Kedzior Karina Karolina, Reitz Sarah Kim, Azorina Valeriya, Loo Colleen
Institute of Psychology and Transfer, University of Bremen, Bremen, Germany; Bremen International Graduate School of Social Sciences (BIGSSS), Jacobs University Bremen, Bremen, Germany.
Depress Anxiety. 2015 Mar;32(3):193-203. doi: 10.1002/da.22339. Epub 2015 Feb 13.
The aim of the current meta-analysis was to investigate predictors of the durability of the antidepressant effect of high-frequency (>1 Hz) repetitive transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex in the absence of active maintenance treatment.
Following a systematic literature search of Medline and PsycInfo, N = 16 double-blind, parallel-design, randomized-controlled trials (RCTs) with high-frequency rTMS and inactive sham were included in the current meta-analysis. The effect size (Cohen's d) was the standardized mean difference in depression scores between sham and rTMS groups (baseline -follow-up). Meta-analysis was conducted according to a random-effects model with inverse-variance weights.
Most RCTs reported only short follow-up phases of 2 weeks (range of 1-16 weeks). The antidepressant effect was observed during follow-up (in the absence of maintenance treatment) compared to baseline (overall mean weighted d = -.48, 95% confidence interval: -.70, -.25, P < .001, N = 16 RCTs with 495 patients). Such an antidepressant effect during follow-up was higher in RCTs with patients who were less severely ill, unipolar, nonpsychotic, treatment-resistant, and on antidepressants (either started with rTMS or continued at stable doses during acute treatment phases). The effect sizes were lower in RCTs with longer (8-16 weeks) compared to shorter (1-4 weeks) follow-up periods. The risk of publication bias was low.
High-frequency rTMS has only a small antidepressant effect during follow-up after short acute treatment (5-15 sessions) in the absence of active maintenance treatment. This effect depends on illness severity, decreases over time, and appears to be enhanced by antidepressants.
当前荟萃分析的目的是研究在无积极维持治疗的情况下，高频（>1Hz）重复经颅磁刺激（rTMS）左侧背外侧前额叶皮质抗抑郁作用的持久性预测因素。
在对Medline和PsycInfo进行系统文献检索后，本荟萃分析纳入了N = 16项采用高频rTMS和无效假刺激的双盲、平行设计、随机对照试验（RCT）。效应量（Cohen's d）为假刺激组与rTMS组之间抑郁评分的标准化平均差异（基线-随访）。采用随机效应模型和逆方差权重进行荟萃分析。
大多数RCT仅报告了2周的短期随访阶段（范围为1 - 16周）。与基线相比，随访期间（无维持治疗）观察到了抗抑郁作用（总体平均加权d = -.48，95%置信区间：-.70，-.25，P <.001，N = 16项RCT，共495例患者）。在病情较轻、单相、非精神病性、难治性且正在服用抗抑郁药（要么在rTMS治疗开始时服用，要么在急性治疗阶段以稳定剂量持续服用）的患者的RCT中，随访期间的这种抗抑郁作用更高。与较短（1 - 4周）随访期的RCT相比，较长（8 - 16周）随访期的RCT效应量更低。发表偏倚风险较低。
在无积极维持治疗的情况下，短期急性治疗（5 - 15次）后随访期间，高频rTMS仅有较小的抗抑郁作用。这种作用取决于疾病严重程度，随时间降低，且似乎会因抗抑郁药而增强。
