Investigating the Impact of rTMS in Combination With Antidepressant Medications on Residual Symptoms in Acute Depression.

Background: After several rounds of optimized pharmacotherapy, approximately one-third of patients with depression still exhibit residual symptoms (RS). While repetitive transcranial magnetic stimulation (rTMS) is an established non-invasive treatment for depression, its effectiveness in treating RS associated with depression remains unclear. This study investigated the effectiveness of different frequencies of repetitive transcranial magnetic stimulatio rTMS combined with antidepressant drugs in treating RS of acute depression.

Methods: This retrospective study included 110 acute depression patients hospitalized in the Huzhou Third Municipal Hospital between April 2020 and April 2022. The clinical data were analyzed, and patients were divided into a control group (n = 31 cases), a low-frequency rTMS (LF-rTMS) group (n = 37 cases), and a high-frequency rTMS (HF-rTMS) group (n = 42 cases). The control group received antidepressant medicines, the LF-rTMS group was treated with LF-rTMS stimulation of the right dorsolateral prefrontal cortex (DLPFC) in addition to standard antidepressant medication, and the HF-rTMS group was given HF-rTMS stimulation of the left DLPFC. These treatment modalities were continued for four weeks. Additionally, the 16-item Quick Inventory of Depressive Symptomatology (QIDS-16), the 24-item Hamilton Depression Rating Scale (HAMD-24), and the number of RS were observed before and after treatment in the three groups, and the clinical effectiveness rates were monitored across these three experimental groups.

Results: After treatment, the total QIDS-16 score, the number of RS, and the total HAMD-24 score were significantly decreased among the three groups compared to the before-treatment levels (p < 0.05). Both the LF-rTMS and HF-rTMS groups exhibited lower QIDS-16 scores, fewer RS, and lower HAMD-24 total scores than the control group (p < 0.05). Following treatment, all three groups demonstrated a significant decrease in the QIDS-16 sleep scores for sleep onset, nighttime sleep, early morning awakening, and sleep duration compared to pre-treatment levels (p < 0.05). Furthermore, the LF-rTMS group had lower post-treatment scores for sleep onset and nighttime sleep than the HF-rTMS group (p < 0.05). Conversely, the HF-rTMS group exhibited lower scores for early morning awakening and sleep duration than the LF-rTMS group (p < 0.05). Additionally, both the LF-rTMS and HF-rTMS groups showed higher clinical effectiveness rates than the control group (p < 0.05).

Conclusion: Our findings showed that HF-rTMS targeting left DLPFC and LF-rTMS targeting right DLPFC could effectively alleviate clinical symptoms in patients with RS of acute depression, thereby increasing the efficacy rate of treatment. However, regarding the sleep disorder factors evaluated by the QIDS-16, there were differences in the emphasis of improvements between HF-rTMS targeting left DLPFC and LF-rTMS targeting right DLPFC.