The expanding evidence base for rTMS treatment of depression.
The expanding evidence base for rTMS treatment of depression.
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DOI：
10.1097/yco.0b013e32835ab46d
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发表时间：
2013-01
影响因子：
6.9
通讯作者：
Short EB
中科院分区：
文献类型：
--
作者：
George MS;Taylor JJ;Short EB
每日左前额叶经颅磁刺激（TMS）数周首次提出作为抑郁症的急性治疗在20世纪90年代初，并于2008年获得FDA批准。在过去的一年里，发表了几项重要的研究，扩展了我们对这种新治疗方法的理解。第一轮TMS多中心临床试验探讨了前额rTMS是否有效，并在精心挑选的无抗抑郁药物的抑郁症患者中进行。最近的几项研究评估了TMS的临床有效性，并报告说，大约35-40%的真实的世界患者通常服用抗抑郁药，达到缓解，具有适度的副作用。也有新的研究检查TMS诱导的抗抑郁作用的持久性。58%的TMS缓解者在3个月随访时保持缓解。这些最近的研究表明，每日左前额经颅磁刺激治疗抑郁症数周，似乎不仅在严格的随机对照试验中有效，而且在真实的世界环境中有效，30-40%的患者缓解。TMS的抗抑郁作用，一旦实现，似乎与其他抗抑郁药物或干预一样持久。需要更多的研究，特别是关于TMS线圈位置，刺激强度和频率以及给药策略等问题。
Daily left prefrontal transcranial magnetic stimulation (TMS) for several weeks was first proposed as an acute treatment for depression in the early 1990’s, and was FDA approved in 2008. In the past year several important studies have been published that extend our understanding of this novel treatment approach. The first round of multisite clinical trials with TMS addressed whether prefrontal rTMS has efficacy and were conducted in carefully selected depressed patients who were antidepressant medication free. Several more recent studies assess the clinical effectiveness of TMS and report that about 35–40% of real world patients who are commonly taking adjunctive antidepressants reach remission with a modest side effect profile. There are also new studies examining the durability of the TMS induced antidepressant effect. 58% of TMS remitters remain remitted at 3-month follow-up. These recent studies suggest that daily left prefrontal TMS over several weeks as a treatment for depression appears to not only have efficacy in rigorous randomized controlled trials, but is effective in real world settings, with remission in 30–40% of patients. The TMS antidepressant effect, once achieved, appears to be as durable as with other antidepressant medications or interventions. Much more research is needed, particular with issues such as the TMS coil location, stimulation intensity and frequency, and dosing strategy.