Exley Shannon L, Oberman Lindsay M
Department of Medical and Clinical Psychology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
Center for Neuroscience and Regenerative Medicine, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA.
Mil Med. 2022 Jan 4;187(1-2):e65-e69. doi: 10.1093/milmed/usab187.
Military mental health conditions, such as depression, PTSD, and suicidal ideation, are currently understudied and undertreated. Repetitive transcranial magnetic stimulation (rTMS) is currently being considered as a treatment for these conditions; however, there exists a paucity of research in this area. This scholarly review will examine the limitations of the existing literature on the use of rTMS to treat depression, PTSD, and suicidal ideation in service members (SMs) and veterans.
Publications that evaluated rTMS for the treatment of depression, PTSD, or suicidal ideation in military samples were identified via a PubMed search. Non-interventional rTMS studies, studies where the sample could not be confirmed to be primarily composed of SMs or veteran participants, studies without psychiatric outcome measures, and studies not published in a peer-reviewed journal were excluded from this review.
This literature search identified 20 total publications (eight primary analyses of randomized controlled trials (RCTs), one longitudinal analysis of an RCT, five open label trials, and six retrospective analyses of clinical data), inclusive of 879 participants. Eighteen studies utilized a protocol targeting the prefrontal cortex (PFC), and one of these also targeted the supplementary motor area (SMA) with the PFC (one study did not specify the stimulation site). Eight studies applied standard 10 Hz frequency stimulation, and four applied standard 1 Hz frequency stimulation. The remainder of studies applied alternative stimulation protocols including 5 Hz (two studies), 20 Hz (one study), a combination of 1 and 10 Hz (two studies), and theta burst stimulation (TBS) (two studies). Twelve studies reported significant results, including four RCTs, three open label studies, and five retrospective analyses.
rTMS offers a promising area of research for mental health conditions in military populations. However, the number of studies that focus specifically on this population are few in number and have many notable limitations. Further research is needed to validate the effectiveness of this tool for SMs and veterans.
军事心理健康状况，如抑郁症、创伤后应激障碍（PTSD）和自杀意念，目前研究不足且治疗不充分。重复经颅磁刺激（rTMS）目前正被考虑用于治疗这些疾病；然而，该领域的研究较少。本学术综述将探讨现有文献中关于使用rTMS治疗军人和退伍军人抑郁症、PTSD和自杀意念的局限性。
通过PubMed搜索确定评估rTMS治疗军事样本中抑郁症、PTSD或自杀意念的出版物。本综述排除了非介入性rTMS研究、样本不能确认为主要由军人或退伍军人参与者组成的研究、没有精神科结局测量的研究以及未在同行评审期刊上发表的研究。
该文献检索共确定了20篇出版物（8篇随机对照试验（RCT）的主要分析、1篇RCT的纵向分析、5篇开放标签试验和6篇临床数据的回顾性分析），包括879名参与者。18项研究采用了针对前额叶皮质（PFC）的方案，其中1项还将辅助运动区（SMA）与PFC作为靶点（1项研究未指定刺激部位）。8项研究应用标准10Hz频率刺激，4项应用标准1Hz频率刺激。其余研究应用了替代刺激方案，包括5Hz（2项研究）、20Hz（1项研究）、1Hz和10Hz组合（2项研究）以及theta爆发刺激（TBS）（2项研究）。12项研究报告了显著结果，包括4项RCT、3项开放标签研究和5项回顾性分析。
rTMS为军事人群心理健康状况提供了一个有前景的研究领域。然而，专门针对该人群的研究数量很少，且有许多明显的局限性。需要进一步研究以验证该工具对军人和退伍军人的有效性。
