Philip Noah S, Nelson Brent G, Frohlich Flavio, Lim Kelvin O, Widge Alik S, Carpenter Linda L
From the Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, and the Center of Excellence for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, R.I.; the Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, Mass., and the Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, Mass.; the Department of Psychiatry, the Department of Biomedical Engineering, the Department of Cell Biology and Physiology, the Department of Neurology, and the Neuroscience Center, University of North Carolina at Chapel Hill; the Department of Psychiatry, University of Minnesota Medical School, Minneapolis, and the Geriatric Research Education and Clinical Center, Minneapolis VA Health Care System, Minneapolis, Minn.; the Butler Hospital Mood Disorders Research Program and Neuromodulation Research Facility, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I.
Am J Psychiatry. 2017 Jul 1;174(7):628-639. doi: 10.1176/appi.ajp.2017.16090996. Epub 2017 Feb 24.
Neurostimulation is rapidly emerging as an important treatment modality for psychiatric disorders. One of the fastest-growing and least-regulated approaches to noninvasive therapeutic stimulation involves the application of weak electrical currents. Widespread enthusiasm for low-intensity transcranial electrical current stimulation (tCS) is reflected by the recent surge in direct-to-consumer device marketing, do-it-yourself enthusiasm, and an escalating number of clinical trials. In the wake of this rapid growth, clinicians may lack sufficient information about tCS to inform their clinical practices. Interpretation of tCS clinical trial data is aided by familiarity with basic neurophysiological principles, potential mechanisms of action of tCS, and the complicated regulatory history governing tCS devices. A growing literature includes randomized controlled trials of tCS for major depression, schizophrenia, cognitive disorders, and substance use disorders. The relative ease of use and abundant access to tCS may represent a broad-reaching and important advance for future mental health care. Evidence supports application of one type of tCS, transcranial direct current stimulation (tDCS), for major depression. However, tDCS devices do not have regulatory approval for treating medical disorders, evidence is largely inconclusive for other therapeutic areas, and their use is associated with some physical and psychiatric risks. One unexpected finding to arise from this review is that the use of cranial electrotherapy stimulation devices-the only category of tCS devices cleared for use in psychiatric disorders-is supported by low-quality evidence.
神经刺激正迅速成为治疗精神疾病的一种重要治疗方式。非侵入性治疗刺激发展最快且监管最少的方法之一涉及弱电流的应用。直接面向消费者的设备营销热潮、自行操作的热情以及临床试验数量的不断增加,都反映出人们对低强度经颅电流刺激(tCS)的广泛热情。在这种快速发展之后,临床医生可能缺乏足够的关于tCS的信息来指导他们的临床实践。熟悉基本神经生理学原理、tCS的潜在作用机制以及tCS设备复杂的监管历史,有助于解读tCS临床试验数据。越来越多的文献包括tCS用于重度抑郁症、精神分裂症、认知障碍和物质使用障碍的随机对照试验。tCS相对易于使用且获取途径丰富,这可能代表着未来精神卫生保健领域一项影响广泛且重要的进展。有证据支持一种类型的tCS,即经颅直流电刺激(tDCS)用于治疗重度抑郁症。然而,tDCS设备尚未获得治疗医学疾病的监管批准,在其他治疗领域的证据大多尚无定论,并且其使用存在一些身体和精神方面的风险。本次综述产生的一个意外发现是,颅骨电刺激治疗设备——唯一一类被批准用于精神疾病的tCS设备——其使用得到的是低质量证据的支持。
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