| Objective:In this study,RS-fMRI-guided repeated transcranial magnetic stimulation combined with SSRIs antidepressants,conventional repeated transcranial magnetic stimulation combined with SSRIs antidepressants,and simple SSRIs antidepressants were used to treat patients with depression,observing the improvement of depression symptoms before and after treatment in each group and the effect on sleep quality and sleep structure parameters of patients with depression.And we compared the effect of repetitive transcranial magnetic stimulation on depression in two positioning methods.The study could provide scientific theoretical basis for improving depression,improving sleep quality,and optimizing sleep structure,and provides new ideas for individualized treatment of depression patients.Methods:1.The study selected inpatients from the 6th people’s Hospital of Hebei Province.We divided the patients who met the admission criteria into three groups according to the method of random number table,one group was the repetitive transcranial magnetic treatment group guided by rs-fMRI(referred to as the navigation version of transcranial magnetic treatment group),one group was the conventional repetitive transcranial magnetic treatment group,and the other group was the blank control group.In this study,59 patients were included,including 19 patients in the navigation version transcranial magnetic treatment group,20 patients in the conventional transcranial magnetic treatment group and 20 patients in the control group.2.In this study,before the treatment of transcranial magnetic group with navigation version,the rest state MRI scan was used for individual localization.Conventional 5 cm localization was used before treatment in the conventional transcranial magnetic group.The frequency of repetitive transcranial magnetic stimulation was 10 Hz,40 sequences were stimulated each time,the stimulation time in each sequence was 5 seconds,the interval time was 20 seconds,1500 stimulation pulses were received in one treatment.All the patients in the three groups were treated with SSRIs.3.Patients in each group were assessed hamilton Depression scale(HAMD),Pittsburgh Sleep Quality Index(PSQI),insomnia severity index(ISI)and Athens insomnia scale(AIS)were assessed at at baseline and after rTMS treatment,respectively.At baseline,patients were required to fill in the general survey,life events scale(LES)and Eysenck Personality Questionnai(EPQ-RSC).After rTMS treatment,patients were given a Treatment Emergent Symptom Scale(TESS)and rTMS side effect assessment scale.At the baseline and two weeks after treatment,the patients in the group should be monitored by portable sleep monitor.Results:1.19 patients were included in the navigation transcranial magnetic group,20 patients in the conventional transcranial magnetic group and 20 patients in the control group.The average age of the patients in the group was 33.97 ± 11.94 years old.There was no significant difference in age,gender,nationality,course of disease,education level,marital status,employment,family history of depression,family history of suicide,EPQ-RSC and LES among the three groups(P > 0.05).2.There was no statistically significant HAMD-17 score at baseline in the three groups(P>0.05).After rTMS treatment,the scores of HAMD-17 and various factors in the three groups all decreased,and the differences were statistically significant compared with the baseline(P<0.05).Comparison between HAMD-17 groups: The total HAMD-17 score of patients in the navigational transcranial magnetic group after rTMS treatment decreased to 11.68 ± 3.00 points,which was significantly lower than that of the conventional transcranial magnetic group and the control group,and the difference was statistically significant(P <0.05);The average HAMD-17 reduction rate in the navigational transcranial magnetic group was(49.68 ± 7.46)%,which was greater than that in the conventional transcranial magnetic group and the control group,and the difference was statistically significant(P <0.05).There was no significant difference in HAMD-17 score between the conventional transcranial magnetic therapy group and the control group after treatment(P> 0.05).3.There was no significant difference in baseline PSQI,ISI,and AIS scores between the three groups of patients at baseline(P> 0.05).After rTMS treatment,the PSQI scores of the three groups of patients were all decreased,which was statistically significant compared with the baseline(P <0.05);compared with before and after rTMS treatment in each factor group,the scores of each factor after rTMS treatment in the three groups were compared with baseline.There was statistical significance(P <0.05).Comparison between PSQI groups: The PSQI score of patients in the navigational transcranial magnetic group decreased to 6.68 ± 1.25 points after rTMS treatment,which was even lower than that of the conventional transcranial magnetic group(9.85 ± 1.87 points)and the control group(8.35 ± 1.87 points).Obviously,and the difference was statistically significant(P <0.05);PSQI scores in the conventional transcranial magnetic group and the control group were also statistically significant after treatment with rTMS(P> 0.05).Comparison between ISI groups: The navigation version of the transcranial magnetic group decreased to 8.16 ± 2.93 points after rTMS treatment,and the difference was statistically significant compared with the conventionall transcranial magnetic group(11.75 ± 2.59 points)and the control group(10.05 ± 3.14 points).(P <0.05).AIS and ISI scores were similar.There was no significant difference in ISI and AIS scores between the conventional transcranial magnetic group and the control group after rTMS treatment(P> 0.05).4.There was no significant difference in the sleep structure parameters of the three groups of patients at baseline(P> 0.05).After treatment,most of the three groups of patients had changes in sleep structural parameters,and the differences before and after treatment were statistically significant(P <0.05);the changes before and after TRT were not significant.The differences between the three groups before and after treatment were statistically significant only in the number of awakenings,N2,N3,and REM(P <0.05).5.In the navigation version of the transcranial magnetic therapy group,the number of effective cases was 10,and the number of invalid cases was 2 with an effective rate of 53.64%.In the conventional transcranial magnetic therapy group,the number of effective cases was 4 and the number of invalid cases was In 2 cases,the effective rate was 20.00%.After treatment,the number of effective cases in the control group was 3,and the number of ineffective cases was 8.The effective rate was 15.00%.The difference in the treatment effectiveness between the three groups was statistically significant(P <0.05).6.Multiple linear regression analysis showed: PSQI,wake period,and number of awakenings were related to the reduction rate of HAMD-17 after navigational transcranial magnetic therapy(P <0.05);PSQI,sleep incubation period,and wake period were related to the reduction rate of HAMD-17 after conventional transcranial magnetic therapy(P <0.05).7.This study analyzed the influencing factors of the therapeutic effect of depression patients treated with rTMS.The navigational transcranial magnetic and conventional transcranial magnetic treatment groups were considered as a whole.The positioning method was combined with age,PSQI,wake,gender,neuroticism,and LES as independent variables,and the treatment effect was included in the multivariate logistic model as the dependent variable.The results showed that after controlling for other confounding factors,the use of navigational positioning was a protective factor affecting the treatment effect of depression(OR = 0.084,95% CI = 0.007 ~ 0.972)..Conclusion:1.The effect of rs-fMRI guided repetitive transcranial magnetic stimulation combined with SSRIs antidepressants in the treatment of depression is better than that of conventional transcranial magnetic stimulation combined with SSRIs antidepressants and SSRIs antidepressants alone,especially in the factors of cognitive impairment,retardation and sleep disorders.2.Rs-fMRI guided repetitive transcranial magnetic stimulation combined with SSRIs antidepressants in the treatment of depression is faster and more effective than conventional transcranial magnetic stimulation combined with SSRIs antidepressants and simple SSRIs antidepressants in improving sleep quality and sleep structure.3.The improvement of subjective sleep quality and wakefulness in sleep structure is related to the improvement of depression after transcranial magnetic therapy.4.The functional magnetic resonance localization method is more conducive to improving the efficiency of repeated transcranial magnetic stimulation in the treatment of depression than the traditional 5-cm localization method. |
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