Clinical Study on the Treatment of Somatisation Disorder With Repetitive Transcranial Magnetic Stimulation Combined With Venlafaxine

Abstract

Background: Somatisation disorder (SD) is a chronic and complex mental health condition characterized by persistent somatic symptoms lacking a clear organic basis, frequently co-occurring with anxiety and depressive disorders. Venlafaxine, a serotonin-norepinephrine reuptake inhibitor, is a standard pharmacotherapy, but its efficacy as monotherapy can be limited. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation technique that has shown promise for various neuropsychiatric conditions. However, evidence regarding the combined application of rTMS and venlafaxine for SD remains scarce.  This study aimed to evaluate the efficacy and safety of rTMS combined with venlafaxine in the treatment of SD.

Methods: This retrospective study analysed clinical data from 126 patients admitted with SD to the Third People's Hospital of Yichun from September 2022 to November 2023. Patients were classified into two groups according to the treatment regimens administered during hospitalization, rather than pre-specified study grouping: a treatment group (n = 63) that received venlafaxine in conjunction with rTMS, and a control group (n = 63) that received venlafaxine monotherapy. Clinical outcomes were evaluated using the Hamilton Anxiety Scale (HAMA), Symptom Checklist 90 (SCL-90), Clinical Global Impression–Severity of Illness Scale (CGI-SI) and Hamilton Depression Scale (HAMD) at baseline (T0) and at weeks 1 (T1), 2 (T2), 4 (T3) and 6 (T4) after treatment initiation. Adverse events were documented and analysed. The study analysed factors affecting treatment efficacy through univariate and multivariate logistic regression analyses.

Results: The treatment group exhibited a statistically significant improvement in overall therapeutic efficacy relative to the control group (p < 0.05). Both groups demonstrated significant decreases in HAMD, HAMA, SCL-90 and CGI-SI scores at all post-treatment time points (T1, T2, T3 and T4) compared with baseline (T0). At each follow-up time point, the treatment group exhibited significantly lower scores on all assessment scales relative to the control group (p < 0.05). Both groups experienced adverse reactions, but the treatment group exhibited a lower incidence of these events (p < 0.05). Univariate analysis revealed that patients in the ineffective group were more likely to have received venlafaxine monotherapy, to be older and to have lower baseline HAMA (T0) scores than the effective group (all p values < 0.05). Multivariate logistic regression revealed that venlafaxine monotherapy (odds ratio [OR] = 3.181, 95% confidence interval [CI] [1.184–8.549]) and baseline HAMA score (OR = 0.784, 95% CI [0.644–0.954]) are significant factors affecting clinical efficacy (p < 0.05).

Conclusions: The combination of rTMS and venlafaxine demonstrates superior efficacy and an improved safety profile compared to venlafaxine monotherapy in treating SD, indicating its potential for wider clinical use. Clinicians should monitor patients' psychological status to reduce adverse reactions and improve treatment adherence.