Department of Psychiatry, Guangzhou Medical University, Guangzhou, PR. China; The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, PR. China.
Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR. China.
Psychiatry Res. 2023 Jul;325:115260. doi: 10.1016/j.psychres.2023.115260. Epub 2023 May 20.
Repetitive transcranial magnetic stimulation (rTMS) is a well-established, safe, and effective brain stimulation technique for depression; however, uniform parameters have not been used in clinical practice. The aim of this study was to identify the parameters that affect rTMS effectiveness and ascertain the range in which that parameter has optimal efficacy. A meta-analysis of sham-controlled trials using rTMS delivered over the left dorsolateral prefrontal cortex (DLPFC) in depression was conducted. In the meta-regression and subgroup analyses, all rTMS stimulation parameters were extracted and their association with efficacy was investigated. Of the 17,800 references, 52 sham-controlled trials were included. Compared to sham controls, our results demonstrated a significant improvement in depressive symptoms at the end of treatment. According to the results of meta-regression, the number of pulses and sessions per day correlated with rTMS efficacy; however, the positioning method, stimulation intensity, frequency, number of treatment days, and total pulses did not. Furthermore, subgroup analysis revealed that the efficacy was correspondingly better in the group with higher daily pulses. In clinical practice, increasing the number of daily pulses and sessions may improve the effectiveness of rTMS.
重复经颅磁刺激（rTMS）是一种成熟、安全且有效的治疗抑郁症的脑刺激技术；然而，目前在临床实践中尚未采用统一的参数。本研究旨在确定影响 rTMS 疗效的参数，并确定该参数具有最佳疗效的范围。对使用 rTMS 刺激左背外侧前额叶皮质（DLPFC）治疗抑郁症的假刺激对照试验进行了荟萃分析。在荟萃回归和亚组分析中，提取了所有 rTMS 刺激参数，并研究了它们与疗效的关系。在 17800 篇参考文献中，纳入了 52 项假刺激对照试验。与假对照相比，我们的结果表明治疗结束时抑郁症状有显著改善。根据荟萃回归的结果，每个脉冲的数量和每天的治疗次数与 rTMS 的疗效相关；然而，定位方法、刺激强度、频率、治疗天数和总脉冲数则不然。此外，亚组分析显示，每天更高脉冲数的治疗组疗效相应更好。在临床实践中，增加每天的脉冲数和治疗次数可能会提高 rTMS 的疗效。
