van Belkum S M, de Boer M K, Taams G-J, Schutter D J L G, Aleman A, Schoevers R A, Haarman B C M
Tijdschr Psychiatr. 2018;60(11):766-773.
At present, the use of repetitive transcranial magnetic stimulation (rtms) for treatment-resistant depression is sufficiently substantiated to be applied in clinical practice. In the Netherlands, it will be reimbursed when offered in combination with cognitive behavior therapy.
AIM: Proposal for a clinical treatment protocol for rtms in The Netherlands.
METHOD: A study of the literature and a critical appraisal of available international guidelines for rtms.
RESULTS: rtms is a safe treatment for patients suffering from a moderate to severe depressive disorder that is relatively treatment-resistant. The duration of the effect is still unknown. It is advised to stimulate the left dorsolateral prefrontal cortex using an intensity of 120% of the resting motor threshold, with a frequency of 10 Hz and using 3000 pulses per session during a total of 20-30 sessions.
CONCLUSION: The proposed treatment protocol is favored based on the available evidence when rtms is used as a treatment aimed to acutely decrease the severity of depressive symptoms. It is further proposed to systematically collect technical and outcome data on treatment with rtms to further improve treatment with rtms in clinical practice.
目前，重复经颅磁刺激（rtms）用于难治性抑郁症的治疗有充分依据，可应用于临床实践。在荷兰，当与认知行为疗法联合使用时，rtms将可报销。
提出荷兰rtms临床治疗方案。
对文献进行研究，并对现有的国际rtms指南进行批判性评估。
rtms对患有中度至重度抑郁症且相对难治的患者是一种安全的治疗方法。其效果持续时间尚不清楚。建议使用静息运动阈值120%的强度刺激左侧背外侧前额叶皮质，频率为10Hz，每次治疗使用3000个脉冲，共进行20 - 30次治疗。
当rtms用作旨在急性减轻抑郁症状严重程度的治疗方法时，根据现有证据，所提出的治疗方案是可取的。进一步建议系统收集rtms治疗的技术和结果数据，以在临床实践中进一步改善rtms治疗。
