J Korean Med Sci.  2020 Jul;35(26):e205. 10.3346/jkms.2020.35.e205.

Effects of Repetitive Transcranial Magnetic Stimulation on Improvement of Mental Health and Clinical Parameters in Depressed Hemodialysis Patients: a Pilot Study

• Hwang JH
• Hwang H
• Kim HR
• Hong JS
• Han DH
• Shin Jh
• Kim SH
• Kim SM

• KMID: 2503679
• DOI: http://doi.org/10.3346/jkms.2020.35.e205

Abstract

Background
This study aimed to evaluate the therapeutic effect of repetitive transcranial magnetic stimulation (rTMS) as a nonpharmacologic treatment in depressed hemodialysis patients.
Methods
Patients who scored ≥ 5 on the Patient Health Questionnaire-9 were randomized to either the rTMS (n = 7) or sham group (n = 7). The rTMS group was stimulated with a 110% motor threshold and 10 Hz on the left dorsolateral prefrontal cortex for 20 minutes, three times a week, for 4 weeks. In the sham group, the “1-wing 90-degree method” was used. We analyzed clinical indices before and after the intervention, as well as data from quantitative electroencephalography (frontal alpha asymmetry [FAA]), and various psychiatric questionnaires (Beck Depression Inventory-II, Beck Anxiety Inventory [BAI], Symptom Checklist-90-Revised Somatization Subscale [SCL-90R-SOM]), and Perceived Stress Scale.
Results
One month after rTMS, the changes in hemoglobin A1c levels in the rTMS group were significantly greater than those in the sham group (F = 6.687, P = 0.032). The changes in BAI scores in the rTMS group were significantly greater than those in the sham group (F = 6.700, P = 0.025), and the changes in SCL-90R-SOM scores in the rTMS group were greater than those in the sham group (F = 4.943, P = 0.048). In addition, the changes in the FAA value at the F7 and F8 electrodes in the rTMS group were greater than those in the sham group (F = 6.468, P = 0.027).
Conclusion
In depressed hemodialysis patients, rTMS may improve anxiety and somatization symptoms, which may lead to improvements in clinical measures.

Keyword

Depression; Kidney; Hemodialysis; Transcranial Magnetic Stimulation; Quantitative Electroencephalogram

Figure

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  Fig. 1 Study flow chart.HD = hemodialysis, PHQ-9 = Patient Health Questionnaire-9, rTMS = repetitive transcranial magnetic stimulation.

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  Fig. 2 Changes in psychological scale scores pre- and post-rTMS.BAI = Beck Anxiety Inventory, BDI-II = Beck Depression Inventory-II, PSS = Perceived Stress Scale, rTMS = repetitive transcranial magnetic stimulation, SCL-90R-SOM = Symptom Checklist-90-Revised Somatization Subscale.

• 

  Fig. 3 Changes in HbA1c levels and psychological scale scores due to intervention. (A) HbA1c levels (%) were significantly improved in the rTMS group (8.3% to 7.1%, P = 0.046) but not in the sham group (7.0% to 7.4%, P = 0.318). The changes in HbA1c levels in the rTMS group were significantly greater than those in the sham group (F = 6.687, P = 0.032). (B) While BAI scores did not significantly improve in the sham group (14.3 to 16.9, P = 0.258) or rTMS group (17.2 to 11.2, P = 0.074), the changes in BAI scores in the rTMS group were significantly greater than those in the sham group (F = 6.700, P = 0.025). (C) BDI-II scores improved both in the sham group (24.0 to 18.4, P = 0.009) and rTMS group (21.2 to 13.8, P = 0.005). However, there were no statistically significant differences in the changes in BDI-II scores between the groups (F = 0.694, P = 0.423). (D) While SCL-90R-SOM scores did not significantly improve in the sham group (21.4 to 22.4, P = 0.675) or rTMS group (27.7 to 20.2, P = 0.065), the changes in SCL-90R-SOM scores in the rTMS group were greater than those in the sham group (F = 4.943, P = 0.048).BAI = Beck Anxiety Inventory, BDI-II = Beck Depression Inventory-II, HbA1c = hemoglobin A1c, rTMS = repetitive transcranial magnetic stimulation, SCL-90R-SOM = Symptom Checklist-90-Revised Somatization Subscale.

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  Fig. 4 Changes in mean FAA values. In the rTMS group, the F4-F3 FAA value (−0.074 to 0.100, P = 0.074) and F8-F7 FAA value (−0.062 to 0.185, P = 0.086) showed no significant changes, although there was a general increasing tendency. The sham group showed no significant changes in either the F4-F3 FAA value (−0.022 to −0.184, P = 0.064) or F8-F7 FAA value (0.011 to −0.148, P = 0.197). The changes in the F4-F3 FAA value (F = 10.199, P = 0.009) and F8-F7 FAA value (F = 6.468, P = 0.027) in the rTMS group were significantly greater than those in the sham group.FAA = frontal alpha asymmetry, rTMS = repetitive transcranial magnetic stimulation.

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