Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital.
Stockholm Health Care Services, Region Stockholm, Stockholm.
J ECT. 2023 Dec 1;39(4):227-234. doi: 10.1097/YCT.0000000000000922. Epub 2023 Apr 14.
Major depressive disorder (MDD) is highly prevalent in individuals with anorexia nervosa (AN) and is a predictor of greater clinical severity. However, there is a limited amount of evidence supporting the use of psychotropic medications for its management. A systematic scoping review was conducted to assess the current literature on brain stimulation treatments for AN with comorbid MDD, with a specific focus on MDD treatment response and weight restoration. This review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the PubMed, PsycInfo, and MEDLINE databases were searched until July 2022 using specific key words related to AN and brain stimulation treatments. A total of 373 citations were identified, and 49 treatment studies that met the inclusion criteria were included in the review. The initial evidence suggests that electroconvulsive therapy, repetitive transcranial magnetic stimulation, and deep-brain stimulation may be effective in managing comorbid MDD in AN. Emerging evidence suggests that transcranial direct current stimulation may have a positive effect on body mass index in individuals with severe to extreme AN. However, there is a need for the development of better measurement techniques for assessing the severity of depression in the context of AN. Controlled trials that are adequately designed to account for these limitations are highly warranted for deep-brain stimulation, electroconvulsive therapy, and repetitive transcranial magnetic stimulation and hold promise for providing clinically meaningful results.
重度抑郁症（MDD）在神经性厌食症（AN）患者中发病率很高，是临床严重程度的预测因素。然而，支持使用精神药物治疗 MDD 的证据有限。本系统范围综述旨在评估目前关于 AN 合并 MDD 的脑刺激治疗的文献，重点关注 MDD 的治疗反应和体重恢复。本综述按照系统评价和荟萃分析的首选报告项目进行，并且直到 2022 年 7 月，通过与 AN 和脑刺激治疗相关的特定关键词，对 PubMed、PsycInfo 和 MEDLINE 数据库进行了搜索。共确定了 373 条引文，并纳入了符合纳入标准的 49 项治疗研究。初步证据表明，电惊厥疗法、重复经颅磁刺激和深部脑刺激可能对治疗 AN 合并 MDD 有效。新兴证据表明，经颅直流电刺激可能对严重至极度 AN 个体的体重指数有积极影响。然而，需要开发更好的评估技术来评估 AN 背景下抑郁的严重程度。对于深部脑刺激、电惊厥疗法和重复经颅磁刺激，需要进行精心设计的对照试验来解决这些限制，这对于提供有临床意义的结果具有重要意义。
