High-dose spaced theta-burst TMS as a rapid-acting antidepressant in highly refractory depression

作者：Nolan Williams, Keith Sudheimer, Brandon S. Bentzley, Jaspreet Pannu, Katy H. Stimpson, Dalton Duvio, Kirsten Cherian, Jessica Hawkins, Kristen Hymel Scherrer, Benjamin Vyssoki, Danielle D. DeSouza, Kristin S. Raj, Jennifer Keller, Alan F. Schatzberg · 发表于：Brain · 年份：2017 · DOI：10.1093/brain/awx379 · 被引用次数：223 · 研究领域：Transcranial Magnetic Stimulation Studies、Treatment of Major Depression、Neuroscience and Neuropharmacology Research

Sir, We read with enthusiasm the article by Li et al. (2014) that describes how a course of intermittent theta-burst stimulation (iTBS) over the left dorsolateral prefrontal cortex (L-DLPFC) produced robust antidepressant responses compared to sham stimulation in patients with treatment-refractory depression (Li et al., 2014). TBS, a patterned form of repetitive transcranial magnetic stimulation (rTMS) modelled after endogenous hippocampal discharge patterns (Larson and Lynch, 1986; Huang et al., 2005), has been shown to be more efficient than standard rTMS in modulating cortical excitability (Cárdenas-Morales et al., 2009). Preliminary results indicate non-inferiority of 600 pulses/day of iTBS versus 3000 pulses/day of conventional rTMS in treating depression (Blumberger et al., 2017). Li et al. found that iTBS in highly refractory depression led to a mean 33% reduction in the 17-item Hamilton Depression Rating Scale (HDRS17) (Li et al., 2014), and degree of refractoriness predicted reduced efficacy (Li et al., 2014). Higher refractoriness may require more rTMS pulses to produce an antidepressant response, which in turn would necessitate more rTMS sessions per acute course (Yip et al., 2017). Multiple spaced TBS sessions can be applied over a day with selected time intervals between sessions in an effort to accelerate the onset of effect, thereby also reducing the number of days required to complete an acute course (Cazzoli et al., 2012). To begin testing this hypothesis, we...