Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
Bipolar Disord. 2022 Feb;24(1):10-26. doi: 10.1111/bdi.13099. Epub 2021 May 26.
Repetitive transcranial magnetic stimulation (rTMS) is commonly used in unipolar depression; yet, its evidence in bipolar disorder (BD) is limited. We sought to review the evidence on the use of rTMS across the different stages of BD.
MEDLINE database was systematically searched using the PubMed interface following the PRISMA guidelines. Inclusion criteria were as follows: (i) randomized clinical trials (RCTs), open-label studies, and case series; (ii) specific evaluation of the treatment outcomes using psychometric scales; (iii) clinical studies in adults; and (iv) articles in the English language. The systematic review has been registered on PROSPERO (CRD42020192788).
Thirty-one papers were included in the review. Most studies included participants diagnosed with a bipolar depressive episode (N = 24), have yielded mixed findings, and have yet to reach a consensus on the most effective rTMS protocol. Few studies examined the effect of rTMS during manic (N = 5) or mixed episode (N = 1), or as maintenance treatment (N = 1). The limited data thus far suggest rTMS to be relatively safe and well tolerated. Small sample sizes, heterogeneity among study designs, patients and control groups recruited, rTMS parameters, and outcome measures are among the most significant limitations to these studies.
The current data regarding the application of rTMS in BD patients remain limited. More adequately powered sham-controlled studies are required to verify its efficacy. Large-scale clinical trials are needed to also determine whether its effects extend to manic and mixed episodes, as well as its role in mood stabilization and amelioration of suicidal behavior.
重复经颅磁刺激（rTMS）常用于单相抑郁症；然而，其在双相障碍（BD）中的证据有限。我们旨在综述 rTMS 在 BD 不同阶段的应用证据。
采用 PRISMA 指南，通过 PubMed 界面对 MEDLINE 数据库进行系统检索。纳入标准如下：（i）随机临床试验（RCT）、开放标签研究和病例系列；（ii）使用心理计量量表对治疗结局进行具体评估；（iii）针对成人的临床研究；以及（iv）英文文章。本系统评价已在 PROSPERO（CRD42020192788）上注册。
共纳入 31 篇论文。大多数研究纳入了被诊断为双相抑郁发作的参与者（N=24），研究结果喜忧参半，尚未就最有效的 rTMS 方案达成共识。少数研究检查了 rTMS 在躁狂（N=5）或混合发作（N=1）期间或作为维持治疗（N=1）的效果。迄今为止有限的数据表明 rTMS 相对安全且耐受良好。这些研究的最大限制包括样本量小、研究设计、患者和对照组的异质性、rTMS 参数和结局测量的差异。
目前关于 rTMS 在 BD 患者中的应用数据仍然有限。需要更多足够大样本量的假对照研究来验证其疗效。需要开展大规模临床试验来确定其效果是否扩展到躁狂和混合发作，以及其在稳定情绪和改善自杀行为方面的作用。
