Lee Jonathan C, Lewis Charles P, Daskalakis Zafiris J, Croarkin Paul E
Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
Front Psychiatry. 2017 Jun 7;8:91. doi: 10.3389/fpsyt.2017.00091. eCollection 2017.
Adolescent depression is a prevalent disorder with substantial morbidity and mortality. Current treatment interventions do not target relevant pathophysiology and are frequently ineffective, thereby leading to a substantial burden for individuals, families, and society. During adolescence, the prefrontal cortex undergoes extensive structural and functional changes. Recent work suggests that frontolimbic development in depressed adolescents is delayed or aberrant. The judicious application of non-invasive brain stimulation techniques to the prefrontal cortex may present a promising opportunity for durable interventions in adolescent depression. Transcranial direct current stimulation (tDCS) applies a low-intensity, continuous current that alters cortical excitability. While this modality does not elicit action potentials, it is thought to manipulate neuronal activity and neuroplasticity. Specifically, tDCS may modulate -methyl-d-aspartate receptors and L-type voltage-gated calcium channels and effect changes through long-term potentiation or long-term depression-like mechanisms. This mini-review considers the neurobiological rationale for developing tDCS protocols in adolescent depression, reviews existing work in adult mood disorders, surveys the existing tDCS literature in adolescent populations, reviews safety studies, and discusses distinct ethical considerations in work with adolescents.
青少年抑郁症是一种普遍存在的疾病，具有较高的发病率和死亡率。目前的治疗干预措施并未针对相关病理生理学，且常常无效，从而给个人、家庭和社会带来沉重负担。在青少年时期，前额叶皮质会经历广泛的结构和功能变化。最近的研究表明，抑郁青少年的额边缘系统发育延迟或异常。将非侵入性脑刺激技术明智地应用于前额叶皮质，可能为青少年抑郁症的持久干预提供一个有前景的机会。经颅直流电刺激（tDCS）施加低强度的连续电流，以改变皮质兴奋性。虽然这种方式不会引发动作电位，但人们认为它能操纵神经元活动和神经可塑性。具体而言，tDCS可能会调节N-甲基-D-天冬氨酸受体和L型电压门控钙通道，并通过长时程增强或类长时程抑制机制产生效应变化。本综述探讨了在青少年抑郁症中开发tDCS方案的神经生物学原理，回顾了成人情绪障碍方面的现有研究，调查了青少年人群中现有的tDCS文献，回顾了安全性研究，并讨论了与青少年相关的独特伦理考量。
