Li Xian, Man Idy S C, Shao Robin, Zhao Xuanhao, Wu Shiyun, Liu Zhongwan, Lin Kangguang
Department of Affective Disorder, The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou, PR China.
Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong Special Administrative Region of China.
J Affect Disord. 2025 Nov 1;388:119561. doi: 10.1016/j.jad.2025.119561. Epub 2025 May 31.
Anhedonia and apathy are core symptoms of Major Depressive Disorder (MDD) and schizophrenia, and respectively refer to deficit in reward processing and motivation. Emerging evidence indicates noninvasive brain stimulation (NIBS) such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) may be effective in treating anhedonia and apathy.
To quantitatively synthesize existing literature on the efficacy of TMS and tDCS in alleviating anhedonia and apathy among individuals with MDD and schizophrenia.
This meta-analysis synthesized findings from 22 previous studies including adults with MDD and schizophrenia (total N = 1258, female% = 43.73 %, age = 37.33 ± 8.35 years, PROSPERO registration no. CRD42023426223). A multilevel random-effect model was adopted to compute pooled effect size and heterogeneity across studies.
NIBS shows an overall significant effect in reducing anhedonia and apathy among individuals with MDD and schizophrenia, which is more robust for unilateral excitatory stimulation over the left DLPFC and for RCT studies. While TMS shows no specific effect in reducing anhedonia, it shows a significant effect in decreasing apathy, with both effects dependent on the outcome measurement method. Limited evidence shows significant overall effect of tDCS in reducing anhedonia and apathy, but its specific effect on apathy is inconclusive.
NIBS methods show overall modest effects in reducing anhedonia and apathy in MDD and schizophrenia, but the heterogeneity is high that may result from limited study number and methodological variations such as stimulation location. More studies need to be conducted particularly for tDCS intervention, and using task and specific measures of anhedonia and apathy.
快感缺失和情感淡漠是重度抑郁症（MDD）和精神分裂症的核心症状，分别指奖赏加工和动机方面的缺陷。新出现的证据表明，经颅磁刺激（TMS）和经颅直流电刺激（tDCS）等非侵入性脑刺激（NIBS）可能有效治疗快感缺失和情感淡漠。
定量综合现有关于TMS和tDCS缓解MDD和精神分裂症患者快感缺失和情感淡漠疗效的文献。
这项荟萃分析综合了之前22项研究的结果，这些研究包括患有MDD和精神分裂症的成年人（总样本量N = 1258，女性占比43.73%，年龄 = 37.33 ± 8.35岁，PROSPERO注册号CRD42023426223）。采用多层次随机效应模型计算各研究的合并效应量和异质性。
NIBS在减少MDD和精神分裂症患者的快感缺失和情感淡漠方面总体上有显著效果，对于左侧背外侧前额叶皮质的单侧兴奋性刺激和随机对照试验研究而言，这种效果更强。虽然TMS在减少快感缺失方面没有特定效果，但在减轻情感淡漠方面有显著效果，这两种效果均取决于结局测量方法。有限的证据表明tDCS在减少快感缺失和情感淡漠方面总体有显著效果，但其对情感淡漠的具体效果尚无定论。
NIBS方法在减少MDD和精神分裂症患者的快感缺失和情感淡漠方面总体有适度效果，但异质性较高，这可能是由于研究数量有限以及刺激部位等方法学差异导致的。需要开展更多研究，特别是针对tDCS干预，并使用快感缺失和情感淡漠的任务及特定测量方法。
