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

Öz

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.

Anahtar Kelimeler

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

Destekleyen Kurum

YOK

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

1. 1. World Health Organization. Depressive disorder (depression) [Internet]. WHO. [cited 18.08.2023]. Available from: https:// www.who.int/news-room/fact-sheets/detail/depression
2. 2. Evans DL, Charney DS, Lewis L, Golden RN, Gorman JM, Krishnan KR, et al. Mood disorders in the medically ill: scientific review and recommendations. Biol Psychiatry 2005; 58(3):175-89.
3. 3. Kverno KS, Mangano E. Treatment-Resistant Depression: Approaches to Treatment. J Psychosoc Nurs Ment Health Serv 2021; 59(9):7-11.
4. 4. Dowd SM, Rado J, Welch MJ, Janicak PG. Transcranial magnetic stimulation for depression. Current Psychiatry 2008; 7(12):27-31.
5. 5. Yaşar AU, Cinemre B, Erdoğan A. Effects of Repetitive Transcranial Magnetic Stimulation (rTMS) Treatment in Comorbid Nicotine Addiction with Major Depressive Disorder and Obsessive- Compulsive Disorder. Bağımlılık Dergisi 2022; 23(3):1-1. doi: 10.51982/bagimli.1016942.
6. 6. Topcuoğlu M, Cinemre B, Erdoğan A, Nabiyeva N. Repetitive Transcranial Magnetic Stimulation in a Group of Treament-Resistant Obsessive-Compulsive Disorder Patients: A Descriptive Study. Acta Medica 2022; 53(2):114–122.
7. 7. Leblhuber F, Geisler S, Ehrlich D, Steiner K, Reibnegger G, Fuchs D, et al. Repetitive transcranial magnetic stimulation in the treatment of resistant depression: changes of specific neurotransmitter precursor amino acids. J Neural Transm (Vienna) 2021; 128(8):1225-1231.
8. 8. Adu MK, Shalaby R, Chue P, Agyapong VIO. Repetitive Transcranial Magnetic Stimulation for the Treatment of Resistant Depression: A Scoping Review. Behav Sci (Basel) 2022; 12(6):195.

9. 9. Kar SK. Predictors of Response to Repetitive Transcranial Magnetic Stimulation in Depression: A Review of Recent Updates. Clin Psychopharmacol Neurosci 2019; 17(1):25-33.
10. 10. Trevizol AP, Downar J, Vila-Rodriguez F, Thorpe KE, Daskalakis ZJ, Blumberger DM. Predictors of remission after repetitive transcranial magnetic stimulation for the treatment of major depressive disorder: An analysis from the randomised non-inferiority THREE-D trial. EClinicalMedicine 2020; 22:100349.
11. 11. Kedzior KK, Reitz SK, Azorina V, Loo C. Durability of the antidepressant effect of the high-frequency repetitive transcranial magnetic stimulation (rTMS) In the absence of maintenance treatment in major depression: a systematic review and meta- analysis of 16 double-blind, randomized, sham-controlled trials. Depress Anxiety 2015; 32(3):193-203.
12. 12. Hamilton M. A Rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23(1):56-62.
13. 13. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 1988; 56(6):893-7.
14. 14. Richards K. Techniques for measurement of sleep in critical care. Focus Crit Care 1987; 14(4):34-40.
15. 15. Gaynes BN, Lloyd SW, Lux L, Gartlehner G, Hansen RA, Brode S, et al. Repetitive transcranial magnetic stimulation for treatment- resistant depression: a systematic review and meta-analysis. J Clin Psychiatry 2014; 75(5):477-89.
16. 16. MacMaster FP, Croarkin PE, Wilkes TC, McLellan Q, Langevin LM, Jaworska N, et al. Repetitive Transcranial Magnetic Stimulation in Youth with Treatment Resistant Major Depression. Front Psychiatry 2019; 10:170.
17. 17. Trevizol AP, Downar J, Vila-Rodriguez F, Konstantinou G, Daskalakis ZJ, Blumberger DM. Effect of repetitive transcranial magnetic stimulation on anxiety symptoms in patients with major depression: An analysis from the THREE-D trial. Depress Anxiety 2021; 38(3):262-271.
18. 18. Nardone R, Sebastianelli L, Versace V, Brigo F, Golaszewski S, Pucks-Faes E, et al. Effects of repetitive transcranial magnetic stimulation in subjects with sleep disorders. Sleep Med 2020; 71:113-121.
19. 19. Antczak JM, Poleszczyk A, Wichniak A, Rakowicz M, Parnowski TJ. The influence of the repetitive transcranial magnetic stimulation on sleep quality in depression. Psychiatr Pol 2017; 51(5):845-857.
20. 20. Cao X, Deng C, Su X, Guo Y. Response and Remission Rates Following High-Frequency vs. Low-Frequency Repetitive Transcranial Magnetic Stimulation (rTMS) Over Right DLPFC for Treating Major Depressive Disorder (MDD): A Meta-Analysis of Randomized, Double-Blind Trials. Front Psychiatry 2018; 9:413.
21. 21. Yesavage JA, Fairchild JK, Mi Z, Biswas K, Davis-Karim A, Phibbs CS, et al. Effect of Repetitive Transcranial Magnetic Stimulation on Treatment-Resistant Major Depression in US Veterans: A Randomized Clinical Trial. JAMA Psychiatry 2018; 75(9):884-893.
22. 22. Cash RFH, Zalesky A, Thomson RH, Tian Y, Cocchi L, Fitzgerald PB. Subgenual Functional Connectivity Predicts Antidepressant Treatment Response to Transcranial Magnetic Stimulation: Independent Validation and Evaluation of Personalization. Biol Psychiatry 2019; 86(2):e5-e7.
23. 23. Pallanti S, Cantisani A, Grassi G, Antonini S, Cecchelli C, Burian J, et al. rTMS age-dependent response in treatment-resistant depressed subjects: a mini-review. CNS Spectr 2012; 17(1):24-30.
24. 24. Kedzior KK, Azorina V, Reitz SK. More female patients and fewer stimuli per session are associated with the short-term antidepressant properties of repetitive transcranial magnetic stimulation (rTMS): a meta-analysis of 54 sham-controlled studies published between 1997-2013. Neuropsychiatr Dis Treat 2014; 10:727-56.
25. 25. Siddiqi SH, Chockalingam R, Cloninger CR, Lenze EJ, Cristancho P. Use of the Temperament and Character Inventory to Predict Response to Repetitive Transcranial Magnetic Stimulation for Major Depression. J Psychiatr Pract 2016; 22(3):193- 202.
26. 26. Rostami R, Kazemi R, Nitsche MA, Gholipour F, Salehinejad MA. Clinical and demographic predictors of response to rTMS treatment in unipolar and bipolar depressive disorders. Clin Neurophysiol 2017; 128(10):1961-1970.
27. 27. Grammer GG, Kuhle AR, Clark CC, Dretsch MN, Williams KA, Cole JT. Severity of Depression Predicts Remission Rates Using Transcranial Magnetic Stimulation. Front Psychiatry 2015; 6:114.
28. 28. Fitzgerald PB, Hoy KE, Anderson RJ, Daskalakis ZJ. A study of the pattern of response to rTMS treatment in depression. Depress Anxiety 2016; 33(8):746-53.