Uskudar University, Neuropsychiatry Istanbul Hospital, Department of Psychiatry, Istanbul, Turkey.
Neuropsychiatr Dis Treat. 2013;9:501-4. doi: 10.2147/NDT.S44241. Epub 2013 Apr 15.
The aim of the study reported here was to examine the safety and effectiveness of high-frequency repetitive transcranial magnetic stimulation (rTMS) in elderly patients with depression.
Sixty-five depressed elderly patients received rTMS over their left prefrontal cortex for 6 days per week, from Monday to Saturday, for 3 weeks. The rTMS intensity was set at 100% of the motor threshold and 25 Hz stimulation with a duration of 2 seconds and was delivered 20 times at 30-second intervals. A full course comprised an average of 1000 magnetic pulses. Depression was rated using the Hamilton Depression Rating Scale (HAMD) before and after treatment. Response was defined as a 50% reduction in HAMD score. Patients with HAMD scores < 8 were considered to be in remission.
The mean HAMD score for the study group decreased from 21.94 ± 5.12 before treatment to 11.28 ± 4.56 after rTMS (P < 0.001). Following the treatment period, 58.46% of the study group demonstrated significant mood improvement, as indexed by a reduction of more than 50% on the HAMD score. Nineteen of these 38 patients attained remission (HAMD score < 8), while 41.54% of all study patients achieved a partial response. None of the patients had a worsened HAMD score at the end of the treatment. Treatment was generally well tolerated and no serious adverse effects were reported.
In this study, rTMS was found to be a safe, well-tolerated treatment, and a useful adjunctive treatment to medications in elderly treatment-resistant depressed patients. This study contributes to the existing evidence on the antidepressant effect of rTMS in the treatment of depression in patients over 60 years of age.
本研究旨在探讨高频重复经颅磁刺激（rTMS）治疗老年抑郁症患者的安全性和有效性。
65 例老年抑郁症患者接受 rTMS 治疗，刺激部位为左侧前额叶皮质，每周 6 天，周一至周六，连续 3 周。rTMS 强度设定为运动阈值的 100%，刺激频率为 25Hz，持续时间为 2 秒，间隔 30 秒给予 20 次刺激。一个疗程平均包含 1000 个磁脉冲。治疗前后采用汉密尔顿抑郁量表（HAMD）对抑郁程度进行评分。以 HAMD 评分降低 50%定义为有效。HAMD 评分<8 分者为缓解。
研究组患者治疗前 HAMD 评分为 21.94±5.12 分，治疗后为 11.28±4.56 分（P<0.001）。治疗后，研究组 58.46%的患者 HAMD 评分显著改善，HAMD 评分降低超过 50%。其中 19 例患者达到缓解（HAMD 评分<8），38 例患者中 41.54%的患者达到部分缓解。治疗结束时，所有患者的 HAMD 评分均未恶化。治疗总体上耐受良好，无严重不良反应发生。
rTMS 治疗老年难治性抑郁症患者安全、耐受性好，可作为药物治疗的辅助手段。本研究为 rTMS 治疗 60 岁以上抑郁症患者的抗抑郁作用提供了新的证据。
