Yang Xinxin, Ma Lijun, Fan Chuan, Wang Huixue, Zhang Mi, Du He, Zhou Tiangang, Li Xiaoming
Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, Anhui, China; Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China.
Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China.
J Affect Disord. 2025 Feb 1;370:62-75. doi: 10.1016/j.jad.2024.10.071. Epub 2024 Oct 28.
The present study aimed to conduct a systematic review and network meta-analysis to investigate the efficacy and acceptability of brain stimulation techniques (BSTs) for anxiety disorders, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD).
A comprehensive search was performed in Embase, PubMed, Web of Science, PsycINFO, Cochrane, ClinicalTrials.gov and HowNet databases for studies published before September 10, 2023. Randomized clinical trials that involved deep brain stimulation (DBS), electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), sham therapy, or health control were included for analysis. The primary outcome was efficacy, while acceptability was considered as a secondary outcome.
The sample consisted of 1333 patients with various anxiety disorders including social anxiety disorder, general anxiety disorder, panic disorder, social panic, obsessive-compulsive disorder, post-traumatic stress disorder, and agoraphobia, recruited from 41 trials with 86 treatment arms. Network meta-analysis showed that some BSTs had higher efficacy compared to controls, including DBS, ECT, cathodal tDCS, high-frequency rTMS (hf-rTMS), anodal tDCS, and low-frequency rTMS (lf-rTMS). Furthermore, hf-rTMS, lf-rTMS, and ECT had high acceptability in terms of odds ratio (OR).
This study has limitations, including a focus on specific types of brain stimulation for anxiety disorders, OCD and PTSD and not considering factors like stimulation parameters. Future research should explore a broader range of technologies and parameters across various psychiatric and neurological conditions.
The study results suggest that BSTs are effective treatments for anxiety disorders, OCD and PTSD; lf-rTMS may be considered as the most promising option.
本研究旨在进行系统评价和网状荟萃分析，以调查脑刺激技术（BSTs）治疗焦虑症、强迫症（OCD）和创伤后应激障碍（PTSD）的疗效和可接受性。
对Embase、PubMed、科学网、PsycINFO、Cochrane、ClinicalTrials.gov和知网数据库进行全面检索，查找2023年9月10日前发表的研究。纳入涉及深部脑刺激（DBS）、电休克治疗（ECT）、重复经颅磁刺激（rTMS）、经颅直流电刺激（tDCS）、假治疗或健康对照的随机临床试验进行分析。主要结局为疗效，可接受性被视为次要结局。
样本包括1333例患有各种焦虑症的患者，包括社交焦虑症、广泛性焦虑症、惊恐障碍、社交惊恐、强迫症、创伤后应激障碍和广场恐惧症，这些患者来自41项试验的86个治疗组。网状荟萃分析表明，与对照组相比，一些BSTs具有更高的疗效，包括DBS、ECT、阴极tDCS、高频rTMS（hf-rTMS）、阳极tDCS和低频rTMS（lf-rTMS）。此外，就优势比（OR）而言，hf-rTMS、lf-rTMS和ECT具有较高的可接受性。
本研究存在局限性，包括专注于针对焦虑症、OCD和PTSD的特定类型脑刺激，未考虑刺激参数等因素。未来的研究应探索更广泛的技术和参数，涵盖各种精神和神经疾病。
研究结果表明，BSTs是治疗焦虑症、OCD和PTSD的有效方法；lf-rTMS可能被认为是最有前景的选择。
