Berlim Marcelo T, McGirr Alexander, Rodrigues Dos Santos Nicole, Tremblay Sara, Martins Ruben
Neuromodulation Research Clinic, Douglas Institute and McGill University, Montréal, Québec, Canada; Depressive Disorders Program, Douglas Institute and McGill University, Montréal, Québec, Canada.
Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
J Psychiatr Res. 2017 Jul;90:102-109. doi: 10.1016/j.jpsychires.2017.02.015. Epub 2017 Feb 21.
Theta burst stimulation (TBS) has been proposed as a novel treatment for major depression (MD). However, randomized and sham-controlled trials (RCTs) published to date have yielded heterogeneous clinical results and we have thus carried out the present systematic review and exploratory meta-analysis of RCTs to evaluate this issue. We searched the literature for RCTs on TBS for MD from January 2001 through September 2016 using MEDLINE, EMBASE, PsycINFO, and CENTRAL. We then performed a random-effects meta-analysis with the main outcome measures including pre-post score changes in the Hamilton Depression Rating Scale (HAM-D) as well as rates of response, remission and dropout. Data were obtained from 5 RCTs, totalling 221 subjects with MD. The pooled Hedges' g for pre-post change in HAM-D scores was 1.0 (p = 0.003), indicating a significant and large-sized difference in outcome favouring active TBS. Furthermore, active TBS was associated with significantly higher response rates when compared to sham TBS (35.6% vs. 17.5%, respectively; p = 0.005), although the groups did not differ in terms of rates of remission (18.6% vs. 10.7%, respectively; p = 0.1) and dropout (4.2% vs. 7.8%, respectively; p = 0.5). Finally, subgroup analyses indicated that bilateral TBS and unilateral intermittent TBS seem to be the most promising protocols. In conclusion, although TBS is a promising novel therapeutic intervention for MD, future studies should identify more clinically-relevant stimulation parameters as well as neurobiological predictors of treatment outcome, and include larger sample sizes, active comparators and longer follow-up periods.
theta爆发刺激（TBS）已被提议作为重度抑郁症（MD）的一种新型治疗方法。然而，迄今为止发表的随机和假刺激对照试验（RCT）产生了异质性的临床结果，因此我们进行了本次RCT的系统评价和探索性荟萃分析以评估此问题。我们使用MEDLINE、EMBASE、PsycINFO和CENTRAL从2001年1月至2016年9月搜索关于TBS治疗MD的RCT文献。然后我们进行了随机效应荟萃分析，主要结局指标包括汉密尔顿抑郁量表（HAM-D）的前后评分变化以及缓解率、治愈率和退出率。数据来自5项RCT，共221名MD患者。HAM-D评分前后变化的合并Hedges' g为1.0（p = 0.003），表明有利于主动TBS的结局存在显著且较大的差异。此外，与假TBS相比，主动TBS的缓解率显著更高（分别为35.6%和17.5%；p = 0.005），尽管两组在治愈率（分别为18.6%和10.7%；p = 0.1）和退出率（分别为4.2%和7.8%；p = 0.5）方面没有差异。最后，亚组分析表明双侧TBS和单侧间歇性TBS似乎是最有前景的方案。总之，尽管TBS是一种有前景的MD新型治疗干预措施，但未来的研究应确定更多与临床相关的刺激参数以及治疗结局的神经生物学预测指标，并纳入更大的样本量、活性对照和更长的随访期。
