Fu Lirong, Ren Juanjuan, Lei Xiaoxia, Zhang Rong, Zhang Chen
Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
J Affect Disord. 2025 Mar 15;373:465-477. doi: 10.1016/j.jad.2025.01.014. Epub 2025 Jan 8.
Cognitive dysfunction is a core symptom of depression and contributes significantly to functional and psychosocial impairment. However, pharmacotherapy has shown limited efficacy in alleviating these cognitive deficits. This study aimed to systematically evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in improving cognitive impairments in patients with depression.
A literature search was conducted across PubMed, Embase, Web of Science, PsycINFO, and the Cochrane Library databases up to June 19, 2024. Studies were included if they met the following criteria: (1) participants were exclusively patients with unipolar depression, (2) both active rTMS and sham stimulation were administered in parallel groups, (3) sufficient data were available, and (4) the study design was a randomized controlled trial (RCT).
A total of 15 studies met the inclusion criteria. The meta-analysis revealed no significant improvement in cognitive impairment with active rTMS compared to sham rTMS across multiple cognitive domains, including global cognitive function, attention, working memory, psychomotor speed, language, visuospatial ability, learning and memory, and executive function.
Current evidence suggests that rTMS does not demonstrate substantial efficacy in alleviating cognitive dysfunction in patients with depression. Future research should focus on elucidating the underlying mechanisms of rTMS efficacy and optimizing stimulation protocols, including the precise targeting of stimulation sites, as well as refining frequency, intensity, and duration parameters to better address cognitive impairment.
认知功能障碍是抑郁症的核心症状，对功能和心理社会功能损害有显著影响。然而，药物治疗在缓解这些认知缺陷方面疗效有限。本研究旨在系统评价重复经颅磁刺激（rTMS）改善抑郁症患者认知障碍的疗效。
截至2024年6月19日，在PubMed、Embase、Web of Science、PsycINFO和Cochrane图书馆数据库中进行文献检索。纳入的研究需符合以下标准：（1）参与者仅为单相抑郁症患者；（2）在平行组中同时给予主动rTMS和假刺激；（3）有足够的数据；（4）研究设计为随机对照试验（RCT）。
共有15项研究符合纳入标准。荟萃分析显示，与假rTMS相比，主动rTMS在多个认知领域（包括整体认知功能、注意力、工作记忆、心理运动速度、语言、视觉空间能力、学习和记忆以及执行功能）并未显著改善认知障碍。
目前的证据表明，rTMS在缓解抑郁症患者认知功能障碍方面未显示出显著疗效。未来的研究应侧重于阐明rTMS疗效的潜在机制并优化刺激方案，包括精确靶向刺激部位，以及完善频率、强度和持续时间参数，以更好地解决认知障碍问题。
