Berman R M, Narasimhan M, Sanacora G, Miano A P, Hoffman R E, Hu X S, Charney D S, Boutros N N
Yale University School of Medicine, Department of Psychiatry, New Haven, Connecticut, USA.
Biol Psychiatry. 2000 Feb 15;47(4):332-7. doi: 10.1016/s0006-3223(99)00243-7.
Multiple groups have reported on the use of repetitive transcranial magnetic stimulation (rTMS) in treatment-resistant major depression. The purpose of this study is to assess the efficacy of rTMS in unmedicated, treatment-resistant patients who meet criteria for major depression.
Depressed subjects, who had failed to respond to a median of four treatment trials, were assigned in a randomized double-blind manner to receive either active (n = 10; 20 2-sec trains of 20 Hz stimulation with 58-sec intervals; delivered at 80% motor threshold with the figure-of-eight coil positioned over the left dorsolateral prefrontal cortex) or sham (n = 10; similar conditions with the coil elevated and angled 45 degrees tangentially to the scalp) rTMS. These sequences were applied during 10 consecutive weekdays. Continuous electroencephalogram sampling and daily motor threshold determinations were also obtained.
The group mean 25-item Hamilton Depression Rating Scale (HDRS) score was 37.2 (+/- 2.0 SEM) points. Adjusted mean decreases in HDRS scores were 14.0 (+/- 3.7) and 0.2 (+/- 4.1) points for the active and control groups, respectively (p <.05). One of 10 subjects receiving active treatment demonstrated a robust response (i.e., HDRS decreased from 47 to 7 points); three other patients demonstrated 40-45% decreases in HDRS scores. No patients receiving sham treatment demonstrated partial or full responses.
A 2-week course of active rTMS resulted in statistically significant but clinically modest reductions of depressive symptoms, as compared to sham rTMS in a population characterized by treatment resistance.
多个研究小组报告了重复经颅磁刺激（rTMS）在难治性重度抑郁症治疗中的应用。本研究的目的是评估rTMS对符合重度抑郁症标准的未用药难治性患者的疗效。
对中位数为4次治疗试验均无反应的抑郁症患者，以随机双盲方式分配，分别接受活性rTMS（n = 10；20次2秒的20赫兹刺激序列，间隔58秒；以80%运动阈值，用8字形线圈置于左侧背外侧前额叶皮质上进行刺激）或假刺激rTMS（n = 10；条件与活性rTMS相似，但线圈抬高并与头皮成45度切线角）。这些序列在连续10个工作日内应用。同时还进行了连续脑电图采样和每日运动阈值测定。
25项汉密尔顿抑郁量表（HDRS）评分的组均值为37.2（±2.0 SEM）分。活性治疗组和对照组的HDRS评分调整后均值分别下降了14.0（±3.7）分和0.2（±4.1）分（p <.05）。接受活性治疗的10名受试者中有1名表现出显著反应（即HDRS评分从47分降至7分）；另外3名患者的HDRS评分下降了40 - 45%。接受假刺激治疗的患者均未表现出部分或完全反应。
与假刺激rTMS相比，为期2周的活性rTMS疗程在以难治性为特征的人群中导致抑郁症状有统计学意义但临床上适度减轻。
