Osuch Elizabeth A, Benson Brenda E, Luckenbaugh David A, Geraci Marilla, Post Robert M, McCann Una
Biological Psychiatry Branch, National Institute of Mental Health, Clinical Center Nursing Department, National Institutes of Health, Bethesda, MD, United States.
J Anxiety Disord. 2009 Jan;23(1):54-9. doi: 10.1016/j.janxdis.2008.03.015. Epub 2008 Mar 28.
Treatment for anxiety and post-traumatic stress disorder (PTSD) includes exposure therapy and medications, but some patients are refractory. Few studies of repetitive transcranial magnetic stimulation (rTMS) for anxiety or PTSD exist. In this preliminary report, rTMS was combined with exposure therapy for PTSD. Nine subjects with chronic, treatment-refractory PTSD were studied in a placebo-controlled, crossover design of imaginal exposure therapy with rTMS (1Hz) versus sham. PTSD symptoms, serum and 24h urine were obtained and analyzed. Effect sizes for PTSD symptoms were determined using Cohen's d. Active rTMS showed a larger effect size of improvement for hyperarousal symptoms compared to sham; 24-h urinary norepinephrine and serum T4 increased; serum prolactin decreased. Active rTMS with exposure may have symptomatic and physiological effects. Larger studies are needed to confirm these preliminary findings and verify whether rTMS plus exposure therapy has a role in the treatment of PTSD.
焦虑症和创伤后应激障碍（PTSD）的治疗方法包括暴露疗法和药物治疗，但有些患者对此并不敏感。关于重复经颅磁刺激（rTMS）治疗焦虑症或创伤后应激障碍的研究很少。在这份初步报告中，rTMS与暴露疗法相结合用于治疗创伤后应激障碍。对9名患有慢性、难治性创伤后应激障碍的受试者进行了研究，采用了安慰剂对照、交叉设计，将想象暴露疗法与rTMS（1Hz）与假刺激进行对比。收集并分析了创伤后应激障碍症状、血清和24小时尿液。使用Cohen's d确定创伤后应激障碍症状的效应大小。与假刺激相比，主动rTMS对过度觉醒症状的改善效应大小更大；24小时尿去甲肾上腺素和血清T4升高；血清催乳素降低。主动rTMS与暴露疗法相结合可能具有症状性和生理性影响。需要进行更大规模的研究来证实这些初步发现，并验证rTMS加暴露疗法在创伤后应激障碍治疗中是否具有作用。
