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Transcranial magnetic stimulation for treating depression

  • Review
  • Intervention

Authors


Abstract

Background

Transcranial magnetic stimulation can either excite or inhibit cortical areas of the brain, depending on whether the speed of the repetitive stimulation is applied at high or low frequencies. It has been used for physiological studies and it has also been proposed as a treatment for depression.

Objectives

To assess the clinical efficacy and safety of transcranial magnetic stimulationfor treating depression.

Search methods

An electronic search was performed including the Cochrane Collaboration Depression, Anxiety and Neurosis Review Group trials register (last searched June 2001), the Cochrane Controlled Trials Register (Issue 2, 2001), MEDLINE (1966-2001), EMBASE (1974-2001), PsycLIT (1980-2001), and bibliographies from reviewed articles. Unpublished data and grey literature were searched through personal communications with researchers.

Selection criteria

Randomised controlled trials assessing the therapeutic efficacy and safety of transcranial magnetic stimulation for depression.

Data collection and analysis

All reviewers independently extracted the information and verified it by cross-checking. Disagreements were resolved through discussion.
Continuous data: When similar studies were grouped, the overall standardised mean difference was calculated under a fixed effect model weighted by the inverse variance method with 95% confidence intervals. (In the presence of statistical heterogeneity, a random effects model was to be used.)

Main results

Sixteen trials were included in the review and fourteen contained data in a suitable form for quantitative analysis. Most comparisons did not show differences between rTMS and other interventions. No difference was seen between rTMS and sham TMS using the Beck Depression Inventory or the Hamilton Depression Rating Scale, except for one time period (after two weeks of treatment) for left dorsolateral prefrontal cortex and high frequency; and also for right dorsolateral prefrontal cortex and low frequency, both in favour of rTMS and both using the Hamilton scale. Comparison of rTMS (left dorsolateral prefrontal cortex and high frequency) with electroconvulsive therapy showed no difference except for psychotic patients after two weeks treatment, using the Hamilton scale, which indicated that electroconvulsive therapy was more effective than rTMS.

Authors' conclusions

The information in this review suggests that there is no strong evidence for benefit from using transcranial magnetic stimulation to treat depression, although the small sample sizes do not exclude the possibility of benefit.

摘要

背景

穿顱磁刺激治療憂鬱症

依照重複性刺激的頻率高低,穿顱磁刺激可刺激或抑制腦部皮質。穿顱磁刺激已經被用於生理學研究,也被人提出是一種治療憂鬱症的方法。

目標

評估穿顱磁刺激治療憂鬱症的臨床療效和安全性。

搜尋策略

執行電子搜尋Cochrane Collaboration Depression, Anxiety and Neurosis Review Group trials register (最後搜尋至2001年6月)、Cochrane Controlled Trials Register (Issue 2, 2001年)、MEDLINE (1966年 – 2001年)、 EMBASE (1974年 – 2001年)、PsycLIT (1980年 – 2001年)和回顧文章的文獻。親自連絡學者,詢問是否有未發表或有爭議的文獻資料。

選擇標準

隨機對照試驗評估穿顱磁刺激治療憂鬱症的臨床療效和安全性。

資料收集與分析

審閱者獨立擷取資料,互相交換檢查。意見不同處以討論解決。連續資料:將相似的資料併組,以反轉方差方法計算固定效果模式的整體標準平均差和95%CI。若有統計異質性,則使用隨機效果模式。

主要結論

回顧納入16個試驗,其中14個試驗的資料可用作量化分析。大部分對重複性穿顱磁刺激和其他治療的比較結果都沒有差異。重複性穿顱磁刺激和偽穿顱磁刺激兩組的貝克憂鬱症量表或漢彌爾頓憂鬱症量表的結果沒有差異,只有在對左背外側前額葉皮層進行2週高頻治療後才有差異。另外此時點的右背外側前額葉皮質低頻治療也有差別。都是重複性穿顱磁刺激表現較好,且都使用漢彌爾頓憂鬱症量表。 比較重複性穿顱磁刺激(左背外側前額葉皮質、高頻)和電痙攣治療憂鬱症,兩組沒有差異。除了經過兩週治療的精神病患者,使用漢彌爾頓憂鬱症量表組,才顯示電痙攣治療比重複性穿顱磁刺激有療效。

作者結論

本回顧的資料顯示沒有強烈的證據證明使用穿顱磁刺激治療憂鬱症的益處。但是小樣本的研究也沒有排除其有益處的可能性。

翻譯人

本摘要由成功大學附設醫院尹子真翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

無內容。

Plain language summary

Transcranial magnetic stimulation (TMS) for depression

Transcranial magnetic stimulation can either excite or inhibit cortical areas of the brain, depending on whether the speed of the repetitive stimulation is applied at high or low frequencies. It has been used for physiological studies and it has also been proposed as a treatment for depression. Sixteen trials were included in the review and fourteen contained data in a suitable form for quantitative analysis. Most comparisons did not show differences between repetitive (rTMS) and other interventions. No difference was seen between rTMS and sham TMS using the Beck Depression Inventory or the Hamilton Depression Rating Scale, except for one time period (after two weeks of treatment) for left dorsolateral prefrontal cortex and high frequency; and also for right dorsolateral prefrontal cortex and low frequency, both in favour of rTMS and both using the Hamilton scale. Comparison of rTMS (left dorsolateral prefrontal cortex and high frequency) with electroconvulsive therapy showed no difference except for psychotic patients after two weeks treatment, using the Hamilton scale, which indicated that electroconvulsive therapy was more effective than rTMS.

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