Effects Of RTMS Combined With Fluoxetine On Mood And Cognitive Function In First-episode Depressive Adolescents

Objective:The efficacy of repetitive transcranial magnetic stimulation(rTMS)in the treatment of adult depression and improvement of cognitive function have been confirmed by some studies.But relatively less studies were focused on adolescent depression.This study was designed to explore the efficacy of rTMS combined with Fluoxetine on the clinical symptoms and cognitive function in adolescents with depression.Methods:1.Forty untreated adolescent depression patients were recruited from the Department of Mental Health at the First Affiliated Hospital,Zhejiang University School of Medicine,from December 2015 to December 2017 were randomized into two groups.A total of 33 patients completed the study.Fluoxetine+active rTMS group(n=17)and fluoxetine+sham rTMS group(n=16).2.The Hamilton Depression Rating Scale(HAMD)and Children's Depression Rating Scale-Revised(CDRS-R)were used to assess the depressive symptoms of the subjects.Continuous performance Test(CPT),Stroop Word-Color Interference Test(SCWT),and MATRICS Consensus Cognitive Battery(MCCB)were used to assess the cognitive function of the subjects.3.Both groups received a fixed dose of 20 mg fluoxetine capsules per day.Active rTMS stimulation sequence:1 Hz,100%motor threshold,stimulation of the right dorsolateral prefrontal lobe.The treatment site,intensity,frequency,and frequency of the sham-group were the same as the true group,but the rTMS coil was perpendicular to the skull,and the magnetic field did not enter the skull.The patients were treated for 6 weeks,the depressive symptoms were assessed at baseline and then weekly,the cognitive function were assessed at baseline and after 6 weeks.The clinical symptoms and cognitive function of depressive adolescents were compared between the active rTMS group and the sham groupResults:1.The main effect of time point showed that with the prolongation of treatment time,the reduction of HAMD scores of the active stimulation group and the sham group increased continuously(F=30.771,P<0.001),suggesting that both groups have improvement in clinical symptoms with prolonged treatment time.There was no significant statistical interaction between treatment time and group(F=1.7584,P=0.1 56)The grouping effect showed that there was a significant difference between the active stimulation group and the sham group(F=12.457,P=0.001),and the HAMD scores at the third week,fourth week,fifth week and sixth week showed significant reduction in the active stimulation group than that in the sham group(P<0.05).2.The main effect of time point indicated that the reduction of CDRS-R scores of the active stimulation group and the sham group gradually increased with the prolongation of treatment time(F=21.511,P<0.001),suggesting that the clinical symptoms of the two groups relieved prolonged with the treatment time.There was no significant statistical effect between treatment time and group(F=3.330,P=0.381).The grouping effect showed significant difference between the active stimulation group and the sham group(F=5.342,P=0.028).At the fourth week,fifth week and sixth week,the reduction of CDRS-R in the stimuli group was more significant than that in the sham-group(P<0.05).3.In the CPT test,SCWT test and MCCB test,there was no significant difference between the two groups before and after treatment(P>0.05).Conclusions:This study suggests that low-frequency rTMS stimulation on the right dorsolateral prefrontal combined with fluoxetine in the treatment of adolescent depression could enhance the early efficacy of fluoxetine,is relatively safe,while has no significant improvement in cognitive function.