Sean J. O’Sullivan , Derrick M. Buchanan , Jean-Marie V. Batail , Nolan R. Williams
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引用次数: 0
摘要
难治性抑郁症(TRD)是一种流行病,其社会、经济和政治成本不断上升。如果重度抑郁发作(MDE)患者经过充分的抗抑郁试验后仍无法治愈,保险公司通常会支付替代治疗费用,其中可能包括重复经颅磁刺激(rTMS)。经颅磁刺激(RTMS)是一种经美国食品及药物管理局(FDA)批准的治疗 TRD 的神经调节技术,具有安全、有效、无创、耐受性好等特点。最近,经颅磁刺激算法和靶向性的优化发展提高了经颅磁刺激治疗抑郁症的疗效,改善了这些治疗的临床便利性,并降低了经颅磁刺激疗程的成本。在这篇论文中,我们论证了为什么常规经 FDA 批准的经颅磁刺激疗法应被视为所有成人 MDE 的一线治疗方法。我们将经颅磁刺激疗法与其他一线疗法(包括心理疗法和 SSRIs)进行了比较。这些观察结果表明,经颅磁刺激具有相似的疗效、较少的副作用、较低的严重不良事件风险、可比的依从性、更快缓解的潜力以及成本效益。不过,如果能进一步研究首次抑郁发作时未接受过治疗的受试者,并将经颅磁刺激疗法与 SSRIs 或心理疗法进行直接对比试验,这一建议将会得到进一步加强。
Should rTMS be considered a first-line treatment for major depressive episodes in adults?
Treatment-resistant depression (TRD) is an epidemic with rising social, economic, and political costs. In a patient whose major depressive episode (MDE) persists through an adequate antidepressant trial, insurance companies often cover alternative treatments which may include repetitive transcranial magnetic stimulation (rTMS). RTMS is an FDA-cleared neuromodulation technique for TRD which is safe, efficacious, noninvasive, and well-tolerated. Recent developments in the optimization of rTMS algorithms and targeting have increased the efficacy of rTMS in treating depression, improved the clinical convenience of these treatments, and decreased the cost of a course of rTMS. In this opinion paper, we make a case for why conventional FDA-cleared rTMS should be considered as a first-line treatment for all adult MDEs. RTMS is compared to other first-line treatments including psychotherapy and SSRIs. These observations suggest that rTMS has similar efficacy, fewer side-effects, lower risk of serious adverse events, comparable compliance, the potential for more rapid relief, and cost-effectiveness. This suggestion, however, would be strengthened by further research with an emphasis on treatment-naive subjects in their first depressive episode, and trials directly contrasting rTMS with SSRIs or psychotherapy.
期刊介绍:
As of January 1999, The journal Electroencephalography and Clinical Neurophysiology, and its two sections Electromyography and Motor Control and Evoked Potentials have amalgamated to become this journal - Clinical Neurophysiology.
Clinical Neurophysiology is the official journal of the International Federation of Clinical Neurophysiology, the Brazilian Society of Clinical Neurophysiology, the Czech Society of Clinical Neurophysiology, the Italian Clinical Neurophysiology Society and the International Society of Intraoperative Neurophysiology.The journal is dedicated to fostering research and disseminating information on all aspects of both normal and abnormal functioning of the nervous system. The key aim of the publication is to disseminate scholarly reports on the pathophysiology underlying diseases of the central and peripheral nervous system of human patients. Clinical trials that use neurophysiological measures to document change are encouraged, as are manuscripts reporting data on integrated neuroimaging of central nervous function including, but not limited to, functional MRI, MEG, EEG, PET and other neuroimaging modalities.