{"title":"实时脑电图触发的经颅磁刺激联合团体治疗青少年抑郁症和自残行为：一项随机对照试验。","authors":"Hong Liu, Shaowei Liu, Ming Yu, Bo Xin, Yanju Liu","doi":"10.1016/j.jad.2025.120144","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy of real-time EEG-triggered repetitive transcranial magnetic stimulation (rTMS) combined with group therapy versus rTMS alone over the left dorsolateral prefrontal cortex (DLPFC) in adolescents with depression and self-harm behavior.</p><p><strong>Methods: </strong>A parallel-group randomized controlled trial (RCT) enrolled 160 inpatients aged 12-18 years with depression and recent self-harm (≤2 weeks prior) from June to December 2024. Participants were 1:1 randomized to rTMS alone (control, n = 80) or rTMS plus group therapy (observation, n = 80).</p><p><strong>Primary outcome: </strong>4-week change in Hamilton Depression Rating Scale (HAMD-24) scores. Secondary outcomes included anxiety (HAMA-14), suicide risk (SPS), self-harm severity, and neurophysiological markers measured by resting-state EEG (α/θ power, θ/β ratio) and event-related potentials (P300 latency/amplitude) from a task-evoked paradigm. Randomization used computer-generated block sequences (size = 4) with sealed-envelope concealment; outcome assessors were blinded.</p><p><strong>Results: </strong>Baseline characteristics were balanced. Intention-to-treat analysis showed greater HAMD-24 reduction in the observation group (-14.5 ± 3.2 vs. -9.8 ± 2.9, P < 0.001). Observation group also had significant improvements in HAMA-14 (-10.2 ± 2.5 vs. -6.7 ± 2.1, P < 0.001), SPS (-12.3 ± 4.1 vs. -7.9 ± 3.5, P < 0.001), self-harm severity (-8.7 ± 2.8 vs. -4.9 ± 2.3, P < 0.001), and neurophysiological indices (shorter P300 latency, lower θ/β ratio, all P < 0.001). No severe adverse events occurred.</p><p><strong>Conclusion: </strong>Real-time EEG-triggered rTMS combined with group therapy demonstrates superior efficacy in improving clinical symptoms and neurophysiological markers for adolescents with depression and self-harm, offering a potential optimized intervention strategy.</p><p><strong>Trial registration: </strong>This study was registered with ClinicalTrials.gov (Identifier: NCT07047534).</p>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":" ","pages":"120144"},"PeriodicalIF":4.9000,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Real-time EEG-triggered transcranial magnetic stimulation combined with group therapy for adolescents with depression and self-harm behavior: A randomized controlled trial.\",\"authors\":\"Hong Liu, Shaowei Liu, Ming Yu, Bo Xin, Yanju Liu\",\"doi\":\"10.1016/j.jad.2025.120144\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To evaluate the efficacy of real-time EEG-triggered repetitive transcranial magnetic stimulation (rTMS) combined with group therapy versus rTMS alone over the left dorsolateral prefrontal cortex (DLPFC) in adolescents with depression and self-harm behavior.</p><p><strong>Methods: </strong>A parallel-group randomized controlled trial (RCT) enrolled 160 inpatients aged 12-18 years with depression and recent self-harm (≤2 weeks prior) from June to December 2024. Participants were 1:1 randomized to rTMS alone (control, n = 80) or rTMS plus group therapy (observation, n = 80).</p><p><strong>Primary outcome: </strong>4-week change in Hamilton Depression Rating Scale (HAMD-24) scores. Secondary outcomes included anxiety (HAMA-14), suicide risk (SPS), self-harm severity, and neurophysiological markers measured by resting-state EEG (α/θ power, θ/β ratio) and event-related potentials (P300 latency/amplitude) from a task-evoked paradigm. Randomization used computer-generated block sequences (size = 4) with sealed-envelope concealment; outcome assessors were blinded.</p><p><strong>Results: </strong>Baseline characteristics were balanced. Intention-to-treat analysis showed greater HAMD-24 reduction in the observation group (-14.5 ± 3.2 vs. -9.8 ± 2.9, P < 0.001). Observation group also had significant improvements in HAMA-14 (-10.2 ± 2.5 vs. -6.7 ± 2.1, P < 0.001), SPS (-12.3 ± 4.1 vs. -7.9 ± 3.5, P < 0.001), self-harm severity (-8.7 ± 2.8 vs. -4.9 ± 2.3, P < 0.001), and neurophysiological indices (shorter P300 latency, lower θ/β ratio, all P < 0.001). No severe adverse events occurred.</p><p><strong>Conclusion: </strong>Real-time EEG-triggered rTMS combined with group therapy demonstrates superior efficacy in improving clinical symptoms and neurophysiological markers for adolescents with depression and self-harm, offering a potential optimized intervention strategy.</p><p><strong>Trial registration: </strong>This study was registered with ClinicalTrials.gov (Identifier: NCT07047534).</p>\",\"PeriodicalId\":14963,\"journal\":{\"name\":\"Journal of affective disorders\",\"volume\":\" \",\"pages\":\"120144\"},\"PeriodicalIF\":4.9000,\"publicationDate\":\"2026-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of affective disorders\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.jad.2025.120144\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/8/26 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of affective disorders","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jad.2025.120144","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/8/26 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Real-time EEG-triggered transcranial magnetic stimulation combined with group therapy for adolescents with depression and self-harm behavior: A randomized controlled trial.
Objective: To evaluate the efficacy of real-time EEG-triggered repetitive transcranial magnetic stimulation (rTMS) combined with group therapy versus rTMS alone over the left dorsolateral prefrontal cortex (DLPFC) in adolescents with depression and self-harm behavior.
Methods: A parallel-group randomized controlled trial (RCT) enrolled 160 inpatients aged 12-18 years with depression and recent self-harm (≤2 weeks prior) from June to December 2024. Participants were 1:1 randomized to rTMS alone (control, n = 80) or rTMS plus group therapy (observation, n = 80).
Primary outcome: 4-week change in Hamilton Depression Rating Scale (HAMD-24) scores. Secondary outcomes included anxiety (HAMA-14), suicide risk (SPS), self-harm severity, and neurophysiological markers measured by resting-state EEG (α/θ power, θ/β ratio) and event-related potentials (P300 latency/amplitude) from a task-evoked paradigm. Randomization used computer-generated block sequences (size = 4) with sealed-envelope concealment; outcome assessors were blinded.
Results: Baseline characteristics were balanced. Intention-to-treat analysis showed greater HAMD-24 reduction in the observation group (-14.5 ± 3.2 vs. -9.8 ± 2.9, P < 0.001). Observation group also had significant improvements in HAMA-14 (-10.2 ± 2.5 vs. -6.7 ± 2.1, P < 0.001), SPS (-12.3 ± 4.1 vs. -7.9 ± 3.5, P < 0.001), self-harm severity (-8.7 ± 2.8 vs. -4.9 ± 2.3, P < 0.001), and neurophysiological indices (shorter P300 latency, lower θ/β ratio, all P < 0.001). No severe adverse events occurred.
Conclusion: Real-time EEG-triggered rTMS combined with group therapy demonstrates superior efficacy in improving clinical symptoms and neurophysiological markers for adolescents with depression and self-harm, offering a potential optimized intervention strategy.
Trial registration: This study was registered with ClinicalTrials.gov (Identifier: NCT07047534).
期刊介绍：
The Journal of Affective Disorders publishes papers concerned with affective disorders in the widest sense: depression, mania, mood spectrum, emotions and personality, anxiety and stress. It is interdisciplinary and aims to bring together different approaches for a diverse readership. Top quality papers will be accepted dealing with any aspect of affective disorders, including neuroimaging, cognitive neurosciences, genetics, molecular biology, experimental and clinical neurosciences, pharmacology, neuroimmunoendocrinology, intervention and treatment trials.
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