Wang Yueying, Feng Huiyue, Wang Hongxia
Department of Medicine, Shandong Xiandai University, Jinan, China.
Department of Rehabilitation Medicine, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.
BMC Psychiatry. 2025 Jul 15;25(1):697. doi: 10.1186/s12888-025-07151-1.
To systematically evaluate the effects of different modes of repetitive transcranial magnetic stimulation (rTMS) on depression in post-stroke depression (PSD) patients using the network meta-analysis method.
PubMed, Web of Science, Cochrane Library, Embase, Wanfang Data, CNKI, VIP, and CBM were searched for randomized controlled trials on rTMS for PSD from the time the database was constructed until April 20th, 2024. Two researchers independently conducted screenings to extract the relevant literature. The meta-analysis was performed using RevMan 5.4.1 software. Network meta-analysis of depression scores was performed using Stata 17.0 software and R 4.4.1 software.
Twelve studies involving four different rTMS modalities were included. The results of the meta-analysis revealed that rTMS significantly improved depression (SMD = -1.47, 95% CI [-1.97, -0.97]) and activity of daily living (ADL) (SMD = 0.78, 95% CI [0.52, 1.04]) in patients with PSD. The follow-up results revealed that rTMS significantly improved depression in the long term (SMD = -1.74, 95% CI [-2.32, -1.17]). The results of the network meta-analysis revealed that dual-rTMS (SMD = -2.33, 95% CI [-3.16, -1.50]), HF-rTMS (SMD = -1.62, 95% CI [-2.11, -1.13]), iTBS (SMD = -1.57, 95% CI [-2.56, -0.57]), and LF-rTMS (SMD = -0.80, 95% CI [-1.36, -0.23]) significantly improved depression compared with sham stimulation. The SUCRA values in descending order were dual-rTMS (95.9%) > HF-rTMS (65.0%) > iTBS (61.9%) > LF-rTMS (27.1%).
Twenty minutes of 4-week dual-rTMS on the DLPFC of PSD patients may produce better therapeutic effects. High-quality, large-sample, standardized RCT trials can be conducted to further test the scientific validity of the findings.
采用网状Meta分析方法系统评价不同模式重复经颅磁刺激（rTMS）对脑卒中后抑郁（PSD）患者抑郁的影响。
检索PubMed、Web of Science、Cochrane图书馆、Embase、万方数据、中国知网、维普资讯和中国生物医学文献数据库中自建库至2024年4月20日关于rTMS治疗PSD的随机对照试验。由两名研究人员独立进行筛选以提取相关文献。使用RevMan 5.4.1软件进行Meta分析。使用Stata 17.0软件和R 4.4.1软件对抑郁评分进行网状Meta分析。
纳入12项涉及四种不同rTMS模式的研究。Meta分析结果显示，rTMS显著改善PSD患者的抑郁（标准化均数差[SMD]=-1.47，95%可信区间[CI][-1.97，-0.97]）和日常生活活动能力（ADL）（SMD=0.78，95%CI[0.52，1.04]）。随访结果显示，rTMS长期显著改善抑郁（SMD=-1.74，95%CI[-2.32，-1.17]）。网状Meta分析结果显示，与假刺激相比，双靶点rTMS（SMD=-2.33，95%CI[-3.16，-1.50]）、高频rTMS（SMD=-1.62，95%CI[-2.11，-1.13]）、间歇性θ波爆发刺激（iTBS）（SMD=-1.57，95%CI[-2.56，-0.57]）和低频rTMS（SMD=-0.80，95%CI[-1.36，-0.23]）显著改善抑郁。累积排序曲线下面积（SUCRA）值从高到低依次为双靶点rTMS（95.9%）＞高频rTMS（65.0%）＞iTBS（61.9%）＞低频rTMS（27.1%）。
对PSD患者的背外侧前额叶皮质进行为期4周、每次20分钟的双靶点rTMS治疗可能产生更好的治疗效果。可开展高质量、大样本、标准化的随机对照试验进一步验证本研究结果的科学性。
