School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.
J ECT. 2009 Dec;25(4):256-60. doi: 10.1097/YCT.0b013e3181a2f87e.
Repetitive transcranial magnetic stimulation (rTMS) has been shown to be a safe treatment of depression, and research efforts are now largely focused on strategies to enhance its efficacy. Motor cortex experiments suggest that the effects of rTMS can be enhanced by first priming the same cortical area with transcranial direct current stimulation (tDCS). We explored this approach in depressed subjects.
Seven depressed subjects were given sessions of combined tDCS-rTMS to the left dorsolateral prefrontal cortex, exploring a range of tDCS and rTMS stimulation parameters and interstimulation intervals. Effects of repeated stimulation sessions on mood state and neuropsychological functioning were evaluated.
Most of the subjects showed little improvement with cathodal tDCS followed by 10-Hz rTMS, although 2 subjects showed marked improvement, one after a single stimulation session. Anodal tDCS followed by rTMS did not lead to any improvement. Preconditioning with tDCS seemed to greatly exacerbate the pain of subsequent rTMS. No adverse effects on neuropsychological functioning were observed.
Overall, preconditioning with cathodal tDCS followed by rTMS did not result in greater antidepressant efficacy than rTMS given at similar parameters in open trials, although the dramatic response in 1 subject is encouraging. Outcomes may be highly dependent on the exact stimulation paradigm in which tDCS and rTMS are combined. Researchers should be aware that preconditioning with tDCS may greatly increase the pain experienced with subsequent rTMS.
重复经颅磁刺激（rTMS）已被证明是一种安全的抑郁症治疗方法，目前的研究重点主要在于提高其疗效的策略。运动皮层实验表明，经颅直流电刺激（tDCS）预先刺激相同的皮层区域可以增强 rTMS 的效果。我们在抑郁患者中探索了这种方法。
7 名抑郁患者接受了左侧背外侧前额叶皮层的 tDCS-rTMS 联合治疗，探索了一系列 tDCS 和 rTMS 刺激参数和刺激间隔。评估了重复刺激疗程对情绪状态和神经心理学功能的影响。
尽管有 2 名患者在单次刺激后表现出明显改善，但大多数患者在阴极 tDCS 后接受 10-Hz rTMS 治疗效果不佳。阳极 tDCS 后 rTMS 治疗则没有任何改善。tDCS 预处理似乎极大地加剧了随后 rTMS 的疼痛。未观察到神经心理学功能的不良反应。
总的来说，与在开放性试验中给予相似参数的 rTMS 相比，阴极 tDCS 预处理后再进行 rTMS 并不能带来更大的抗抑郁疗效，尽管 1 名患者的显著反应令人鼓舞。结果可能高度依赖于 tDCS 和 rTMS 联合使用的确切刺激方案。研究人员应该意识到，tDCS 预处理可能会大大增加随后 rTMS 治疗时的疼痛。
