We investigated the neuroimaging changes and clinical efficacy of repetitive transcranial magnetic stimulation (rTMS) combined with antidepressants in major depressive disorder (MDD) patients. We scanned 35 patients with MDD and 27 healthy controls (HC) with resting-state functional magnetic resonance imaging (fMRI) before and after treatment. We analyzed amplitude of low-frequency fluctuation (ALFF) and the correlation with clinical variables. The rate of significant efficacy after treatment was higher in the combination treatment group than in the antidepressant group, although not statistically significant. At baseline, ALFF increased in the left middle temporal, brain stem, and left cerebellum and decreased in the right anterior cingulate (ACC), right orbital frontal cortex (OFC), and right caudate. ALFF increased in the left fusiform and decreased in the right lingual gyrus, left middle occipital gyrus, and left superior occipital gyrus after antidepressants. ALFF increased in the right ACC, right OFC, and right rectus after combination treatment. ALFF changes in the right ACC/OFC were negatively correlated with HAMD changes. After treatment, abnormal activity in some brain regions normalized, but these regions differed between the two treatment groups. rTMS combined with antidepressants therapy may improve MDD symptoms by improving neuronal activity levels in the right ACC and right OFC.

中文翻译：

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重复经颅磁刺激联合抗抑郁药物治疗重度抑郁症低频波动幅度的变化

我们研究了重复经颅磁刺激（rTMS）联合抗抑郁药物对重度抑郁症（MDD）患者的神经影像学变化和临床疗效。我们在治疗前后对 35 名 MDD 患者和 27 名健康对照 (HC) 进行了静息态功能磁共振成像 (fMRI) 扫描。我们分析了低频波动（ALFF）的幅度及其与临床变量的相关性。联合治疗组治疗后显效率高于抗抑郁药组，但没有统计学意义。基线时，左侧颞中叶、脑干和左侧小脑的 ALFF 增加，右侧前扣带回 (ACC)、右侧眶额皮质 (OFC) 和右侧尾状核的 ALFF 减少。抗抑郁药后，左侧梭状回的 ALFF 增加，右侧舌回、左侧枕中回和左侧枕上回的 ALFF 减少。联合治疗后，右侧 ACC、右侧 OFC 和右侧直肌 ALFF 增加。右侧 ACC/OFC 的 ALFF 变化与 HAMD 变化呈负相关。治疗后，某些大脑区域的异常活动恢复正常，但这些区域在两个治疗组之间存在差异。 rTMS 联合抗抑郁药治疗可以通过改善右侧 ACC 和右侧 OFC 的神经元活动水平来改善 MDD 症状。