Vogel Jake, Soti Varun
Psychiatry, Lake Erie College of Osteopathic Medicine, Elmira, USA.
Pharmacology and Therapeutics, Lake Erie College of Osteopathic Medicine, Elmira, USA.
Cureus. 2022 Jun 14;14(6):e25928. doi: 10.7759/cureus.25928. eCollection 2022 Jun.
Antidepressant drugs have been the mainstay for treating patients with major depressive disorder. However, with a rapid rise in the rates of major depressive disorder, there has been a substantial increase in the resistance to antidepressants in the last decade. This has augmented the need for alternative treatment modalities, including repetitive transcranial magnetic stimulation. This review assesses the progress repetitive transcranial magnetic stimulation has made in treating patients resistant to antidepressants. We conducted a comprehensive literature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The clinical studies reviewed under the scope of this paper showed significant benefits in treatment-resistant patients. Several studies demonstrated that the prefrontal cortex's unilateral and bilateral transcranial magnetic stimulation increased the remission rates in active treatment groups compared to the control. Treatments ranged from 10 to 20 sessions, with 1,600 pulses to a maximum of 4,000 pulses in unilateral stimulation and 720 to 2,100 pulses in bilateral stimulation per session. Interestingly, bilateral stimulation utilizing fewer pulses showed notable improvement than a higher number of pulses in unilateral stimulation. However, the lack of standardized dose, dosing frequency, treatment duration, and follow-up protocols warrant further research to bring this therapy into clinical practice.
抗抑郁药物一直是治疗重度抑郁症患者的主要手段。然而,随着重度抑郁症发病率的迅速上升,在过去十年中对抗抑郁药物的耐药性大幅增加。这增加了对包括重复经颅磁刺激在内的替代治疗方式的需求。本综述评估了重复经颅磁刺激在治疗对抗抑郁药物耐药的患者方面所取得的进展。我们按照系统评价和Meta分析的首选报告项目指南进行了全面的文献检索。本文范围内所综述的临床研究表明,对耐药患者有显著益处。多项研究表明,与对照组相比,前额叶皮质的单侧和双侧经颅磁刺激提高了积极治疗组的缓解率。治疗疗程为10至20次,单侧刺激每次1600脉冲至最多4000脉冲,双侧刺激每次720至2100脉冲。有趣的是,使用较少脉冲的双侧刺激比使用较多脉冲的单侧刺激显示出更显著的改善。然而,缺乏标准化的剂量、给药频率、治疗持续时间和随访方案,需要进一步研究以使这种疗法应用于临床实践。
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