Teng S, Guo Z, Peng H, Xing G, Chen H, He B, McClure M A, Mu Q
The Department of Imaging & Imaging Institute of Rehabilitation and Development of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, 637000 Nanchong, China.
The Department of Imaging & Imaging Institute of Rehabilitation and Development of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, 637000 Nanchong, China; Lotus Biotech.com LLC., John Hopkins University-MCC, Rockville, Maryland, USA.
Eur Psychiatry. 2017 Mar;41:75-84. doi: 10.1016/j.eurpsy.2016.11.002. Epub 2017 Feb 3.
Depression is a major debilitating psychiatric disorder. Current antidepressant drugs are often associated with side effects or treatment resistance. The aim of this meta-analysis was to evaluate therapeutic effects of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) in major depression (MD).
The medical data bases of PubMed, Medline, Embase and Cochrane Central Register were searched for randomized controlled trials (RCTs) reporting the therapeutic effects of high-frequency rTMS for depression, which were published in English between January 1990 and June 2016. The index terms were "depress*", "depression" and "transcranial magnetic stimulation". Depression outcome data of different sessions (5, 10, 15, and 20 sessions of rTMS treatment) were extracted and synthesized by calculating standardized mean difference (SMD) with 95% confidence intervals (CI) by using a random-effect model. Within each session group, the subgroup analyses based on the number of pulses (≤1000, 1200-1500, 1600-1800, and 2000-3000) were also conducted.
Thirty RCTs with a total of 1754 subjects including 1136 in the rTMS group and 618 in the sham group were included in this meta-analysis. rTMS had a significant overall therapeutic effect on depression severity scores (SMD=-0.73, P<0.00001). The five, 10, 15, 20 sessions of rTMS treatments yielded the significant mean effect sizes of -0.43, -0.60, -1.13, and -2.74, respectively. In the four groups (5, 10, 15, 20 sessions), the maximal mean effect size was all obtained in the subgroup of 1200-1500 pulses per day (-0.97, -1.14, -1.91, -5.47; P<0.05).
The increasing of HF-rTMS sessions is associated with the increased efficacy of HF-rTMS in reducing depressed patients' symptom severity. A total number of pulses of 1200-1500 per day appear to deliver the best antidepressant effects of HF-rTMS.
抑郁症是一种严重的致残性精神障碍。目前的抗抑郁药物常常伴有副作用或治疗抵抗。本荟萃分析的目的是评估高频重复经颅磁刺激（HF-rTMS）治疗重度抑郁症（MD）的疗效。
检索PubMed、Medline、Embase和Cochrane Central Register等医学数据库，查找1990年1月至2016年6月间以英文发表的关于高频rTMS治疗抑郁症的随机对照试验（RCT）。检索词为“depress*”“depression”和“transcranial magnetic stimulation”。提取不同疗程（5、10、15和20次rTMS治疗）的抑郁结局数据，并采用随机效应模型计算标准化均数差（SMD）及95%置信区间（CI）进行综合分析。在每个疗程组内，还基于脉冲数（≤1000、1200 - 1500、1600 - 1800和2000 - 3000）进行亚组分析。
本荟萃分析纳入了30项RCT，共1754例受试者，其中rTMS组1136例，假刺激组618例。rTMS对抑郁严重程度评分具有显著的总体治疗效果（SMD = -0.73，P < 0.00001）。5、10、15、20次rTMS治疗的平均效应量分别为-0.43、-0.60、-1.13和-2.74。在四组（5、10、15、20次疗程）中，最大平均效应量均出现在每天1200 - 1500脉冲的亚组中（-0.97、-1.14、-1.91、-5.47；P < 0.05）。
HF-rTMS疗程的增加与HF-rTMS减轻抑郁症患者症状严重程度的疗效增加相关。每天1200 - 1500个脉冲似乎能产生最佳的HF-rTMS抗抑郁效果。
