Arns M, Bervoets C, van Eijndhoven P, Baeken C, van den Heuvel O A, Aleman A, Schutter D J L G, van der Werf Y, van Belkum S, Sommer I E, van Ruth R, Haarman B, Spijker J, Sack A T
Tijdschr Psychiatr. 2019;61(6):411-420.
Since 2017, repetitive transcranial magnetic stimulation (rTMS) has become eligible for reimbursement for the treatment of therapy-resistant depression in the Dutch healthcare system.
AIM: To initiate a guideline in the Netherlands and Belgium for the safe and effective application of rTMS for the treatment of depression.
METHOD: Based on literature review, existing guidelines and consensus among Dutch rTMS experts, recommendations were developed regarding the implementation of rTMS as a treatment of depression. All available evidence was weighed and discussed among all co-authors and recommendations were reached by consensus among the group.
RESULTS: rTMS targeting the dorsolateral prefrontal cortex (DLPFC) should be seen as a first choice in the treatment of depression using high-frequency rTMS (left) or, as an alternative, low-frequency rTMS (right). Stimulation protocols should use more than 1000 pulses per session for an average of 20-30 sessions, offered in 2-5 sessions per week. Contraindications for rTMS include epilepsy, intracranial presence of (magnetisable) metals, pacemaker and cochlear implant.
CONCLUSION: rTMS, performed by competent professionals is an effective and safe treatment for depression.
自2017年以来，在荷兰医疗保健系统中，重复经颅磁刺激（rTMS）已被纳入对难治性抑郁症治疗的报销范围。
在荷兰和比利时制定一项关于安全有效应用rTMS治疗抑郁症的指南。
基于文献综述、现有指南以及荷兰rTMS专家的共识，制定了关于实施rTMS治疗抑郁症的建议。对所有可得证据进行权衡，并在所有共同作者之间进行讨论，通过小组共识达成建议。
使用高频rTMS（左侧）或低频rTMS（右侧）治疗抑郁症时，靶向背外侧前额叶皮质（DLPFC）的rTMS应被视为首选。刺激方案每次疗程应使用超过1000个脉冲，平均进行20 - 30个疗程，每周进行2 - 5个疗程。rTMS的禁忌症包括癫痫、颅内存在（可磁化的）金属、起搏器和人工耳蜗。
由专业人员进行的rTMS是一种治疗抑郁症的有效且安全的方法。
