Cosmo Camila, Zandvakili Amin, Petrosino Nicholas J, Berlow Yosef A, Philip Noah S
VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Healthcare System, 830 Chalkstone Ave, Providence, 02908 USA.
Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI USA.
Curr Treat Options Psychiatry. 2021;8(2):47-63. doi: 10.1007/s40501-021-00238-y. Epub 2021 Mar 11.
Transcranial magnetic stimulation (TMS) is an evidence-based treatment for pharmacoresistant major depressive disorder (MDD). In the last decade, the field has seen significant advances in the understanding and use of this new technology. This review aims to describe the large, randomized controlled studies leading to the modern use of rTMS for MDD. It also includes a special section briefly discussing the use of these technologies during the COVID-19 pandemic.
Several new approaches and technologies are emerging in this field, including novel approaches to reduce treatment time and potentially yield new approaches to optimize and maximize clinical outcomes. Of these, theta burst TMS now has evidence indicating it is non-inferior to standard TMS and provides significant advantages in administration. Recent studies also indicate that neuroimaging and related approaches may be able to improve TMS targeting methods and potentially identify those patients most likely to respond to stimulation.
While new data is promising, significant research remains to be done to individualize and optimize TMS procedures. Emerging new approaches, such as accelerated TMS and advanced targeting methods, require additional replication and demonstration of real-world clinical utility. Cautious administration of TMS during the pandemic is possible with careful attention to safety procedures.
经颅磁刺激（TMS）是一种针对药物难治性重度抑郁症（MDD）的循证治疗方法。在过去十年中，该领域在对这项新技术的理解和应用方面取得了重大进展。本综述旨在描述促成rTMS在MDD治疗中现代应用的大型随机对照研究。它还包括一个特别部分，简要讨论在2019冠状病毒病大流行期间这些技术的使用情况。
该领域正在出现几种新方法和技术，包括缩短治疗时间的新方法，并有可能产生优化和最大化临床结果的新方法。其中，theta波爆发式TMS现在有证据表明它不劣于标准TMS，并且在给药方面具有显著优势。最近的研究还表明，神经影像学及相关方法可能能够改进TMS靶向方法，并有可能识别出最可能对刺激产生反应的患者。
虽然新数据很有前景，但仍需开展大量研究以实现TMS程序的个体化和优化。新兴的新方法，如加速TMS和先进的靶向方法，需要进一步重复验证并证明其在实际临床中的效用。在大流行期间谨慎使用TMS并仔细关注安全程序是可行的。
