经皮耳迷走神经刺激治疗抑郁症:现状与未来展望

Treating Depression with Transcutaneous Auricular Vagus Nerve Stimulation: State of the Art and Future Perspectives.

作者信息

Kong Jian, Fang Jiliang, Park Joel, Li Shaoyuan, Rong Peijing

机构信息

Psychiatry Department, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States.

Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.

出版信息

Front Psychiatry. 2018 Feb 5;9:20. doi: 10.3389/fpsyt.2018.00020. eCollection 2018.

Abstract

Depression is a highly prevalent disorder, and its treatment is far from satisfactory. There is an urgent need to develop a new treatment for depression. Although still at its early stage, transcutaneous auricular vagus nerve stimulation (taVNS) has shown promising potential for treating depression. In this article, we first summarize the results of clinical studies on the treatment effect of taVNS on depression. Then, we re-analyze a previous study to identify the specific symptoms taVNS can relieve as indicated by subscores of the 24-item Hamilton Depression Scale in patients with depression. We found that taVNS can significantly reduce multiple symptoms of depression patients, including anxiety, psychomotor retardation, sleep disturbance, and hopelessness. Next, we pose several hypotheses on the mechanism of taVNS treatment of depression, including directly and indirectly modulating the activity and connectivity of key brain regions involved in depression and mood regulation; inhibiting neuro-inflammatory sensitization; modulating hippocampal neurogenesis; and regulating the microbiome-brain-gut axis. Finally, we outline current challenges and lay out the future directions of taVNS treatment of depression, which include (1) intensively comparing stimulation parameters and "dose effect" (treatment frequency and duration) to maximize the treatment effect of taVNS; (2) exploring the effect of taVNS on disorders comorbid with depression (such as chronic pain disorders, cardiovascular disorder, and autism) to provide new "two-for-one" treatment approaches for patients with these disorders; and (3) applying multiple scale methods to explore the underlying mechanism of taVNS.

摘要

抑郁症是一种非常普遍的疾病,其治疗效果远不尽如人意。迫切需要开发一种新的抑郁症治疗方法。虽然经皮耳迷走神经刺激(taVNS)仍处于早期阶段,但已显示出治疗抑郁症的潜在前景。在本文中,我们首先总结了关于taVNS治疗抑郁症效果的临床研究结果。然后,我们重新分析了一项先前的研究,以确定taVNS可以缓解的特定症状,这些症状由抑郁症患者24项汉密尔顿抑郁量表的子分数表示。我们发现taVNS可以显著减轻抑郁症患者的多种症状,包括焦虑、精神运动迟缓、睡眠障碍和绝望感。接下来,我们对taVNS治疗抑郁症的机制提出了几个假设,包括直接和间接调节参与抑郁症和情绪调节的关键脑区的活动和连接性;抑制神经炎症敏感性;调节海马神经发生;以及调节微生物群-脑-肠轴。最后,我们概述了当前的挑战,并阐述了taVNS治疗抑郁症的未来方向,其中包括:(1)深入比较刺激参数和“剂量效应”(治疗频率和持续时间),以最大化taVNS的治疗效果;(2)探索taVNS对与抑郁症共病的疾病(如慢性疼痛疾病、心血管疾病和自闭症)的影响,为这些疾病的患者提供新的“一举两得”的治疗方法;(3)应用多种量表方法探索taVNS的潜在机制。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f6e5/5807379/42f68be4e9b8/fpsyt-09-00020-g001.jpg

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