Epworth Centre for Innovation in Mental Health, Epworth Healthcare, Camberwell, VIC, Australia.
Department of Psychiatry, Monash University, Melbourne, VIC, Australia.
Aust N Z J Psychiatry. 2022 Jul;56(7):745-751. doi: 10.1177/00048674211043047. Epub 2021 Aug 28.
Despite more than 25 years of research establishing the antidepressant efficacy of repetitive transcranial magnetic stimulation, there remains uncertainty about the depth and breadth of this evidence base, resulting in confusion as to where repetitive transcranial magnetic stimulation fits in the therapeutic armamentarium in the management of patients with mood disorders. The purpose of this article is to provide a concise description of the evidence base supporting the use of repetitive transcranial magnetic stimulation in the context of the stages of research that typically accompanies the development of evidence for a new therapy. The antidepressant efficacy for the use of repetitive transcranial magnetic stimulation in the treatment of depression has been established through a relatively traditional pathway beginning with small case series, progressing to single-site clinical trials and then to larger multisite randomised double-blind controlled trials. Antidepressant effects have been confirmed in numerous meta-analyses followed more recently by large network meta-analysis and umbrella reviews, with evidence that repetitive transcranial magnetic stimulation may have greater efficacy than alternatives for patients with treatment-resistant depression. Finally, repetitive transcranial magnetic stimulation has been shown to produce meaningful response and remission rates in real-world samples of greater than 5000 patients. The evidence for the antidepressant efficacy of repetitive transcranial magnetic stimulation therapy is overwhelming, and it should be considered a routine part of clinical care wherever available.
尽管已有 25 多年的研究证明重复经颅磁刺激具有抗抑郁作用，但对于这一证据基础的深度和广度仍存在不确定性，导致人们对于在治疗心境障碍患者的治疗武器库中重复经颅磁刺激的位置感到困惑。本文的目的是在通常伴随着新疗法证据发展的研究阶段的背景下，对支持重复经颅磁刺激应用的证据基础进行简要描述。在治疗抑郁症方面，重复经颅磁刺激的抗抑郁疗效已经通过相对传统的途径得到确立，从小型病例系列开始，逐步发展到单中心临床试验，然后是更大规模的多中心随机双盲对照试验。大量荟萃分析证实了抗抑郁作用，随后又进行了大型网络荟萃分析和伞式综述，有证据表明重复经颅磁刺激对治疗抵抗性抑郁症患者可能比其他替代方法更有效。最后，重复经颅磁刺激在超过 5000 名患者的真实样本中显示出了有意义的反应和缓解率。重复经颅磁刺激治疗的抗抑郁疗效证据确凿，在有条件的地方，应将其视为临床常规治疗的一部分。
