Effects of deep transcranial magnetic stimulation combined with fluoxetine therapy on the hypothalamic-pituitary-adrenal axis and inflammatory factors in adolescent patients with depression
10.3760/cma.j.cn341190-20240516-00569
- VernacularTitle:深部经颅磁刺激联合氟西汀对青少年抑郁症患者HPA轴及炎症因子的影响
- Author:
Mengxin WANG
1
;
Lingli ZHU
Author Information
1. 浙江中医药大学研究生院，杭州 310032
- Publication Type:Journal Article
- Keywords:
Transcranial magnetic stimulation;
Fluoxetine;
Depressive disorder;
Hypothalamo-hypophyseal system;
Adrenocorticotropic hormone;
Corticosterone;
Cyclooxygen
- From:
Chinese Journal of Primary Medicine and Pharmacy
2025;32(5):657-662
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the efficacy of deep transcranial magnetic stimulation combined with fluoxetine therapy in the treatment of depression in adolescent patients and its effects on the hypothalamic-pituitary-adrenal axis.Methods:A randomized controlled study was conducted, enrolling 108 adolescent patients with depression diagnosed and treated at The Third Hospital of Quzhou from May 2022 to April 2023. The participants were randomly assigned to an observation group and a control group, with 54 patients in each group. The control group received fluoxetine hydrochloride capsules, while the observation group received deep transcranial magnetic stimulation in addition to the treatment provided to the control group. Both groups underwent a treatment course of 4 weeks. The scores of the Hamilton Depression Rating Scale scores and the World Health Organization Quality of Life-BREF were compared before and after treatment. Serum levels of corticotropin-releasing hormone, cortisol, and adrenocorticotropic hormone were measured before and after treatment. Additionally, the expression levels of cyclooxygenase-2, tumor necrosis factor-alpha, and interleukin-6 in peripheral blood cells were also detected using western blot assay. The specific regulatory signaling pathways involved in the combined treatment was investigated using transcriptome sequencing.Results:At 2 and 4 weeks after treatment, the Hamilton Depression Rating Scale scores in the observation group [(15.62 ± 1.64), (9.56 ± 1.19)] were significantly lower than those in the control group [(16.69 ± 1.89), (13.47 ± 1.16), t = 3.14, 17.29, both P < 0.01]. The scores of the physiological, psychological, social, and environmental domains in the the World Health Organization Quality of Life-BREF in the observation group were significantly higher than those in the control group ( t = -5.06, -3.86; -2.17, -3.26; -1.99, -2.15; -2.02, -3.55, all P < 0.05). After 4 weeks of treatment, serum levels of cortisol, corticotropin-releasing hormone, and adrenocorticotropic hormone in the observation group were (8.97 ± 2.26) mmol/L, (86.33 ± 13.76) ng/L, and (8.69 ± 2.98) mmol/L, respectively. These values were significantly lower than those in the control group, which were (13.06 ± 2.91) mmol/L, (97.41 ± 15.58) ng/L, and (12.77 ± 3.06) mmol/L ( t = 13.73, 16.75, 36.21, all P < 0.001). The levels of cyclooxygenase-2, interleukin-6, and tumor necrosis factor-alpha in peripheral blood in the observation group were significantly lower than those in the control group ( t = 8.16, 3.92, 6.16, all P < 0.001). Furthermore, tumor necrosis factor-α levels were positively correlated with serum levels of corticotropin-releasing hormone, cortisol, and adrenocorticotropic hormone ( r = 0.803, 0.846, 0.879, all P < 0.05). Transcriptome sequencing results showed that inflammatory response was a specific regulatory pathway involved in the combined therapy. Conclusions:Deep transcranial magnetic stimulation combined with fluoxetine therapy can effectively improve the clinical symptoms of adolescent patients with depression and further regulate the hypothalamic-pituitary-adrenal axis and micro-inflammatory state. Therefore, this combined therapy is of great clinical application value.
