OBJECTIVE Although repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for depression, little is known about the comparative effectiveness of rTMS and other treatment options, such as antidepressants. In this multicenter randomized controlled trial, rTMS was compared with the next pharmacological treatment step in patients with treatment-resistant depression. METHODS Patients with unipolar nonpsychotic depression (N=89) with an inadequate response to at least two treatment trials were randomized to treatment with rTMS or to a switch of antidepressants, both in combination with psychotherapy. Treatment duration was 8 weeks and consisted of either 25 high-frequency rTMS sessions to the left dorsolateral prefrontal cortex or a switch of antidepressant medication following the Dutch treatment algorithm. The primary outcome was change in depression severity based on the Hamilton Depression Rating Scale (HAM-D). Secondary outcomes were response and remission rates as well as change in symptom dimensions (anhedonia, anxiety, sleep, rumination, and cognitive reactivity). Finally, expectations regarding treatment were assessed. RESULTS rTMS resulted in a significantly larger reduction in depressive symptoms than medication, which was also reflected in higher response (37.5% vs. 14.6%) and remission (27.1% vs. 4.9%) rates. A larger decrease in symptoms of anxiety and anhedonia was observed after rTMS compared with a switch in antidepressants, and no difference from the medication group was seen for symptom reductions in rumination, cognitive reactivity, and sleep disorders. Expectations regarding treatment correlated with changes in HAM-D scores. CONCLUSIONS In a sample of patients with moderately treatment-resistant depression, rTMS was more effective in reducing depressive symptoms than a switch of antidepressant medication. In addition, the findings suggest that the choice of treatment may be guided by specific symptom dimensions.

中文翻译：

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rTMS 作为抗抑郁治疗无反应者的下一步：与当前抗抑郁治疗方法的随机比较。


目的 虽然重复经颅磁刺激 (rTMS) 是治疗抑郁症的有效方法，但人们对 rTMS 与其他治疗方案（例如抗抑郁药）的比较效果知之甚少。在这项多中心随机对照试验中，rTMS 与难治性抑郁症患者的下一步药物治疗步骤进行了比较。方法 对至少两项治疗试验反应不佳的单相非精神病性抑郁症患者 (N=89) 被随机分配接受 rTMS 治疗或换用抗抑郁药，两者均与心理治疗相结合。治疗持续时间为 8 周，包括对左背外侧前额皮质进行 25 次高频 rTMS 治疗，或者按照荷兰治疗算法更换抗抑郁药物。主要结局是基于汉密尔顿抑郁评定量表（HAM-D）的抑郁严重程度的变化。次要结果是缓解率和缓解率以及症状维度的变化（快感缺失、焦虑、睡眠、沉思和认知反应性）。最后，评估了对治疗的期望。结果 与药物治疗相比，rTMS 能显着更大程度地减少抑郁症状，这也反映在更高的缓解率（37.5% vs. 14.6%）和缓解率（27.1% vs. 4.9%）上。与换用抗抑郁药物相比，rTMS 治疗后焦虑和快感缺乏症状的减轻幅度更大，并且在沉思、认知反应和睡眠障碍的症状减轻方面与药物组没有差异。对治疗的期望与 HAM-D 评分的变化相关。 结论 在中度难治性抑郁症患者样本中，rTMS 在减轻抑郁症状方面比更换抗抑郁药物更有效。此外，研究结果表明，治疗的选择可能会受到特定症状维度的指导。