Abstract
ObjectivesTo investigate the improvement effect of occipital repetitive transcranial magnetic stimulation (rTMS) combined with escitalopram oxalate tablets on pre-attentive processing in patients with first-episode, medication-naive depression.MethodsPatients who were hospitalized between January and December 2019 were selected. They were randomly allocated to real occipital rTMS stimulation group with 27 cases receiving intermittent theta-burst (iTBS) and sham stimulation group with 24 cases over 20 days. The rTMS treatment target is located at the Oz point of the occipital region. Both groups took escitalopram oxalate tablets, and the average daily drug dose was 15.294 ± 5.041 mg. Hamilton Depression Rating Scale (HAMD) was used to assess the symptoms of depression before and after treatment, and mismatch negativity (MMN) was used to assess the improvement of pre-attentive processing before and after treatment.ResultsAfter 20 days of treatment, the total score of HAMD (13.495 ± 3.700) in both groups was significantly lower than that before treatment [21.910 ± 3.841, F(1, 49) = 46, 3.690, p < 0.001]. After treatment, the latency of MMN in the real stimulation group (182.204 ± 31.878 ms) was significantly lower than that in the sham stimulation group (219.896 ± 42.634 ms, p < 0.001), and the amplitude of MMN in the real stimulation group (−7.107 ± 3.374 ms) was significantly higher than that in the sham stimulation group (−2.773 ± 3.7 32 ms, p < 0.001).ConclusionOccipital rTMS treatment can enhance the early therapeutic effect and effectively improve the pre-attentive processing of patients with depression and provide a scientific basis for the new target of rTMS therapy in clinical patients with depression.
Highlights
Depression is a common mental illness characterized by persistent depressed mood and loss of interest (Suslow et al, 2020)
Zhang et al (2020) demonstrated that left occipital repetitive transcranial magnetic stimulation (rTMS) provides effective and well-tolerated treatment, and functional magnetic resonance imaging (fMRI) measures functional change of the left occipital as a biomarker of therapeutic effect in major depressive disorder (MDD). These results suggest that the occipital lobe may represent a highly promising target region for effective rTMS treatment in MDD (Zhang et al, 2020)
Further analysis showed that the total Hamilton Depression Rating Scale (HAMD) score of the real stimulation group and the sham stimulation group after treatment was significantly lower than the total HAMD score before treatment (p < 0.001), while there was no significant difference in the total HAMD score between the real stimulation group and the sham stimulation group after treatment (p > 0.05) (Table 2)
Summary
Depression is a common mental illness characterized by persistent depressed mood and loss of interest (Suslow et al, 2020). Cognitive dysfunction is a common symptom of major depressive disorder (MDD), and it persists in the remission period. Neuroelectrophysiological and neuroimaging studies have found that the impairment of cognitive function in patients with depression is closely related to the structural and functional abnormalities of the occipital lobe (Shen et al, 2016; Zhang B. et al, 2016). Functional magnetic resonance imaging (fMRI) and PET studies have found reduced occipital blood perfusion in patients with depression (Oda et al, 2003; Brockmann et al, 2009; Nagafusa et al, 2012; Qiu et al, 2014) and thickening of the occipital cortex (Ge et al, 2019) and high gray matter volume (RubinFalcone et al, 2018) in patients with first-episode, medicationnaive depression. The structural alteration of the occipital lobe in patients with depression is associated with occipital bending, which is an abnormality of neurodevelopment or anatomy (Maller et al, 2014). The structural alteration of the occipital lobe in patients with depression is associated with occipital bending, which is an abnormality of neurodevelopment or anatomy (Maller et al, 2014). Fullard et al (2019) proposed that occipital bending can be used as a structural biomarker for depression susceptibility and treatment effectiveness
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