The Add-on Role of Combined Transcranial Magnetic Stimulation Combined with Transcranial Direct Current Stimulation on Depressive Disorders and Related Electroencephalographic Mechanism
Objective: Depression is a common mental disorder with a high incidence in China. The current treatment for depression mainly includes pharmacotherapy, psychotherapy and physical therapy. Non-invasive brain stimulation technique, as a new physical therapy technique, can directly modulate the cerebral cortex. Physiotherapy techniques represented by transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are now widely used in the treatment of depression. In this study, we combined the two therapeutic techniques and used a combined protocol of transcranial magnetic stimulation combined with transcranial direct current stimulation to intervene in the treatment of depressed patients to examine the therapeutic effects and electroencephalographic mechanisms.
Methods: This study consisted of two parts that examined the efficacy and electroencephalographic mechanisms of the combined treatment at the clinical and brain levels. Study one examined the clinical efficacy of rTMS combined with tDCS in the treatment of depression. Subjects were assigned to four treatment regimen groups for a total of 10 sessions over 2 weeks: rTMS combined with tDCS treatment, rTMS +sham tDCS treatment, sham rTMS + tDCS treatment, and sham rTMS + sham tDCS treatment groups. A single-blind randomized controlled experimental design was used, and only the experimental investigator was clear about the enrollment of the subjects; neither the subjects nor the evaluators were clear about which treatment the subjects received. The Hamilton Depression and Anxiety Inventory was used to assess the subjects' clinical symptoms. Study 2 used transcranial magnetic stimulation-electroencephalography (TMS-EEG) technique to explore the electroencephalographic mechanisms of rTMS combined with tDCS in the treatment of depression. Subjects underwent TMS- EEG data acquisition at both baseline and post-test, which was used to compare the changes in TMS-evoked EEG signal activity before and after treatment, and to compare the differences in EEG signals between the four treatment groups at post-test, in order to establish the relationship between EEG signals and depressive symptoms and explore the electroencephalographic mechanisms behind the remission of depressive symptoms.
Results: The results of Study 1 showed that the rTMS combined with tDCS treatment group had the greatest reduction in Hamilton Depression Inventory scores and the least severe depression after 2 weeks of treatment, with higher remission and response rates. The results suggest that rTMS combined with tDCS treatment can accelerate the improvement of depressive symptoms after two weeks of treatment. Study 2 results showed that after 2 weeks of treatment, subjects experienced different degrees of reduction reductions in N45, N100, P60 and P180 amplitudes, and the P60 amplitude was significantly smaller in the rTMS combined with tDCS treatment group than in the sham rTMS + sham tDCS group, and the P180 amplitude in the rTMS combined with tDCS treatment, rTMS + sham tDCS and sham rTMS + sham tDCS groups. P180 amplitude in the rTMS combined with tDCS treatment group, rTMS + sham tDCS group and sham rTMS + sham tDCS group were significantly smaller than that in the sham rTMS + tDCS group. The findings suggest that the rTMS combined with tDCS treatment group may achieve the improvement of depression by effectively modulating the cortical excitability mechanism.
Conclusion: rTMS combined with tDCS treatment can effectively alleviate depressive symptoms and can produce better efficacy at 2 weeks compared to single physical therapy regimen. rTMS combined with tDCS treatment for depression involves electroencephalographic mechanisms that modulate abnormal excitatory and inhibitory mechanisms in the brain, thus providing relief from clinical symptoms.
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