Martin J L, Barbanoj M J, Schlaepfer T E, Clos S, Perez V, Kulisevsky J, Gironell A
Iberoamerican Cochrane Centre, Department of Epidemiology, Hospital de la Santa Creu i Sant Pau, Sant Antoni M feminine Claret, 171, Barcelona, Catalunya, Spain, 08041.
Cochrane Database Syst Rev. 2002;2002(2):CD003493. doi: 10.1002/14651858.CD003493.
Transcranial magnetic stimulation can either excite or inhibit cortical areas of the brain, depending on whether the speed of the repetitive stimulation is applied at high or low frequencies. It has been used for physiological studies and it has also been proposed as a treatment for depression.
To assess the clinical efficacy and safety of transcranial magnetic stimulation for treating depression.
An electronic search was performed including the Cochrane Collaboration Depression, Neurosis and Anxiety Review Group trials register (last searched June, 2001), the Cochrane Controlled Trials Register (Issue 2, 2001), MEDLINE (1966-2001), EMBASE (1974-2001), PsycLIT (1980-2001), and bibliographies from reviewed articles. Unpublished data and grey literature were searched through personal communications with researchers.
Randomised controlled trials assessing the therapeutic efficacy and safety of transcranial magnetic stimulation for depression.
All reviewers independently extracted the information and verified it by cross-checking. Disagreements were resolved through discussion. Continuous data: When similar studies were grouped, the overall standardised mean difference was calculated under a fixed effect model weighted by the inverse variance method with 95% confidence intervals. (In the presence of statistical heterogeneity, a random effects model was to be used.)
Sixteen trials were included in the review and fourteen contained data in a suitable form for quantitative analysis. Most comparisons did not show differences between rTMS and other interventions. No difference was seen between rTMS and sham TMS using the Beck Depression Inventory or the Hamilton Depression Rating Scale, except for one time period (after two weeks of treatment) for left dorsolateral prefrontal cortex and high frequency; and also for right dorsolateral prefrontal cortex and low frequency, both in favour of rTMS and both using the Hamilton scale. Comparison of rTMS (left dorsolateral prefrontal cortex and high frequency) with electroconvulsive therapy showed no difference except for psychotic patients after two weeks treatment, using the Hamilton scale, which indicated that electroconvulsive therapy was more effective than rTMS.
REVIEWER'S CONCLUSIONS: The information in this review suggests that there is no strong evidence for benefit from using transcranial magnetic stimulation to treat depression, although the small sample sizes do not exclude the possibility of benefit.
经颅磁刺激可兴奋或抑制大脑皮质区域，这取决于重复刺激的速度是高频还是低频。它已被用于生理学研究，也有人提出将其作为治疗抑郁症的一种方法。
评估经颅磁刺激治疗抑郁症的临床疗效和安全性。
进行了电子检索，包括Cochrane协作网抑郁症、神经症和焦虑症综述组试验注册库（最后检索时间为2001年6月）、Cochrane对照试验注册库（2001年第2期）、MEDLINE（1966 - 2001年）、EMBASE（1974 - 2001年）、PsycLIT（1980 - 2001年）以及已发表文章的参考文献。通过与研究人员的个人交流检索未发表的数据和灰色文献。
评估经颅磁刺激治疗抑郁症的疗效和安全性的随机对照试验。
所有评审员独立提取信息并通过交叉核对进行验证。分歧通过讨论解决。连续数据：当对相似研究进行分组时，在固定效应模型下采用逆方差加权法计算总体标准化均数差，并给出95%置信区间。（若存在统计学异质性，则采用随机效应模型。）
本综述纳入了16项试验，其中14项包含适合定量分析的数据形式。大多数比较未显示重复经颅磁刺激（rTMS）与其他干预措施之间存在差异。使用贝克抑郁量表或汉密尔顿抑郁评定量表时，rTMS与假刺激经颅磁刺激之间未见差异，但在一个时间段（治疗两周后），对于左侧背外侧前额叶皮质高频刺激以及右侧背外侧前额叶皮质低频刺激，使用汉密尔顿量表时，均显示rTMS更具优势。rTMS（左侧背外侧前额叶皮质高频刺激）与电休克治疗的比较显示，除了治疗两周后的精神病患者使用汉密尔顿量表显示电休克治疗比rTMS更有效外，两者无差异。
本综述中的信息表明，虽然样本量小不能排除经颅磁刺激治疗抑郁症有益的可能性，但目前尚无有力证据支持其有益。
