| Treatment of depression is main in drug, but because of sideeffects in patients, treatment compliance is not high. Theatmeat ofdepression depends on drugs most, whose compliance is not good, forthe drugs’ side effect. Repetitive transcranial magnetic stimulation,as a new and powerful tool used in researches on the relationshipbetween humen’s brain and beharior, which could supply non-invasivestimulations on the patient with conscions. After a large number ofclinical trials, it was proved that a few weeks rTMS has alleviatedthe symptoms of depression. It was proved by a large number of clinicaltrials, that a few weeks treatment of rTMS could alleviate symptionof depression. And that’s why the U.S. Food and Drug Administrationhad already approved it applied to treat patients suffered a lot fromthe treament-resistent depression. Whether it has a therapeuticeffect in the white matter and the the specific mechanism remainsunclear or not. In this randomized double-blind controlled study, weapplicate DTI to patient with depression before and after rTMS, inorder to verify that recovery of white matter integrity through rTMSand rTMS can play a therapeutic role of depression.Object：1、From the two dimensions of the clinical symptoms and neural imagingwe want to observate clinical curative effect of repeat transcranialmagnetic stimulation (rTMS).2、watching clinical curative effect of high frequency repetitive transcranial magnetic stimulation (rTMS)with venlafaxine compared with treatment only use venlafaxine, andthe safety of the differences, and using diffusion tensor imaging(DTI),we could find the white matter between abnormalities’ andhealthy volunteers’ has changed. We also find white matter has changeafter rTMS. To further explore repeat transcranial magneticstimulation (rTMS) treatment mechanism.Methods:We selected the patients with major depression disorder, diagnosedin Xi Jing hospital. Patients were randomly divided into two groups:1. study group, patients took venlafaxine (75mg/day-225mg/day), whilereceived rTMS (5times per week) at the same time.2.control group,patients only took venlafaxine (75mg/day-225mg/day). The stimulationsite of rTMS is DLPFC. Stimulating frequency is15Hz, strength110%MT,3000times per treatment,5times per week, and a total coursewas6weeks. The clinical symptoms observed indicators:(1) HAMD,patients were assessed at2,4,6weeks quantifing the degree ofdepression.⑵HAMA, were assessed at2,4,6weeks to quantifing thedegree of anxiety.⑶TESS, side effects on medicatiare respectivelydescribed. In addition, cooperation from the doctors in MRI room,depressed patients accpted magnetic resonance DTI scans before andafter treatment.We also recruited healthy volunteers to participate in the collectionof magnetic resonance DTI data,who matching with the patient’s.Results:1Clinical symptoms of indicators Rate of the HAMD in2and4weeks of treatment: The patients in studygroup’s scores lower than those in control group, and statisticallysignificant (p <0.05), receiving rTMS with venlafaxine together. Thepatients’ clinical symptoms are much more better than the other grouponly took pills.Rate of the HAMD in the6weeks of treatment: the scores of patientsin the study group were still lower than those in the control group,but not statistically significant (p>0.05), the clinical efficacybetween two groups are basically the same in6weeks.HAMA score and HAMD score was basically the same.TESS: the patients in study group and control group, nausea, vomitingand other side effects (such as dry mouth, constipation, lethargy),was statistically significant (p <0.05). RTMS treatment alleviatedthe nause and vomiting in patients caused by venlafaxine.2neuroimaging indicatorsCompared depressed patients and healthy volunteers: patients withright frontal and right temporal lobe, right posterior cingulate, leftfrontal lobe, corpus callosum, fractional anisotropy (FA) valuesdecrease, indicating that depressed patients had white matter damageand white matter damage in the right frontal lobe.Depressed patients before and after treatment: the probe to stimulateparts of rTMS treatment in patients, that left frontal fractionalanisotropy (FA) value recovery was statistically significant (p<0.05). I brain regions of the opposite sex fraction (FA) values toreduce the tendency, but without statistical significance (p>0.05).Both rTMS promote the recovery of white matter integrity. Conclusion:1. Comparing with single venlafaxine, the rTMS with venlafaxine couldaccelerate the recovery in patients of the depressive symptoms, andalleviated the side effects of venlafaxine, induced nausea andvomiting.2. Between first-episode depression patients and healthy volunteers,the study found that white matter damage in patients was more oftenin the right hemisphere, such as right frontal lobe, right temporallobe, the right posterior cingulate. This may be related to thepathogenesis of depression and right-brain function overload.3. Patients with first-episode depression after rTMS treatment,compared with before treatment, the probe directly stimulate the partsof DLPFC where white matter nerve fiber integrity recovery, which maybe related to the rTMS treatment mechanism. |
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