Clinical Effects Evaluation Of RTMS On The Cognitive Function And P300 Event-related Potentials In The Treatment Of Treatment-resistant Depression

Objective:This study was designed to apply repeat transcranial magnetic stimulation(rTMS)combined with anti-depression drugs to treat treatment-resistant depression(TRD) and use ERP to study the visual-P300 of TRD patients and evaluate the clinical effects of rTMS combined with anti-depression drugs, which may help us understand the neurophysiological mechanisms of rTMS in the treatment of TRD and determine the characteristic of cognitive function damage to provide an objective basis for the treatment and prognosis evaluation of TRD.Methods:16 TRD patients that treated by rTMS,SSRIs drugs or venlafaxine were set as rTMS group(rTMS group), select the gender, age, handedness, cultural level that matched rTMS group and simply taking SSRIs or venlafaxine 18 cases as drug group and 17 cases of healthy subjects as controls. All the subjects were conducted of visual oddball paradigm practices to evaluate visual-P300 before treatment(W0) and at six weeks after treatment(W6). The rTMS group and drug groups were tested the Hamilton Depression Rating Scale(HAMD) and the Hamilton Anxiety Scale(HAMA) to investigate the improvement of psychiatric symptoms in TRD patients,using the Wisconsin Card Sorting Test(WCST) to investigate the executive function in TRD patients at the same time.Results:1. Before treatment there was no significant different of visual-P300 indexes between rTMS group and drug group(P>0.05). The amplitude were significantly lower and the incubation period were significantly longer than those in controlgroup(P<0.01). After treatment, the amplitude in both groups were increased and incubation period were shorten, but rTMS group was better than drug group(P<0.05).2. Before treatment there was no significant difference of HAMD and HAMA between rTMS group and drug group(P>0.05). After treatment, the HAMD and HAMA score were significantly improved in both group and rTMS group was significantly better than those in drug group(P<0.05).3. Before treatment there was no significant difference of WCST indexes between rTMS group and drug group(P>0.05). After treatment, the WCST indexes were significantly improved in both group and rTMS group was significantly better than those in drug group(P<0.05).Conclusion:1. The TRD patients have a characteristic of amplitude decreased and latency increased in visual-P300, indicating the presence of cognitive impairment in patients with TRD; however, after treatment the amplitude and latencies of P300 were improved, suggesting that P300 amplitude and latencies are state identification of TRD.2. rTMS can improve the cognitive function of TRD.3. rTMS has the role of adjuvant therapy of TRD.