O'Reardon John P, Blumner Kate H, Peshek Andrew D, Pradilla Rocio Romero, Pimiento Pilar Cristancho
Department of Psychiatry, University of Pennsylvania, Ste. 4005, 3535 Market Street, Philadelphia, PA 19104, USA.
J Clin Psychiatry. 2005 Dec;66(12):1524-8. doi: 10.4088/jcp.v66n1205.
There is growing evidence to support the short-term antidepressant effects of repetitive transcranial magnetic stimulation (rTMS), but few published data pertain to the maintenance treatment of patients with DSM-IV-diagnosed major depressive disorder who have responded acutely to rTMS. We describe long-term maintenance therapy for major depressive disorder with rTMS.
Repetitive transcranial magnetic stimulation was applied in 10 adults over the left prefrontal cortex at 100% of motor threshold, most often at a frequency of 10 Hz for sessions consisting of 40 trains at 5 seconds per train (2000 pulses per session), for periods ranging from 6 months to 6 years. Session frequency averaged 1 to 2 per week. The study was conducted in the TMS lab of an academic medical center.
Seven of the 10 subjects experienced either marked or moderate benefit, which was sustained without the addition of concomitant antidepressant medication in 3 cases. There were no serious adverse events reported by any participant. The seizure rate for the 1831 reported rTMS sessions was zero.
These data, while open label, suggest that maintenance rTMS may be a safe and effective treatment modality in some patients with unipolar depression. Further research into the long-term safety and efficacy of rTMS is warranted.
越来越多的证据支持重复经颅磁刺激（rTMS）的短期抗抑郁作用，但关于经DSM-IV诊断为重度抑郁症且对rTMS有急性反应的患者进行维持治疗的已发表数据很少。我们描述了用rTMS对重度抑郁症进行长期维持治疗的情况。
对10名成年人的左侧前额叶皮质施加重复经颅磁刺激，刺激强度为运动阈值的100%，最常用的频率为10Hz，每次治疗由40串脉冲组成，每串脉冲持续5秒（每次治疗2000个脉冲），治疗时间从6个月到6年不等。治疗频率平均为每周1至2次。该研究在一家学术医学中心的TMS实验室进行。
10名受试者中有7名经历了显著或中度的改善，其中3例在未加用抗抑郁药物的情况下症状持续缓解。没有任何参与者报告严重不良事件。在报告的1831次rTMS治疗中，癫痫发作率为零。
这些数据虽然是开放标签的，但表明维持性rTMS可能是一些单相抑郁症患者安全有效的治疗方式。有必要对rTMS的长期安全性和有效性进行进一步研究。
