Efficacy And Safety Of Electroacupuncture Combined With LF-rTMS In The Treatment Of Treatment Resisdant Depression

ObjectiveThe lifetime prevalence rate of major depressive disorder(MDD)is 3.4%,which is a mental illness that seriously affects the social function and quality of life of patients.However,30% of patients with depressive disorder fail to respond to adequate drug treatment and turn into treatment resistant depression(TRD).At present,there is no optimal treatment plan still.This study was aimed to observe the effects of low-frequency rTMS combined with electroacupuncture on depressive symptoms,anxiety,suicidal ideation,and cognitive function in the treatment of TRD,analyze the mechanism of electroacupuncture and low-frequency rTMS on treatment resistant depression,and evaluate whether electroacupuncture has a synergic effect.MethodTwenty-eight subjects who met the diagnosis of treatment resisdant depression were divided into two groups,randomly.The observation group received electroacupuncture combined with low-frequency rTMS,which selected the right dorsolateral prefrontal lobe(R-DLPFC)at a frequency of 1Hz and 90% motor threshold(MT).This treatment lasted for 30 minuties,5 times per week for 2 weeks.After that,acupuncture points such as Baihui,Yintang,Shenting and Sishencong were selected and stimulated with 1Hz continuous wave.And the needles were retained for30 minuties each time.The control group received low frequency rTMS treatment,and the treatment regimen was the same as the observation group.Hamilton Depression Scale(HAMD-17)and Hamilton Anxiety Scale(HAMA)were used to evaluate depression and anxiety after every two interventions.Beck Suicide ideation Scale(BSI)was used to evaluate suicidal ideation at the begining and after the treatment.The reduction rate of HAMD-17 ≥50% was defined as response,and the end point score ≤7 was defined as remission.The main outcome was HAMD-17 score,and the secondary outcome was anxiety score and suicidal ideation reduction score in TRD patients.Before and after treatment,the MATRICE Consensus cognitive test(MCCB)was used to evaluate the cognitive changes of information processing speed,working memory,language learning,visual-spatial learning.And the adverse affairs of patients should be recorded truthfullyduring the treatment.Results(1)There are 28 patients with TRD enrolled in this study,among which 16 patients received electroacupuncture combined with low-frequency repetitive transcranial magnetic stimulation,with a response rate of 56.3% and a remission rate of 37.5%;12 patients received low-frequency repetitive transcranial magnetic stimulation,with a response rate of 75% and a remission rate of 33.33%.(2)After treatment,HAMD-17,HAMA and BSI scores of the two groups were significantly decreased compared with before treatment,p<0.001.In the mixed model,no interaction effect was shown at each evaluation time point before and after treatment,and the difference was not significant(p>0.05).(3)Before and after treatment,the cognitive function scores of the two groups increased,no cognitive impairment was observed,and there was no statistical significance in MCCB scores(p>0.05).(4)The most common adverse reactions in the two groups were headache,dizziness,fatigue,and no serious adverse reactions were reported.Conclusion(1)Electroacupuncture combined with low-frequency rTMS and low-frequency rTMS can significantly improve depression and anxiety and reduce suicidal ideation in TRD patients.(2)Both treatments could improve the cognitive function of patients with refractory depressive disorder,but there was no significant difference in improvement.No serious adverse reactions were observed in the two groups during treatment,and the safety was comparable.(3)Electro-acupuncture combined with low-frequency rTMS has a higher remission rate after treatment,which is more advantageous to improve the clinical outcome of patients with TRD,and can be used as a treatment plan for refractory depressive disorder.Electroacupuncture has not been found to have a synergistic effect on rTMS treatment.In the future,the sample size can be expanded to further clarify the efficacy of electroacupuncture combined with rTMS,and explore its related mechanism.