Cusin Cristina, Dougherty Darin D
Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital, 149 13th Street, Rm 2612, Charlestown, MA 02129, USA.
Biol Mood Anxiety Disord. 2012 Aug 17;2:14. doi: 10.1186/2045-5380-2-14.
The field of non-pharmacological therapies for treatment resistant depression (TRD) is rapidly evolving and new somatic therapies are valuable options for patients who have failed numerous other treatments. A major challenge for clinicians (and patients alike) is how to integrate the results from published clinical trials in the clinical decision-making process.We reviewed the literature for articles reporting results for clinical trials in particular efficacy data, contraindications and side effects of somatic therapies including electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), vagal nerve stimulation (VNS) and deep brain stimulation (DBS). Each of these devices has an indication for patients with different level of treatment resistance, based on acuteness of illness, likelihood of response, costs and associated risks. ECT is widely available and its effects are relatively rapid in severe TRD, but its cognitive adverse effects may be cumbersome. TMS is safe and well tolerated, and it has been approved by FDA for adults who have failed to respond to one antidepressant, but its use in TRD is still controversial as it is not supported by rigorous double-blind randomized clinical trials. The options requiring surgical approach are VNS and DBS. VNS has been FDA-approved for TRD, however it is not indicated for management of acute illness. DBS for TRD is still an experimental area of investigation and double-blind clinical trials are underway.
难治性抑郁症（TRD）的非药物治疗领域正在迅速发展，对于那些多种其他治疗均告失败的患者而言，新的躯体治疗是有价值的选择。临床医生（以及患者）面临的一项重大挑战是如何将已发表临床试验的结果纳入临床决策过程。我们查阅了文献，以寻找报告临床试验结果的文章，特别是躯体治疗（包括电休克治疗（ECT）、经颅磁刺激（TMS）、迷走神经刺激（VNS）和深部脑刺激（DBS））的疗效数据、禁忌症和副作用。基于疾病的急性程度、反应可能性、成本和相关风险，这些设备中的每一种都有针对不同治疗抵抗水平患者的适应症。ECT广泛可用，在重度TRD中其效果相对较快，但其认知不良反应可能很麻烦。TMS安全且耐受性良好，已获美国食品药品监督管理局（FDA）批准用于对一种抗抑郁药无反应的成年人，但它在TRD中的应用仍存在争议，因为缺乏严格的双盲随机临床试验支持。需要手术方法的选择是VNS和DBS。VNS已获FDA批准用于TRD，但它不适用于急性疾病的治疗。TRD的DBS仍处于实验研究领域，双盲临床试验正在进行中。
