over the dorsolateral prefrontal cortex (DLPFC) on depressive symptoms and dysfunction of hypothalamic-pituitary-adrenal (HPA) axis in patients with major depressive disorder (MDD). MATERIALS AND METHODS One hundred and thirty-six adults with MDD were administrated drugs combined with 3 weeks of active rTMS (n = 68) or sham (n = 68) treatment. The 17-item Hamilton Depression Rating Scale for Depression (HAMD-17) was to elevate depression severity at baseline and weeks 4. To test the influence of rTMS on the HPA axis, plasma adrenocorticotropic hormone (ACTH) and serum cortisol (COR) were detected in pre- and post-treatment. RESULTS No statistical significance was found for the baseline of sociodemographic, characteristics of depression, and psychopharmaceutical dosages between sham and rTMS groups (p > 0.05). There was a significant difference in the HAMD-17 total score between the two groups at end of 4 weeks after treatment (p < 0.05). Compared to the sham group, the rTMS group demonstrated a more significant score reduction of HAMD-17 and sleep disorder factor (HAMD-SLD) including sleep onset latency, middle awakening, and early awakening items at end of 4-week after treatment (p < 0.05). Furthermore, total score reduction of HAMD-17 was correlated with a decrease in plasma ACTH, not in COR, by rTMS stimulation (p < 0.05). CONCLUSION Bilateral rTMS for 3 weeks palliated depression via improvement of sleep disorder, and plasma ACTH is a predictor for the efficacy of rTMS, especially in male patients with MDD.
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Affiliation(s)
- Xing Chen
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Fei Jiang
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Qun Yang
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Peiyun Zhang
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Haijiao Zhu
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Chao Liu
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Tongtong Zhang
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Weijun Li
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Jian Xu
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China
| | - Hongmei Shen
- Laboratory of Biological Psychiatry, Nantong Mental Health Center & Nantong Brain Hospital, Nantong, China.,Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong, China
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