DEPRESİF BOZUKLUKTA TEKRARLAYAN TRANSKRANİYAL MANYETİK STİMÜLASYON (RTMS) TEDAVİSİNE YANIT OLARAK KLİNİK REMİSYON İÇİN PREDİKTİF FAKTÖRLERİN ARAŞTIRILMASI

Abstract

Amaç Depresif bozukluk nedeniyle Tekrarlayan Transkraniyal Manyetik Stimülasyon (rTMS) tedavisi alan hastaların sosyo-demografik ve klinik verilerinin incelenmesi ve bu verilerin rTMS tedavisine verilen remisyon yanıtı ile ilişkisinin değerlendirilmesi amaçlandı. Gereç ve Yöntem 120 hastanın tıbbi kayıtları retrospektif olarak değerlendirildi. Hamilton Depresyon Ölçeği (HAM-D), Beck Anksiyete Ölçeği (BAÖ), Richard-Campbell Uyku Ölçeği (RCUÖ) puanları analiz edildi. Bulgular Hastaların %60'ı (72/120) kadındı ve yaş ortalaması 42.80±12.80 idi. HAM-D skorlarına göre (7 ve altı) hastaların %41,4'ü (46/111) tedavi sonunda remisyondaydı. Ayrıca tedavi öncesi ve tedavi sonrası ölçek puanları değerlendirildiğinde, tedavi sonrası HAM-D puanları ve BAÖ puanları anlamlı olarak azalırken (sırasıyla; p<0.001, p<0.001), tedavi sonrası RCUÖ puanları anlamlı olarak arttı (p<0.001). rTMS tedavisi ile remisyon yanıtını yordayan faktörleri araştırmak üzere ikili regresyon analizi yapıldı. Tedavi başlangıcında HAM-D skorunun yüksek olması remisyon ile negatif prediktif ilişki gösterirken (p<0.001), tedavinin ikinci haftasında HAM-D skorlarında azalma remisyon ile pozitif prediktif ilişki gösterdi (p=0.009). Sonuç rTMS tedavisinin depresyon ve anksiyete belirtilerini azalttığını ve uyku kalitesini iyileştirdiğini söyleyebiliriz. Ayrıca rTMS tedavisi öncesi şiddetli depresyonun remisyona girme olasılığını azalttığı, tedavinin ikinci haftasında görülen depresyon şiddetindeki azalmanın ise bu olasılığı artırdığı söylenebilir.

Keywords

• Depresyon
• Tekrarlayan transkraniyal manyetik stimülasyon
• rTMS
• Prediktif faktörler
• Remisyon

INVESTIGATION OF PREDICTIVE FACTORS FOR CLINICAL REMISSION IN RESPONSE TO REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (RTMS) TREATMENT IN DEPRESSIVE DISORDER

Abstract

Objective It was aimed to examine the socio-demographic and clinical data of patients treated with Repetitive Transcranial Magnetic Stimulation (rTMS) for depressive disorder and to evaluate the relationship of these data with remission response to rTMS treatment. Material and Method: The medical records of 120 patients were evaluated retrospectively. Hamilton Depression Scale (HAM-D), Beck Anxiety Scale (BAI), and Richard-Campbell Sleep Scale (RCSQ) scores were analyzed. Results 60% (72/120) of the patients were women and the mean age was 42.80±12.80 years. According to the HAM-D scores (7 and below), 41.4% (46/111) of the patients were in remission at the end of the treatment. In addition, when the pre-treatment and post-treatment scale scores were evaluated, HAM-D scores and BAI scores decreased significantly after treatment (respectively; p<0.001, p<0.001), while RCSQ scores increased significantly after treatment (p<0.001). Binary regression analysis was performed to investigate the predictive factors for remission of depressive symptoms after rTMS treatment. A high HAM-D score at the beginning of the treatment showed a negative predictive relationship with remission (p<0.001), while a decrease in HAM-D scores at the second week of treatment showed a positive predictive relationship with remission (p=0.009). Conclusion We may suggest that rTMS treatment reduces depression and anxiety symptoms and improves sleep quality. In addition, it can be said that the severe depression before the rTMS treatment reduces the likelihood of going into remission, whereas the decrease in the severity of depression observed in the second week of the treatment increases this likelihood.

Keywords

• Depression
• Repetitive transcranial magnetic stimulation
• rTMS
• Predictive factors
• Remission

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