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重复经颅磁刺激在治疗难治性抑郁症患者方面进展如何?

How Far Has Repetitive Transcranial Magnetic Stimulation Come Along in Treating Patients With Treatment-Resistant Depression?

作者信息

Vogel Jake, Soti Varun

机构信息

Psychiatry, Lake Erie College of Osteopathic Medicine, Elmira, USA.

Pharmacology and Therapeutics, Lake Erie College of Osteopathic Medicine, Elmira, USA.

出版信息

Cureus. 2022 Jun 14;14(6):e25928. doi: 10.7759/cureus.25928. eCollection 2022 Jun.


DOI:10.7759/cureus.25928
PMID:35711250
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9196141/
Abstract

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.

摘要

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。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0db9/9196141/d6bf256ee928/cureus-0014-00000025928-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0db9/9196141/d6bf256ee928/cureus-0014-00000025928-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0db9/9196141/d6bf256ee928/cureus-0014-00000025928-i01.jpg

相似文献

[1]
How Far Has Repetitive Transcranial Magnetic Stimulation Come Along in Treating Patients With Treatment-Resistant Depression?

Cureus. 2022-6-14

[2]
Repetitive transcranial magnetic stimulation for the treatment of major depressive disorder: an evidence-based analysis.

Ont Health Technol Assess Ser. 2004

[3]
The association of total pulses with the efficacy of repetitive transcranial magnetic stimulation for treatment-resistant major depression: A dose-response meta-analysis.

Asian J Psychiatr. 2024-2

[4]
Repetitive Transcranial Magnetic Stimulation for People With Treatment-Resistant Depression: A Health Technology Assessment.

Ont Health Technol Assess Ser. 2021

[5]
High-frequency repetitive transcranial magnetic stimulation over the left DLPFC for major depression: Session-dependent efficacy: A meta-analysis.

Eur Psychiatry. 2017-3

[6]
Optimally combining transcranial magnetic stimulation with antidepressants in major depressive disorder: A systematic review and Meta-analysis.

J Affect Disord. 2024-8-1

[7]
Crossover to Bilateral Repetitive Transcranial Magnetic Stimulation: A Potential Strategy When Patients Are Not Responding to Unilateral Left-Sided High-Frequency Repetitive Transcranial Magnetic Stimulation.

J ECT. 2019-3

[8]
EEG synchronized left prefrontal transcranial magnetic stimulation (TMS) for treatment resistant depression is feasible and produces an entrainment dependent clinical response: A randomized controlled double blind clinical trial.

Brain Stimul. 2023

[9]
Pattern of Compliance and Efficacy of Repetitive Transcranial Magnetic Stimulation Protocol for Treating Major Depressive Disorder Among Treatment Participants and Completers: A Report From Iran.

Basic Clin Neurosci. 2023

[10]
Bilateral vs. unilateral repetitive transcranial magnetic stimulation in treating major depression: a meta-analysis of randomized controlled trials.

Psychiatry Res. 2014-5-14

引用本文的文献

[1]
Repetitive transcranial magnetic stimulation in the treatment of middle-aged and elderly major depressive disorder: A randomized controlled trial.

Medicine (Baltimore). 2023-9-1

本文引用的文献

[1]
The global gap in treatment coverage for major depressive disorder in 84 countries from 2000-2019: A systematic review and Bayesian meta-regression analysis.

PLoS Med. 2022-2-15

[2]
Effect of rTMS on GABA and glutamate levels in treatment-resistant depression: An MR spectroscopy study.

Psychiatry Res Neuroimaging. 2021-11-30

[3]
Neurophysiological effects of repetitive transcranial magnetic stimulation (rTMS) in treatment resistant depression.

Clin Neurophysiol. 2021-9

[4]
The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.

Syst Rev. 2021-3-29

[5]
A retrospective analysis to estimate the healthcare resource utilization and cost associated with treatment-resistant depression in commercially insured US patients.

PLoS One. 2020-9-11

[6]
Transcranial Magnetic and Direct Current Stimulation in the Treatment of Depression: Basic Mechanisms and Challenges of Two Commonly Used Brain Stimulation Methods in Interventional Psychiatry.

Neuropsychobiology. 2020

[7]
Unilateral and bilateral MRI-targeted repetitive transcranial magnetic stimulation for treatment-resistant depression: a randomized controlled study.

J Psychiatry Neurosci. 2016-6

[8]
Repetitive Transcranial Magnetic Stimulation (rTMS) Modulates Event-Related Potential (ERP) Indices of Attention in Autism.

Transl Neurosci. 2012-6-1

[9]
Improvement in quality of life with left prefrontal transcranial magnetic stimulation in patients with pharmacoresistant major depression: acute and six month outcomes.

Brain Stimul. 2013-11-4

[10]
Treatment-resistant depression: therapeutic trends, challenges, and future directions.

Patient Prefer Adherence. 2012

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