Padberg Frank, Zwanzger Peter, Keck Martin E, Kathmann Norbert, Mikhaiel Patrick, Ella Robin, Rupprecht Philipp, Thoma Heike, Hampel Harald, Toschi Nicola, Möller Hans-Jürgen
Department of Psychiatry, Ludwig-Maximilian University, Munich, Germany.
Neuropsychopharmacology. 2002 Oct;27(4):638-45. doi: 10.1016/S0893-133X(02)00338-X.
Repetitive transcranial magnetic stimulation (rTMS) has been found to exert modest to substantial antidepressant effects in the majority of prior clinical studies. As effect sizes and stimulation conditions have varied greatly, controversy persists regarding effective stimulation parameters (e.g. intensity, frequency, localization). In the present controlled study, we investigated whether the antidepressant efficacy of rTMS may be related to the stimulation intensity applied. Thirty-one patients suffering from a pharmacotherapy-resistant major depressive episode were randomly assigned to three treatment groups receiving rTMS at different stimulation intensities: (1) intensity at the individual motor threshold (MT); (2) 90% subthreshold intensity; and (3) low intensity of standard sham rTMS. Each patient underwent 10 sessions of 10 Hz rTMS with 1500 stimuli/day over the left dorsolateral prefrontal cortex. Improvement of depressive symptoms after rTMS significantly increased with stimulation intensity across the three groups. A 30% to 33% reduction of baseline depression scores was observed after rTMS at MT intensity. Similarly, groups differed significantly regarding the clinical course after rTMS with the lowest number of antidepressant interventions and the shortest hospital stay in the MT intensity group. These findings support the hypothesis of a relationship between stimulation intensity of rTMS and its antidepressant efficacy.
在大多数先前的临床研究中，重复经颅磁刺激（rTMS）已被发现能产生中度到显著的抗抑郁效果。由于效应大小和刺激条件差异很大，关于有效刺激参数（如强度、频率、定位）仍存在争议。在本对照研究中，我们调查了rTMS的抗抑郁疗效是否可能与所施加的刺激强度有关。31名患有药物治疗抵抗性重度抑郁发作的患者被随机分配到三个治疗组，接受不同刺激强度的rTMS治疗：（1）个体运动阈值（MT）强度；（2）阈下强度的90%；以及（3）标准假rTMS的低强度。每位患者在左侧背外侧前额叶皮层接受10次10Hz的rTMS治疗，每天1500次刺激。三组患者rTMS治疗后抑郁症状的改善程度随刺激强度显著增加。在MT强度的rTMS治疗后，观察到基线抑郁评分降低了30%至33%。同样，rTMS治疗后的临床病程在三组之间也有显著差异，MT强度组的抗抑郁干预次数最少，住院时间最短。这些发现支持了rTMS刺激强度与其抗抑郁疗效之间存在关联的假设。
