Milev Roumen, Abraham Gaby, Hasey Gary, Cabaj Jason Lee
Department of Psychiatry, Queen's University, 752 King Street West, Kingston, Ontario, Canada.
J ECT. 2009 Mar;25(1):44-9. doi: 10.1097/YCT.0b013e3181770237.
The antidepressant effects of repetitive transcranial magnetic stimulation (rTMS) are well documented, but studies to date have produced heterogeneous results in late-life depression.
To address this matter, we evaluated the efficacy of both high- and low-frequency rTMS delivered to the prefrontal cortex of older adults with treatment-resistant major depression.
Forty-nine older adults (69 +/- 6.7 years) with treatment-refractory major depressive disorders underwent a series of rTMS treatments as an adjuvant to pharmacotherapy. Patients received high-frequency rTMS delivered to the left dorsolateral prefrontal cortex, low-frequency stimulation to the right dorsolateral prefrontal cortex, or a combination thereof, at 80-110% of the motor threshold.
There was a modest, but statistically significant, mean reduction (24.7%) in Hamilton Depression Rating Scale (HDRS) scores from baseline to the end of treatment. Nine patients were classified as responders (50% HDRS reduction), and 4 patients reached remission status (final HDRS score <8). Similar improvements in HDRS scores were observed for high- and low-frequency rTMS. Treatment was generally well tolerated, and no serious adverse effects were reported.
The findings support the contention that in older adults with treatment-refractory depression, rTMS can be an effective treatment alternative for some patients.
重复经颅磁刺激（rTMS）的抗抑郁作用已有充分文献记载，但迄今为止的研究在老年抑郁症患者中得出了不一致的结果。
为解决这一问题，我们评估了高频和低频rTMS对难治性重度抑郁症老年患者前额叶皮质的疗效。
49名（69±6.7岁）难治性重度抑郁症老年患者接受了一系列rTMS治疗作为药物治疗的辅助手段。患者接受左侧背外侧前额叶皮质的高频rTMS、右侧背外侧前额叶皮质的低频刺激或两者联合，刺激强度为运动阈值的80%-110%。
从基线到治疗结束，汉密尔顿抑郁量表（HDRS）评分平均有适度但具有统计学意义的降低（24.7%）。9名患者被归类为有反应者（HDRS降低50%），4名患者达到缓解状态（最终HDRS评分<8）。高频和低频rTMS在HDRS评分上有相似的改善。治疗总体耐受性良好，未报告严重不良反应。
研究结果支持这样的观点，即在难治性抑郁症老年患者中，rTMS对一些患者来说可以是一种有效的治疗选择。
