Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Cologne, Germany.
Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Eur Child Adolesc Psychiatry. 2022 Oct;31(10):1501-1525. doi: 10.1007/s00787-022-02021-7. Epub 2022 Jun 24.
Transcranial magnetic stimulation (TMS) is a non-invasive treatment for adolescent major depressive disorder (MDD). Existing evidence on the efficacy of TMS in adolescent MDD awaits quantitative synthesis. A systematic literature search was conducted, and data from eligible studies were synthesized using random-effects models. Treatment-covariate interactions were examined in exploratory analyses of individual-patient data (IPD). Systematic search of the literature yielded 1264 hits, of which 10 individual studies (2 randomized trials) were included for quantitative synthesis of mainly uncontrolled studies. Individual patient data (IPD) were available from five trials (all uncontrolled studies). Quantitative synthesis of aggregated data revealed a statistically significant negative overall standardized mean change (pooled SMCC = 2.04, 95% CI [1.46; 2.61], SE = 0.29, p < .001), as well as a significant overall treatment response rate (Transformed Proportion = 41.30%, 95% CI [31.03; 51.57], SE = 0.05; p < 0.001), considering data from baseline to post-treatment. Exploratory IPD analyses suggests TMS might be more effective in younger individuals and individuals with more severe depression, and efficacy might be enhanced with certain treatment modality settings, including higher number of TMS sessions, longer treatment durations, and unilateral and not bilateral stimulation. Existing studies exhibit methodological shortcomings, including small-study effects and lack of control group, blinding, and randomization-compromising the credibility of the present results. To date, two randomized controlled trials on TMS in adolescent depression have been published, and the only large-scale randomized trial suggests TMS is not more effective than sham stimulation. Future large-scale, randomized, and sham-controlled trials are warranted. Future trials should ensure appropriate selection of patients for TMS treatment and guide precision medicine approaches for stimulation protocols.
经颅磁刺激（TMS）是一种治疗青少年重度抑郁症（MDD）的非侵入性方法。目前尚需对 TMS 在青少年 MDD 中的疗效进行定量综合评估。对现有文献进行了系统检索，并使用随机效应模型对符合条件的研究数据进行了综合分析。在对个体患者数据（IPD）的探索性分析中，研究了治疗-协变量的相互作用。对文献进行系统搜索后得到了 1264 个结果，其中有 10 项单独的研究（2 项随机试验）纳入了主要为非对照研究的定量综合分析。五项试验（均为非对照研究）提供了个体患者数据（IPD）。对汇总数据的定量综合分析显示，总体标准化平均变化（ pooled SMCC）具有统计学显著的负值（pooled SMCC=2.04，95%CI[1.46;2.61]，SE=0.29，p<.001），总体治疗反应率（Transformed Proportion）也具有统计学显著的正值（Transformed Proportion=41.30%，95%CI[31.03;51.57]，SE=0.05；p<.001），数据来源于基线至治疗后。对 IPD 的探索性分析表明，TMS 可能对年龄较小和抑郁程度较重的个体更有效，并且通过某些治疗模式设置（包括增加 TMS 治疗次数、延长治疗持续时间、单侧而非双侧刺激）可能会增强疗效。现有研究存在方法学缺陷，包括小样本研究效应和缺乏对照组、盲法以及随机分配，这降低了目前结果的可信度。迄今为止，已有两项关于 TMS 治疗青少年抑郁症的随机对照试验发表，唯一一项大型随机试验表明，TMS 并不比假刺激更有效。需要开展大规模、随机、假对照试验。未来的试验应确保适当选择 TMS 治疗的患者，并为刺激方案指导精准医学方法。
