Laboratory of Brain and Cognition, 4804 Montgomery Avenue, Bethesda, MD 20814, USA.
Behavioral Neurology Unit, NINDS, NIH, DHHS, USA.
Brain Stimul. 2014 Jan-Feb;7(1):36-41. doi: 10.1016/j.brs.2013.07.004. Epub 2013 Jul 29.
While the efficacy of repetitive transcranial magnetic stimulation (rTMS) at 10 Hz over the left prefrontal cortex has been repeatedly demonstrated, it is not clear that the optimal parameters for the treatment of depression have been adequately elucidated.
We sought to assess the antidepressant effectiveness of high and low frequency at a higher intensity rTMS compared to sham in patients with moderately treatment resistant depression.
The authors conducted a three-week, double-blind, randomized, sham-controlled study of 24 acutely depressed patients given either active 20 Hz (n = 8) or 1 Hz (n = 8) rTMS (at 110% of motor threshold [MT]) or sham treatments (n = 8) over the left prefrontal cortex. Hamilton Depression ratings were analyzed by ANOVA.
Patients on both frequencies showed greater improvement than on sham, which was associated with minor increases in depression. During open continuation to allow 7 weeks of active treatment in all individuals, additional improvement was observed.
The results seen here using 110% of MT for 3 weeks were more robust than those of previous studies of 1-Hz or 20-Hz rTMS for 2 weeks (at 80% and 100% of MT). The results also raise the possibility that both high and low frequency rTMS over left prefrontal cortex (and not just low frequency over the right prefrontal cortex) exert antidepressant effects, but further work is required to assess what parameters may be most effective in general and for a given individual.
虽然经颅重复磁刺激（rTMS）在左前额皮质的 10Hz 频率下的疗效已被反复证明，但治疗抑郁症的最佳参数是否已得到充分阐明尚不清楚。
我们旨在评估与假刺激相比，高频和低频 rTMS 在治疗中度抗抑郁药物治疗抵抗的抑郁症患者中的抗抑郁效果。
作者进行了一项为期 3 周的双盲、随机、假对照研究，共纳入 24 例急性抑郁患者，分别接受左前额皮质的高频（20Hz，n=8）、低频（1Hz，n=8）rTMS（110%运动阈值[MT]）或假刺激（n=8）治疗。汉密尔顿抑郁量表评分采用方差分析进行分析。
与假刺激相比，两种频率的患者均有更大的改善，这与抑郁程度的轻微增加有关。在开放延续治疗中，允许所有患者接受 7 周的积极治疗，观察到了进一步的改善。
与之前使用 80%和 100% MT 的 1Hz 或 20Hz rTMS 治疗 2 周的研究相比，此处使用 110% MT 进行 3 周的治疗结果更为显著。结果还提示高频和低频 rTMS （而不仅仅是低频 rTMS）都可能对左前额皮质产生抗抑郁作用，但需要进一步研究来评估哪些参数在一般情况下和对于特定个体可能最有效。
