重复经颅磁刺激治疗成人和青少年难治性抑郁症：系统文献综述与荟萃分析
Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression in Adult and Youth Populations: A Systematic Literature Review and Meta-Analysis.
作者信息
Leggett Laura E, Soril Lesley J J, Coward Stephanie, Lorenzetti Diane L, MacKean Gail, Clement Fiona M
机构信息
Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Institute of Health Economics, Edmonton, Alberta, Canada.
出版信息
Prim Care Companion CNS Disord. 2015 Nov 5;17(6). doi: 10.4088/PCC.15r01807. eCollection 2015.
BACKGROUND
Between 30% and 60% of individuals with major depressive disorder will have treatment-resistant depression (TRD): depression that does not subside with pharmaceutical treatment. Repetitive transcranial magnetic stimulation (rTMS) is an emerging treatment for TRD.
OBJECTIVE
To establish the efficacy and optimal protocol for rTMS among adults and youth with TRD.
DATA SOURCES
Two systematic reviews were conducted: one to determine the efficacy of rTMS for adults with TRD and another to determine the effectiveness of rTMS for youth with TRD. For adults, MEDLINE, Cochrane Central Register of Controlled Trials, PubMed, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews, and Health Technology Assessment Database were searched from inception until January 10, 2014 with no language restrictions. Terms aimed at capturing the target diagnosis, such as depression and depressive disorder, were combined with terms describing the technology, such as transcranial magnetic stimulation and rTMS. Results were limited to studies involving human participants and designed as a randomized controlled trial. For youth, the search was altered to include youth only (aged 13-25 years) and all study designs. When possible, meta-analysis of response and remission rates was conducted.
STUDY SELECTION
Seventy-three articles were included in this review: 70 on adult and 3 on youth populations.
RESULTS
Meta-analysis comparing rTMS and sham in adults found statistically significant results favoring rTMS for response (RR: 2.35 [95% CI, 1.70-3.25]) and remission (RR: 2.24 [95% CI, 1.53-3.27]). No statistically significant differences were found when comparing high- and low-frequency, unilateral and bilateral, low- and high-intensity rTMS or rTMS and electroconvulsive therapy (ECT). While meta-analysis of results from the youth literature was not possible, the limited evidence base suggests that rTMS may be effective for treating TRD in youth.
CONCLUSIONS
The evidence available on the use of rTMS for adults with TRD indicates that rTMS is approximately twice as effective as a sham procedure, although the optimal rTMS protocol remains unclear. Evidence also indicates that rTMS is as effective as ECT and appears promising as a treatment for youth with TRD; however, the evidence base is underdeveloped.
背景
在重度抑郁症患者中，30%至60%的人会出现难治性抑郁症（TRD），即药物治疗后抑郁症状仍未缓解。重复经颅磁刺激（rTMS）是一种新兴的TRD治疗方法。
目的
确定rTMS在成年和青少年TRD患者中的疗效及最佳方案。
数据来源
进行了两项系统评价：一项确定rTMS对成年TRD患者的疗效，另一项确定rTMS对青少年TRD患者的有效性。对于成年人，检索了MEDLINE、Cochrane对照试验中心注册库、PubMed、EMBASE、PsycINFO、Cochrane系统评价数据库和卫生技术评估数据库，检索时间从建库至2014年1月10日，无语言限制。旨在捕捉目标诊断的术语，如抑郁症和抑郁障碍，与描述该技术的术语，如经颅磁刺激和rTMS相结合。结果仅限于涉及人类参与者且设计为随机对照试验的研究。对于青少年，检索范围调整为仅包括青少年（13至25岁）及所有研究设计。尽可能对反应率和缓解率进行荟萃分析。
研究选择
本综述纳入73篇文章：70篇针对成年人，3篇针对青少年人群。
结果
对成年人中rTMS与假刺激进行比较的荟萃分析发现，在反应方面（RR：2.35 [95% CI，1.70 - 3.25]）和缓解方面（RR：2.24 [95% CI，1.53 - 3.27]），rTMS具有统计学显著优势。在比较高频与低频、单侧与双侧、低强度与高强度rTMS或rTMS与电休克治疗（ECT）时，未发现统计学显著差异。虽然无法对青少年文献的结果进行荟萃分析，但有限的证据表明rTMS可能对治疗青少年TRD有效。
结论
现有关于rTMS用于成年TRD患者的证据表明，rTMS的疗效约为假手术的两倍，尽管最佳rTMS方案仍不明确。证据还表明，rTMS与ECT效果相当，且作为青少年TRD的治疗方法似乎很有前景；然而，证据基础尚不充分。
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