Department of Psychiatry, University of Toronto; Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
Department of Psychiatry, University of Toronto; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
J Affect Disord. 2020 Jul 1;272:259-268. doi: 10.1016/j.jad.2020.03.151. Epub 2020 May 1.
Antidepressant use in pregnancy is associated with high levels of decision-making difficulty for patients, and psychotherapy may not be effective for severe symptoms. Alternative treatment options are needed. We conducted a systematic review of the clinical effects and tolerability of non-invasive neurostimulation: repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), trigeminal nerve stimulation (TNS), and transcutaneous vagus nerve stimulation (tVNS) for the treatment of antenatal depression.
We searched PubMed, Google Scholar and Scopus for published articles in English (1990 to June 2019). Two reviewers reviewed full-text articles, assessed quality, and extracted data on maternal psychiatric, pregnancy and neonatal outcomes.
Of 565 articles, 21 met inclusion criteria: two RCTs (1 rTMS; 1 tDCS), four open-label studies (3 rTMS; 1 tDCS), three case series (3 rTMS), and twelve case reports (9 rTMS; 1 tDCS; 1 tACS; 1 TNS). In all but one published study (1 rTMS), non-invasive neurostimulation resulted in either response or remission of antenatal depression. Minor maternal side effects were reported in rTMS and tDCS studies, but not in other modalities. Fetal adverse effects were not reported in any intervention. A small proportion of participants dropped out of treatment (rTMS, tDCS).
Very few randomized trials have been conducted and there is significant heterogeneity in the parameters of the modalities that have been studied.
Non-invasive neurostimulation holds promise as a potentially effective and feasible alternative treatment for antenatal depression. Strategies to enhance recruitment of pregnant women into non-invasive neurostimulation trials that have longitudinal follow-up are needed.
抗抑郁药在怀孕期间的使用与患者的决策困难程度较高有关，而心理治疗可能对严重症状无效。需要替代治疗方案。我们对非侵入性神经刺激的临床效果和耐受性进行了系统评价：重复经颅磁刺激（rTMS）、经颅直流电刺激（tDCS）、经颅交流电刺激（tACS）、三叉神经刺激（TNS）和经皮迷走神经刺激（tVNS）治疗产前抑郁症。
我们在 PubMed、Google Scholar 和 Scopus 中搜索了 1990 年至 2019 年 6 月发表的英文文章。两名审查员审查了全文文章，评估了质量，并提取了产妇精神、妊娠和新生儿结局的数据。
在 565 篇文章中，有 21 篇符合纳入标准：两项随机对照试验（1 项 rTMS；1 项 tDCS），四项开放标签研究（3 项 rTMS；1 项 tDCS），三项病例系列研究（3 项 rTMS）和十二项病例报告（9 项 rTMS；1 项 tDCS；1 项 tACS；1 项 TNS）。除了一项已发表的研究（1 项 rTMS）外，非侵入性神经刺激均导致产前抑郁症的反应或缓解。rTMS 和 tDCS 研究报告了轻微的母体副作用，但其他模式则没有。在任何干预措施中均未报告胎儿不良反应。一小部分参与者退出了治疗（rTMS、tDCS）。
很少有随机试验进行，并且已经研究的模式的参数存在很大的异质性。
非侵入性神经刺激作为产前抑郁症的一种潜在有效且可行的替代治疗方法具有广阔的前景。需要制定策略，以增加具有纵向随访的非侵入性神经刺激试验中孕妇的参与度。
