Repetitive transcranial magnetic stimulation for major depressive disorder: a review.

摘要: Several studies demonstrated that repetitive transcranial magnetic stimulation (rTMS) is an efficacious treatment for treatment-resistant major depressive disorder (TRD). Recent metaanalyses and more recent large multicentre provided evidence suggesting rTMS indeed a promising treatment; however, its efficacy has often been shown to be modest, compared with sham stimulation. We review these lines of discuss several reasons may explain the modest therapeutic in most studies, including: involved left-sided alone dorsolateral prefrontal cortex (DLPFC) only, which less optimal than applying bilateral stimulation; suboptimal methods were used target DLPFC (that is, 5-cm anterior method), limiting potential inherently targeted form some durations short 2 4 weeks); intensity might have insufficient by not considering coil-to-cortex distance, linked rTMS-induced antidepressant response. Future attempting address above-mentioned limitations are necessary potentially optimize this already option TRD. Finally, it also essential research investigate mechanisms efficacy, thus increases understanding can translated into enhanced treatment. For will reviewed, cortical excitability represent important mechanism, disorder. Can J Psychiatry 2008;53(9):555-566 Highlights * was effective tool resistant depression. However, clinical varies widely between studies. designed directly brain regions associated depression, further evaluate stimulation, duration promising, novel Key Words: cortex, treatment, Abbreviations article BA Brodmann area BDI Beck Depression Inventory ECT electroconvulsive therapy EEG electroencephalogram GABA gamma amino butyric acid GABAergic acidergic HDRS Hamilton Rating Scale HFL high-frequency left LFR low-frequency right DLPRC MADRS Montgomery-Ashberg MDD MRI resonance imaging TMS TRD one prevalent mental illnesses North America, affecting about 4% Canadians annually.1 Though numerous treatments available, as many 30% patients fail respond treatment2 60% experience relapse.3 These statistics emphasize need alternative strategies outcomes; few alternatives available treat symptoms. One ECT; significant side effects, notably memory impairment. Also, requires use general anaesthetic induction seizure thereby making invasive procedure increased risk complications. In addition, stigma limits widespread acceptance neuropsychiatrie disorders including schizophrenia.4-6 paper, we intend existing literature evaluating MDD. …