Adu Medard Kofi, Shalaby Reham, Chue Pierre, Agyapong Vincent I O
Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre (WMC), 8440 112 St NW, Edmonton, AB T6G 2B7, Canada.
Department of Psychiatry, Dalhousie University, Halifax, NS B3H 4R2, Canada.
Behav Sci (Basel). 2022 Jun 17;12(6):195. doi: 10.3390/bs12060195.
Treatment-resistant depression (TRD) is associated with significant disability, and due to its high prevalence, it results in a substantive socio-economic burden at a global level. TRD is the inability to accomplish and/or achieve remission after an adequate trial of antidepressant treatments. Studies comparing repetitive transcranial magnetic stimulation (rTMS) with electroconvulsive therapy (ECT) and pharmacotherapy have revealed evidence of the therapeutic efficacy of rTMS in TRD. These findings suggest a crucial role for rTMS in the management of TRD. This article aims to conduct a comprehensive scoping review of the current literature concerning the use of rTMS and its therapeutic efficacy as a treatment modality for TRD. PubMed, PsycINFO, Medline, Embase, and Cinahl were used to identify important articles on rTMS for TRD. The search strategy was limited to English articles within the last five years of data publication. Articles were included if they reported on a completed randomized controlled trial (RCT) of rTMS intervention for TRD. The exclusion criteria involved studies with rTMS for the treatment of conditions other than TRD, and study and experimental protocols of rTMS on TRD. In total, 17 studies were eligible for inclusion in this review. The search strategy spanned studies published in the last five years, to the date of the data search (14 February 2022). The regional breakdown of the extracted studies was North American (n = 9), European (n = 5), Asian (n = 2) and Australian (n = 1). The applied frequencies of rTMS ranged from 5 Hz to 50 Hz, with stimulation intensities ranging from 80% MT to 120% MT. Overall, 16 out of the 17 studies suggested that rTMS treatment was effective, safe and tolerated in TRD. For patients with TRD, rTMS appears to provide significant benefits through the reduction of depressive symptoms, and while there is progressive evidence in support of the same, more research is needed in order to define standardized protocols of rTMS application in terms of localization, frequency, intensity, and pulse parameters.
难治性抑郁症（TRD）与严重的残疾相关，由于其高患病率，在全球范围内造成了巨大的社会经济负担。TRD是指在充分试用抗抑郁治疗后仍无法实现和/或达到缓解。比较重复经颅磁刺激（rTMS）与电休克治疗（ECT）及药物治疗的研究已揭示了rTMS治疗TRD的疗效证据。这些发现表明rTMS在TRD的管理中起着关键作用。本文旨在对当前有关rTMS的使用及其作为TRD治疗方式的疗效的文献进行全面的范围综述。使用PubMed、PsycINFO、Medline、Embase和Cinahl来识别关于rTMS治疗TRD的重要文章。搜索策略限于过去五年内数据发表的英文文章。如果文章报道了rTMS干预TRD的完整随机对照试验（RCT），则将其纳入。排除标准包括rTMS用于治疗TRD以外疾病的研究，以及rTMS治疗TRD的研究和实验方案。总共有17项研究符合纳入本综述的条件。搜索策略涵盖了截至数据搜索日期（2022年2月14日）过去五年内发表的研究。所提取研究的地区分布为北美（n = 9）、欧洲（n = 5）、亚洲（n = 2）和澳大利亚（n = 1）。rTMS的应用频率范围为5赫兹至50赫兹，刺激强度范围为80%运动阈值至120%运动阈值。总体而言，17项研究中的16项表明rTMS治疗在TRD中是有效、安全且耐受性良好的。对于TRD患者，rTMS似乎通过减轻抑郁症状带来显著益处，虽然有越来越多的证据支持这一点，但仍需要更多研究来确定rTMS在定位、频率、强度和脉冲参数方面的标准化应用方案。
