[Comprehensive treatment of adynamic depression with the combined use of traditional psychopharmacotherapy, transcranial magnetic stimulation and virtual reality technologies].

Objective: To study the efficacy and safety of activity-dependent neuromodulation using transcranial magnetic stimulation with intermittent theta flashes (iTBS) as priming stimulation with multimodal parameters of the virtual environment (VR) for the treatment of adynamic depression in comparison with psychopharmacotherapy (PFT).

Material And Methods: The comparative study included 85 patients with adynamic depression who were randomized into four groups: iTBS + VR + PFT (=19), iTBS + PFT (=19), VR + PFT (=23), PFT (=24). The duration of therapy was 20 days, the procedures were carried out daily, with a break for weekends, followed by an assessment of side-effects and control over compliance with the patient's drinking regimen. The study was conducted by clinical, standardized and statistical methods.

Results: After 4 weeks of therapy, a final analysis of efficacy and safety indicators was performed. When testing the main statistical hypothesis of the study, the combined therapy of adynamic depression with the use of traditional PFT, iTBS and VR technologies proved to be more effective than traditional PFT. A significant decrease in the parameters of adynamic depression after 4 weeks on the Hamilton psychiatric rating scale for depression by 76%, according to the Clinical Global Impression scale - by the severity of the disorder by 65%, the dynamics of the overall improvement by 76% versus 55% (=0.0199), 37%, (=0.0033) 43% (=0.0047), respectively, in the PFT group.

Conclusion: Activity-dependent neuromodulation using transcranial magnetic stimulation with intermittent theta flashes (iTBS) as priming stimulation with multimodal parameters of the virtual environment is an effective and safe way to treat adynamic depression, having an advantage over traditional psychopharmacotherapy.