Perera Tarique, George Mark S, Grammer Geoffrey, Janicak Philip G, Pascual-Leone Alvaro, Wirecki Theodore S
Contemporary Care, Greenwich, CT, USA.
Brain Stimulation Division, Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson VA Medical Center, Charleston, SC, USA.
Brain Stimul. 2016 May-Jun;9(3):336-346. doi: 10.1016/j.brs.2016.03.010. Epub 2016 Mar 16.
Prefrontal Transcranial Magnetic Stimulation (TMS) therapy repeated daily over 4-6 weeks (20-30 sessions) is US Food and Drug Administration (FDA) approved for treating Major Depressive Disorder in adults who have not responded to prior antidepressant medications. In 2011, leading TMS clinical providers and researchers created the Clinical TMS Society (cTMSs) (www.clinicaltmssociety.org, Greenwich, CT, USA), incorporated in 2013.
This consensus review was written by cTMSs leaders, informed by membership polls, and approved by the governing board. It summarizes current evidence for the safety and efficacy of the use of TMS therapy for treating depression in routine clinical practice. Authors systematically reviewed the published TMS antidepressant therapy clinical trials. Studies were then assessed and graded on their strength of evidence using the Levels of Evidence framework published by the University of Oxford Centre for Evidence Based Medicine. The authors then summarize essentials for using TMS therapy in routine clinical practice settings derived from discussions and polls of cTMSs members. Finally, each summary clinical recommendation is presented with the substantiating peer-reviewed, published evidence supporting that recommendation. When the current published clinical trial evidence was insufficient or incomplete, expert opinion was included when sufficient consensus was available from experienced clinician users among the membership of the cTMSs, who were polled at the Annual Meetings in 2014 and 2015.
Daily left prefrontal TMS has substantial evidence of efficacy and safety for treating the acute phase of depression in patients who are treatment resistant or intolerant. Following the clinical recommendations in this document should result in continued safe and effective use of this exciting new treatment modality.
经美国食品药品监督管理局（FDA）批准，每天重复进行经颅磁刺激（TMS）治疗，持续4至6周（20至30次疗程），可用于治疗对先前抗抑郁药物无反应的成年重度抑郁症患者。2011年，领先的TMS临床供应商和研究人员创建了临床TMS协会（cTMSs）（www.clinicaltmssociety.org，美国康涅狄格州格林威治），该协会于2013年注册成立。
本共识性综述由cTMSs的负责人撰写，参考了会员调查结果，并经理事会批准。它总结了目前关于TMS治疗在常规临床实践中治疗抑郁症的安全性和有效性的证据。作者系统地回顾了已发表的TMS抗抑郁治疗临床试验。然后，根据牛津大学循证医学中心发布的证据水平框架，对研究的证据强度进行评估和分级。作者随后总结了在常规临床实践环境中使用TMS治疗的要点，这些要点源自对cTMSs成员的讨论和调查。最后，每项总结性临床建议均配有经同行评审并发表的证据，以支持该建议。当目前已发表的临床试验证据不足或不完整时，如果cTMSs成员中的经验丰富的临床使用者在2014年和2015年的年会上达成了足够的共识，则纳入专家意见。
对于难治性或不耐受性抑郁症患者的急性期治疗，每日左侧前额叶TMS有充分的疗效和安全性证据。遵循本文档中的临床建议应能使这种令人兴奋的新治疗方式持续安全有效地使用。
