From Health Quality Ontario, Toronto, Ont., Canada (Sehatzadeh, Tu, Palimaka); the Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ont., Canada (Daskalakis); the Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe’s Hamilton, Hamilton, Ont., Canada (Yap, Bowen, O’Reilly); and the Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ont., Canada (Bowen, O’Reilly).
J Psychiatry Neurosci. 2019 May 1;44(3):151-163. doi: 10.1503/jpn.180056.
Approximately 35% of people with depression do not respond to 2 courses of antidepressant medications of adequate dosage, and treatment-resistant depression (TRD) is still a major clinical concern with a great impact on patients, their families, society and the health system. The present meta-analysis evaluates antidepressant efficacy of unilateral and bilateral repetitive transcranial magnetic stimulation (rTMS) in patients with unipolar TRD.
We searched for randomized controlled trials that compared rTMS with sham treatment and were published by Apr. 3, 2017. The primary outcome was improvement in depression scores measured using the Hamilton Rating Scale for Depression. The secondary outcomes were remission and response rates. Two independent review authors screened the studies and extracted the data.
Twenty-three studies met the inclusion criteria. Meta-analysis of the depression scores showed a weighted mean difference (WMD) of 3.36 (95% confidence interval [CI] 1.85–4.88) between unilateral rTMS and sham treatment. Stratified data showed that the effect was relatively higher when rTMS was used as an add-on to antidepressant medications (WMD 3.64, 95% CI 1.52–5.76) than when it was used as a stand-alone treatment (WMD 2.47, 95% CI 0.90–4.05). The WMD between bilateral rTMS and sham was 2.67 (95% CI 0.83–4.51), and all studies that contributed to this outcome used rTMS while participants were taking antidepressant medications. The pooled remission and response rates for unilateral rTMS versus sham treatment were 16.0% and 25.1% for rTMS and 5.7% and 11.0% for sham treatment, respectively. The pooled remission and response rates for bilateral rTMS versus sham treatment were 16.6% and 25.4% for rTMS and 2.0% and 6.8% for sham treatment, respectively.
This study suggests that rTMS has moderate antidepressant effects and appears to be promising in the short-term treatment of patients with unipolar TRD.
约 35%的抑郁症患者对 2 个疗程足量的抗抑郁药物治疗没有反应，治疗抵抗性抑郁症（TRD）仍然是一个主要的临床关注点，对患者、他们的家庭、社会和卫生系统都有很大的影响。本荟萃分析评估了单侧和双侧重复经颅磁刺激（rTMS）治疗单相 TRD 患者的抗抑郁疗效。
我们检索了截至 2017 年 4 月 3 日比较 rTMS 与假刺激治疗的随机对照试验。主要结局是使用汉密尔顿抑郁量表（Hamilton Rating Scale for Depression）测量的抑郁评分改善。次要结局是缓解率和反应率。两位独立的综述作者筛选了研究并提取了数据。
23 项研究符合纳入标准。荟萃分析显示，单侧 rTMS 与假刺激治疗相比，抑郁评分的加权均数差（WMD）为 3.36（95%置信区间 [CI] 1.85-4.88）。分层数据显示，当 rTMS 作为抗抑郁药物的附加治疗（WMD 3.64，95% CI 1.52-5.76）时，效果相对较高，而当 rTMS 作为单独治疗（WMD 2.47，95% CI 0.90-4.05）时效果较低。双侧 rTMS 与假刺激治疗的 WMD 为 2.67（95% CI 0.83-4.51），所有对该结果有贡献的研究均在参与者服用抗抑郁药物的同时使用 rTMS。单侧 rTMS 与假刺激治疗相比，缓解率和反应率分别为 16.0%和 25.1%（rTMS）和 5.7%和 11.0%（假刺激）。双侧 rTMS 与假刺激治疗相比，缓解率和反应率分别为 16.6%和 25.4%（rTMS）和 2.0%和 6.8%（假刺激）。
本研究表明，rTMS 具有中等的抗抑郁作用，在短期治疗单相 TRD 患者方面似乎很有前景。
