Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.
Neuropsychiatr Dis Treat. 2012;8:55-64. doi: 10.2147/NDT.S27025. Epub 2012 Jan 16.
Biological treatments are considered as additional options for the treatment of resistant unipolar depression. Controversial data exist about the efficacy and tolerability of three of the most used somatic treatments: electroconvulsive therapy (ECT), transcranial magnetic stimulation (rTMS), and deep transcranial magnetic stimulation (deepTMS). The aim of this review is to investigate and compare the efficacy and tolerability of these three techniques in drug-free patients with pharmacoresistant unipolar depression.
Three independent reviewers extracted data and assessed the quality of methodological reporting of selected studies. The first outcome was the clinical response to the three different techniques defined as a percentage improvement of Hamilton Depression Rating Scale (HDRS). The second outcome was the evaluation of their neuropsychological effects. The third outcome was the evaluation of the number of remitted patients; remission was defined as an absolute HDRS-24 score of ≤11 or as an absolute HDRS-17 score of ≤8. Tolerability was the fourth outcome; it was evaluated by examining the number of dropped-out patients.
The comparative evaluation of HDRS percentage variations shows ECT as the most effective method after 4 weeks of therapy; on the other hand, a better efficacy is obtainable by deepTMS after 2 weeks of therapy. DeepTMS is the technique that gives the best improvement of cognitive performances. The percentage of remitted patients obtained with ECT treatment is the same obtained in the deepTMS group. Both techniques have a remitted patients percentage two times larger than the rTMS. DeepTMS shows a tolerability, measured by the number of dropped-out patients, worse than ECT.
Our investigation confirms the great therapeutic power of ECT. DeepTMS seems to be the only therapy that provides a substantial improvement of both depressive symptoms and cognitive performances; nevertheless it is characterized by a poor tolerability. rTMS seems to provide a better tolerability for patients, but its therapeutic efficacy is lower. Considering the small therapeutic efficacy of deepTMS in the last 2 weeks of treatment, it could be reasonable to shorten the standard period of deepTMS treatment from 4 to 2 weeks, expecting a reduction of dropped-out patients and thus optimizing the treatment outcome.
生物治疗被认为是治疗耐药单相抑郁症的额外选择。有争议的数据存在于三种最常用的躯体治疗方法的疗效和耐受性：电惊厥疗法（ECT）、经颅磁刺激（rTMS）和深部经颅磁刺激（deepTMS）。本研究旨在调查和比较这三种技术在无药物治疗的药物抵抗性单相抑郁症患者中的疗效和耐受性。
三名独立的审查员提取数据并评估所选研究的方法报告质量。第一个结果是三种不同技术的临床反应，定义为汉密尔顿抑郁评定量表（HDRS）的百分比改善。第二个结果是评估它们的神经心理学影响。第三个结果是评估缓解患者的数量；缓解定义为绝对 HDRS-24 评分≤11 或绝对 HDRS-17 评分≤8。耐受性是第四个结果；通过检查退出患者的数量来评估。
HDRS 百分比变化的比较评估显示 ECT 在治疗 4 周后是最有效的方法；另一方面，在治疗 2 周后，deepTMS 可以获得更好的疗效。deepTMS 是改善认知表现的最佳技术。ECT 治疗获得的缓解患者百分比与 deepTMS 组相同。两种技术的缓解患者百分比均比 rTMS 高两倍。deepTMS 的耐受性（以退出患者的数量衡量）比 ECT 差。
我们的研究证实了 ECT 的强大治疗能力。deepTMS 似乎是唯一一种既能显著改善抑郁症状又能改善认知表现的治疗方法；然而，它的耐受性较差。rTMS 似乎为患者提供了更好的耐受性，但疗效较低。考虑到 deepTMS 在治疗最后 2 周的疗效较小，可以将 deepTMS 的标准治疗时间从 4 周缩短至 2 周，预期会减少退出患者，从而优化治疗结果。
