Case Control Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2024; 12(21): 4476-4482
Published online Jul 26, 2024. doi: 10.12998/wjcc.v12.i21.4476
Comparing pharmacotherapy and transcranial magnetic stimulation for the treatment of anxiety and depression after aortic dissection surgery
Jie-Qiong Su, Feng Liang
Jie-Qiong Su, Department of Neurology, Qinghai Province Cardiovascular and Cerebrovascular Disease Specialist Hospital, Xining 810012, Qinghai Province, China
Feng Liang, Department of Vascular Surgery, Qinghai Province Cardiovascular and Cerebrovascular Disease Specialist Hospital, Xining 810012, Qinghai Province, China
Author contributions: Su JQ performed the majority of experiments and wrote the manuscript; Liang F designed the study and corrected the manuscript; Su JQ was involved in analytical tools and participated in the collection of human material; Liang F served as a scientific advisor and participated in the collection of human material; Liang F is the guarantor.
Institutional review board statement: This study was approved by the Institutional Review Board of Qinghai Province Cardiovascular and Cerebrovascular Disease Specialist Hospital.
Informed consent statement: Written informed consent for publication was obtained from all participants.
Conflict-of-interest statement: The authors declare no conflicts of interest related to the publication of this study.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Feng Liang, MBChB, Associate Chief Physician, Department of Vascular Surgery, Qinghai Province Cardiovascular and Cerebrovascular Disease Specialist Hospital, No. 7 Zhuanchang Road, Nanchuan West Road, Xining 810012, Qinghai Province, China. feng_liang0163@163.com
Received: March 25, 2024
Revised: May 13, 2024
Accepted: May 30, 2024
Published online: July 26, 2024
Processing time: 96 Days and 16.7 Hours
Abstract
BACKGROUND

Aortic coarctation is a potentially fatal condition that is primarily treated surgically. Despite successful procedures, patients frequently experience postoperative anxiety and depression, which can hinder recovery and worsen outcomes. Pharmacological interventions, such as 5-hydroxytryptamine (5-HT) and norepinephrine reuptake inhibitors, are commonly prescribed; however, their efficacy alone or in combination with non-invasive brain stimulation techniques, such as repetitive transcranial magnetic stimulation (TMS), remains unclear.

AIM

To assess the effect of medications and TMS on post-aortic surgery anxiety and depression.

METHODS

We analyzed the outcomes of 151 patients with anxiety and depression who were hospitalized for aortic dissection between January 2020 and September 2022. Using the random number table method, 75 and 76 patients were allocated to the normal control and study groups, respectively. All the patients were treated using routine procedures. The control group was administered anti-anxiety and anti-depression drugs, whereas the study group was treated with TMS in addition to these medications. The patients in both groups showed improvement after two courses of treatment. The Hamilton Anxiety Scale (HAMA) and the Hamilton Depression Scale (HAMD) were used to assess anxiety and depression, respectively. The serum levels of brain-derived neurotrophic factor (BDNF) and 5-HT were determined using enzyme-linked immunosorbent assay. The Pittsburgh Sleep Quality Index (PSQI) was used to estimate sleep quality, and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was used to assess cognitive function.

RESULTS

The HAMD and HAMA scores reduced in 2 groups, with the study group achieving a lower level than control (P < 0.05). In the control group, 43 patients recovered, 17 showed improvement, and 15 were deemed invalid. In the study group, 52 recovered, 20 improved, and four were invalid. The efficacy rate in study group was 94.74% compared to 80.00% in control (P < 0.05). The BDNF and 5-HT levels increased in both groups, with higher levels observed in the experimental group (P < 0.05). Moreover, the PSQI scores decreased in 2 groups, but were lower in the intervention group than control (P < 0.05). The scores of the RBANS items increased, with the study group scoring higher than control (P < 0.05).

CONCLUSION

Combining anti-anxiety and anti-depressive drugs with repetitive TMS after aortic surgery may enhance mood and treatment outcomes, offering a promising clinical approach.

Keywords: Aortic dissection, Anxiety and depression, Simple anti-anxiety and depression medications, Repetitive transcranial magnetic stimulation, Curative effect

Core Tip: Our study of 151 patients with post-aortic dissection surgery anxiety and depression found that adding repetitive transcranial magnetic stimulation to standard drug therapy significantly improved outcomes, as measured by anxiety and depression scales, serum brain-derived neurotrophic factor and 5-hydroxytryptamine levels, sleep quality, and cognitive function. This combination therapy represents a potent clinical strategy for optimizing postoperative emotional and functional recovery.