Canadian Network for Mood and Anxiety Treatments (CANMAT) Clinical guidelines for the management of major depressive disorder in adults. IV. Neurostimulation therapies
Canadian Network for Mood and Anxiety Treatments (CANMAT) Clinical guidelines for the management of major depressive disorder in adults. IV. Neurostimulation therapies
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DOI：
10.1016/j.jad.2009.06.039
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发表时间：
2009-10-01
影响因子：
6.6
通讯作者：
Ravindran, Arun V.
中科院分区：
文献类型：
--
作者：
Kennedy, Sidney H.;Milev, Roumen;Ravindran, Arun V.
背景：2001 年，加拿大精神病学协会和加拿大情绪和焦虑治疗网络 (CANMAT) 合作制定了治疗抑郁症的循证临床指南。 CANMAT 在 2008-2009 年对这些指南进行了修订，以反映该领域的进展。人们对精细的脑刺激方法重新产生了兴趣，特别是针对难治性重度抑郁症 (MDD)。方法：CANMAT 指南基于问答格式，以提高临床医生的可及性。采用基于证据的格式，并对文献进行更新的系统评价，并使用预先定义的标准根据证据水平对建议进行分级。根据包括证据和专家临床支持在内的标准确定治疗方案。本节“神经刺激疗法”是 5 篇指南文章之一。结果：在本节回顾的四种神经刺激形式中，电惊厥疗法 (ECT) 拥有最广泛的证据，跨越了七十年。在加拿大和美国，重复经颅磁刺激 (rTMS) 和迷走神经刺激 (VNS) 已被批准用于治疗成人抑郁症，但证据基础要小得多。还有新的证据表明深部脑刺激 (DBS) 对其他治疗抵抗性抑郁症有效，但这是 2009 年的一项研究方法。 局限性：与治疗 MDD 的其他方式相比，基于的数据受到随机对照试验 (RCT) 数量相对较少和样本量较小的限制。结论：大多数证据支持 ECT 作为特定情况下的一线治疗，而 rTMS 作为二线治疗。 DBS 仍然是一种研究性治疗方法。 (C) 2009 年，Elsevier B.V. 出版
Background: In 2001, the Canadian Psychiatric Association and the Canadian Network for Mood and Anxiety Treatments (CANMAT) partnered to produce evidence-based clinical guidelines for the treatment of depressive disorders. A revision of these guidelines was undertaken by CANMAT in 2008-2009 to reflect advances in the field. There is renewed interest in refined approaches to brain stimulation, particularly for treatment resistant major depressive disorder (MDD).Methods: The CANMAT guidelines are based on a question-answer format to enhance accessibility to clinicians. An evidence-based format was used with updated systematic reviews of the literature and recommendations were graded according to Level of Evidence using pre-defined criteria. Lines of Treatment were identified based on criteria that included evidence and expert clinical support. This section on "Neurostimulation Therapies" is one of 5 guidelines articles.Results: Among the four forms of neurostimulation reviewed in this section, electroconvulsive therapy (ECT) has the most extensive evidence, spanning seven decades. Repetitive transcranial magnetic (rTMS) and vagus nerve stimulation (VNS) have been approved to treat depressed adults in both Canada and the United States with a much smaller evidence base. There is also emerging evidence that deep brain stimulation (DBS) is effective for otherwise treatment resistant depression, but this is an investigational approach in 2009. Limitations: Compared to other modalities for the treatment of MDD, the data based is limited by the relatively small numbers of randomized controlled trials (RCTs) and small sample sizes.Conclusions: There is most evidence to support ECT as a first-line treatment under specific circumstances and rTMS as a second-line treatment Evidence to support VNS is less robust and DBS remains an investigational treatment. (C) 2009 Published by Elsevier B.V.