School of Humanities and Social Sciences, Jacobs University Bremen, Bremen, Germany.
School of Engineering and Science, Jacobs University Bremen, Bremen, Germany.
Neuropsychiatr Dis Treat. 2014 May 7;10:727-56. doi: 10.2147/NDT.S58405. eCollection 2014.
Repetitive transcranial magnetic stimulation (rTMS) of the dorsolateral prefrontal cortex (DLPFC) appears to have short-term antidepressant properties. The aim of the current study was to update our previous meta-analysis and to investigate factors associated with the antidepressant properties of rTMS.
Following a systematic literature search conducted in Medline and PsycInfo, N=14 sham-controlled, parallel design studies (published after 2008 to August 2013) that had utilized rTMS of the DLPFC in major depression were included in the current meta-analysis. The sensitivity and moderator analyses also included data from N=40 studies (published in 1997-2008) from our previous meta-analysis. The effect size (Cohen's d) in each study was the standardized difference in mean depression scores (on Hamilton Depression Rating Scale, Beck Depression Inventory, Montgomery Åsberg Depression Rating Scale) from baseline to final (after last session) in rTMS compared to sham groups.
According to a random-effects model with inverse-variance weights, depression scores were significantly reduced after rTMS compared to sham in studies published from 2008-2013 based on N=659 patients (overall mean weighted d=-0.42, 95% confidence interval: -0.66, -0.18, P=0.001). Combining studies from our past and current meta-analyses (published in 1997-2013; N=54) revealed that depression was significantly reduced after left-fast (>1 Hz), right-slow (≤1 Hz), and bilateral (or sequential) rTMS of DLPFC compared to sham. Significant antidepressant properties of rTMS were observed in studies with patients who were treatment resistant, unipolar (or bipolar), non-psychotic, medication-free (or started on antidepressants concurrently with rTMS). According to univariate meta-regressions, depression scores were significantly lower in studies with more female patients and fewer stimuli per session. There was little evidence that publication bias occurred in the analysis.
According to this study, the largest meta-analysis to date, short-term antidepressant properties of rTMS are independent of concurrent antidepressants and might depend on sex and the number of stimuli per session.
重复经颅磁刺激（rTMS）于背外侧前额叶皮质（DLPFC）似乎具有短期抗抑郁的特性。本研究的目的是更新我们之前的荟萃分析，并研究与 rTMS 的抗抑郁特性相关的因素。
通过在 Medline 和 PsycInfo 中进行系统的文献检索，我们纳入了 14 项随机对照、平行设计的研究（2008 年后至 2013 年 8 月发表），这些研究均使用了 rTMS 对重度抑郁症患者的 DLPFC 进行了治疗。敏感性和调节分析还包括了我们之前荟萃分析中 40 项研究（1997 年至 2008 年发表）的数据。每个研究的效应量（Cohen's d）是 rTMS 组与假刺激组之间基线至最后一次（最后一次治疗后）平均抑郁评分（汉密尔顿抑郁量表、贝克抑郁量表、蒙哥马利抑郁评定量表）的标准化差异。
根据基于 N=659 例患者的随机效应模型，根据Inverse-variance weights 计算的结果，与假刺激相比，2008-2013 年发表的研究中 rTMS 后抑郁评分显著降低（总体平均加权 d=-0.42，95%置信区间：-0.66，-0.18，P=0.001）。将我们过去和当前荟萃分析中的研究（1997-2013 年发表；N=54）合并后发现，与假刺激相比，左侧快速（>1 Hz）、右侧缓慢（≤1 Hz）和双侧（或序贯）DLPFC rTMS 治疗后抑郁显著减轻。在治疗抵抗、单相（或双相）、非精神病、无药物（或同时开始抗抑郁药和 rTMS）的患者中，rTMS 具有显著的抗抑郁特性。根据单变量荟萃回归分析，女性患者较多和每个疗程刺激次数较少的研究中抑郁评分显著较低。分析结果几乎没有证据表明存在发表偏倚。
根据这项迄今为止最大的荟萃分析，rTMS 的短期抗抑郁特性独立于同时使用的抗抑郁药物，可能取决于性别和每个疗程的刺激次数。
