High Frequency Repetitive Transcranial Magnetic Stimulation As An Augmentative Treatment Strategy In Depressive Episode

Background : Depression is one of very common mental disorders. Patients with depression have confronted severe difficulties of life and work, and the burden of family and society is heavy. However, the treatment of depressive episode is not satisfactory, since remission rate is not high, poor treatment adherence and a delay treatment effect. High frequency repetitive transcranial magnetic stimulation( HF‐r TMS) is a noninvasive and safe neuromodulation therapy, and the antidepressant effect has been confirmed by many large‐scale randomized controlled studies. As yet, it is not clear how about the augmentative effect of high frequency repetitive transcranial magnetic stimulation in patients with depressive episode. We initiated an open label study to explore the antidepressant effect of HF‐r TMS as an augmentative strategy in depressive episode.Objective : This study is aimed at explore the augmentative antidepressant effect of HF‐r TMS for depressive episode.Methods : 42 patients were assessed by psychiatrists in Hangzhou Seventh People ’s Hospital with Mini‐International Neuropsychiatric Interview(MINI). All met ICD‐10criteria for depressive episode or recurrent depressive disorder.22 Patients accepted r TMS combined antidepressant therapy, 20 patients accepted only antidepressant.r TMS treatment is 100% stimulus intensity threshold(MT).The target of stimulation was the left dorsolateral prefrontal cortex(DLPFC) with "5cm" positioning method. The frequency of HF‐r TMS is 10 HZ. The parameter was 60 trains,5s on,25 s off, total 3000 pulses in one day. Patients accept 5 sessions in one week for 3 weeks, and total experienced 15 sessions. Hamilton Depression Scale(HAMD‐17)and Beck Depression Inventory(BDI) were used to assess the therapeutic effect. Side effects were measured with the Treatment Emergent Symptom Scale(TESS).All the statistical analyses were performed using SPSS 19.0 software for Windows.Results: After 3 weeks, all subjects’ depression scores decreased significantly,depression in TMS combined antidepressant group decreased 18.95( BDI, t=9.87,p<0.001)and 14.41(HAMD‐17, t=12.25, p<0.001); in antidepressant group15.30(BDI,t=6.17, p<0.001) and 10.75(HAMD‐17, t=7.09, p<0.001).The response rate in TMS combined group and antidepressants group is 77.3% vs 55.0%(p=0.126); and remission rate is 63.6% vs 45.0%(p=0.226).There is no significant difference between two groups. At 1st and 2nd week, the HAMD‐17 mean decreased scores of r TMS combined antidepressant group are significant higher than that of antidepressant group. At 2nd week, the remission rate of r TMS combined antidepressant group are significant higher than that of antidepressant group.Conclusions:High frequency repetitive transcranial magnetic stimulation as an augmentative strategy for the treatment of depressive episode can add the the antidepressant effect, and r TMS is well tolerated. It suggests that r TMS as an augmentative strategy can be used as a good choice in the treatment of depressive episode.