Abstract：
The depression response trajectory after a course of repetitive transcranial magnetic stimulation(rTMS) remains understudied. We searched for blinded randomized controlled trials(RCTs) that examined conventional rTMS over left dorsolateral prefrontal cortex(DLPFC) for major depressive episodes(MDE). The effect size was calculated as the difference in depression improvement, between active and sham rTMS. We conducted a random-effects dose-response meta-analysis to model the response trajectory from the beginning of rTMS to the post-treatment follow-up phase. The area under curve (AUC) of the first 8-week response trajectory was calculated to compare antidepressant efficacy between different rTMS protocols. We included 40 RCTs(n = 2012). The best-fitting trajectory model exhibited a logarithmic curve(X2=17.7, P < 0.001), showing a gradual ascent with tapering off around the 3-4th week mark and maintaining until week 16. The maximum effect size was 6.1(95 %CI: 1.25-10.96) at week 16. The subgroup analyses showed distinct trajectories across different rTMS protocols. Besides, the comparisons of AUC showed that conventional rTMS protocols with more pulse/session group or more total pulses were associated with greater efficacy than those with fewer pulse/session or fewer total pulses, respectively. A course of conventional left DLPFC rTMS could lead to both acute antidepressant effects and sustained after-effects, which were modeled by different rTMS protocols in MDE.
摘要：
重复经颅磁刺激（rTMS）后的抑郁反应轨迹仍未得到充分研究。我们搜索了盲法随机对照试验（RCT），该试验检查了左背外侧前额叶皮层（DLPFC）上常规rTMS的重度抑郁发作（MDE）。效应大小计算为抑郁症改善的差异，在活跃和假rTMS之间。我们进行了随机效应剂量反应荟萃分析，以模拟从rTMS开始到治疗后随访阶段的反应轨迹。计算第一个8周反应轨迹的曲线下面积(AUC)以比较不同rTMS方案之间的抗抑郁功效。我们纳入了40项随机对照试验(n=2012)。最佳拟合轨迹模型呈现对数曲线(X2=17.7,P<0.001),显示出逐步上升，在3-4周左右逐渐缩小，并保持到16周。在第16周时，最大效应大小为6.1（95CI：1.25-10.96）。亚组分析显示了不同rTMS协议的不同轨迹。此外,AUC的比较表明，具有更多脉冲/会话组或更多总脉冲的常规rTMS方案比具有更少脉冲/会话或更少总脉冲的方案具有更大的疗效。分别。一个疗程的常规左DLPFCrTMS可能导致急性抗抑郁作用和持续的后遗症，在MDE中通过不同的rTMS协议建模。
