Valkonen-Korhonen Minna, Leinola Hanna, Könönen Mervi, Niskanen Eini, Purhonen Maija, Pakarinen Maarit, Ruusunen Anu, Lehto Soili M, Mervaala Esa, Honkalampi Kirsi, Koivumaa-Honkanen Heli, Viinamäki Heimo
a Department of Psychiatry , Kuopio University Hospital , Kuopio , Finland.
b Institute of Clinical Medicine/Psychiatry , University of Eastern Finland , Kuopio , Finland.
Nord J Psychiatry. 2018 Nov;72(8):586-592. doi: 10.1080/08039488.2018.1500640. Epub 2018 Oct 23.
Prevention of the recurrence of major depression and its residual symptoms requires effective treatment. Our aim was to study the effects of bifrontal active rTMS controlled by sham rTMS in treatment-resistant unipolar major depressive disorder (MDD).
Thirty-seven patients with treatment-resistant MDD were randomized into two groups. One group received a total of 30 sessions of active bifrontal rTMS (10 Hz rTMS on left dorsolateral prefrontal cortex (DLPFC) and 1 Hz rTMS on right DLPFC) and the other group received bilateral sham rTMS on five days a week for six weeks.
Depressive symptoms significantly improved in both the groups, but without a significant group difference. Furthermore, patients with psychotic depression improved similarly to those with moderate or severe depression.
The results of present study indicate a large sham effect of stimulation treatment. The intensive structured treatment protocol may explain the positive outcome in both the groups. It is important to recognize, appreciate, and utilize placebo effects as a significant means of rehabilitation in psychiatric care.
预防重度抑郁症复发及其残留症状需要有效的治疗方法。我们的目的是研究假刺激重复经颅磁刺激（rTMS）对照下的双额叶主动rTMS治疗难治性单相重度抑郁症（MDD）的效果。
37例难治性MDD患者被随机分为两组。一组接受总共30次双额叶主动rTMS治疗（左侧背外侧前额叶皮质（DLPFC）给予10Hz rTMS，右侧DLPFC给予1Hz rTMS），另一组每周五天接受双侧假rTMS治疗，持续六周。
两组的抑郁症状均显著改善，但组间差异不显著。此外，伴有精神病性症状的抑郁症患者与中度或重度抑郁症患者的改善情况相似。
本研究结果表明刺激治疗存在较大的假刺激效应。强化的结构化治疗方案可能解释了两组的积极结果。认识、重视并将安慰剂效应作为精神科护理中一种重要的康复手段很重要。
