Department of Psychiatry, Mount Sinai School of Medicine, Bronx, New York, NY, USA.
Neuropsychobiology. 2012 Jun;65(4):227-35. doi: 10.1159/000336999. Epub 2012 May 25.
Clinical studies have shown that repetitive transcranial magnetic stimulation (rTMS) is effective in a certain percentage of treatment-resistant depression (TRD). The left dorsolateral prefrontal cortex (DLPFC) 10 Hz rTMS stimulation received FDA approval in 2008, although different rTMS protocols have also shown their effectiveness in reducing depressive symptoms. We investigated the clinical, cognitive and neurophysiologic effects of a 3 weeks' protocol of low-frequency rTMS applied over the right DLPFC in resistant depression.
Twenty-eight patients with TRD (age range 28-55) received low-frequency rTMS (1 Hz) over the right DLPFC in a 3-week open trial. Hamilton scales for depression and anxiety, Corsi block-tapping test, phonemic verbal fluency, right and left resting motor thresholds were evaluated in each subject over the trial period.
At the end of the trial 42.9% of the subjects were considered as responders. A significant reduction of both HAMD (p < 0.001) and HAMA (p < 0.01) total scores was observed. At the 3rd week, the performances in Corsi test (p < 0.02) and phonemic verbal fluency (p = 0.065) were improved independently from depressive symptoms variation. At the end of the rTMS protocol, a significantly decreased left hemisphere resting motor threshold was registered (p < 0.01), while right hemisphere resting motor threshold did not show significant variation.
Low-frequency rTMS over the right DLPFC appeared effective in 42.9% of depressive resistant subjects in this sample. A significant decrease in left hemisphere resting motor threshold was observed only in responders, while a trend for improvement in cognitive function has been found and appeared independent from clinical response.
临床研究表明，重复经颅磁刺激（rTMS）在一定比例的治疗抵抗性抑郁症（TRD）患者中有效。2008 年，FDA 批准了左背外侧前额叶皮层（DLPFC）10Hz rTMS 刺激的使用，尽管不同的 rTMS 方案也显示出降低抑郁症状的有效性。我们研究了右 DLPFC 接受 3 周低频 rTMS 刺激对抵抗性抑郁症的临床、认知和神经生理影响。
28 例 TRD 患者（年龄 28-55 岁）接受右 DLPFC 低频 rTMS（1Hz）3 周开放试验。在试验期间，对每位受试者进行汉密尔顿抑郁和焦虑量表、Corsi 方块测试、语音流畅性、右和左静息运动阈值评估。
试验结束时，42.9%的受试者被认为是应答者。HAMD（p<0.001）和 HAMA（p<0.01）总分显著降低。第 3 周，Corsi 测试（p<0.02）和语音流畅性（p=0.065）的表现独立于抑郁症状的变化而改善。在 rTMS 方案结束时，左半球静息运动阈值显著降低（p<0.01），而右半球静息运动阈值无显著变化。
在本样本中，右 DLPFC 低频 rTMS 对 42.9%的抵抗性抑郁患者有效。仅在应答者中观察到左半球静息运动阈值显著降低，而认知功能改善趋势明显，且与临床反应无关。
