■尽管双相抑郁(BDE)具有临床重要性,有效的治疗选择仍然有限。经颅磁刺激(rTMS)已被证明对重度抑郁症有中等疗效,但是对于BDE来说,证据仍然没有定论。
■四周,双盲,随机化,平行组,假对照研究(试验IDISRCTN77188420)探讨了10HzMRI引导的右腹外侧(RVL)rTMS和左背外侧(LDL)rTMS作为BDE的附加治疗的益处。结果指标包括蒙哥马利-奥斯贝格抑郁量表(MADRS)评分的变化,自我评估,反应和缓解率,和副作用。
■60名患者被随机分配到研究组,46人完成了双盲阶段。与假手术相比,两个活动组的MADRS从基线到第4周的平均变化更大,但差异无统计学意义(RVL与假手术:-4.50,95CI-10.63~1.64,p=0.3;LDL与假手术:-4.07,95CI-10.24~2.10,p=0.4).其他结果衡量标准均未产生重大成果。
■虽然没有证明10HzrTMS优于假,由于样本量有限,我们不能排除中等但有临床意义的效果.进一步的有力研究对于阐明rTMS在管理BDE中的作用至关重要。
Despite the clinical importance of bipolar depression (BDE), effective treatment options are still limited. Transcranial magnetic stimulation (rTMS) has proven of moderate efficacy in major depression, but the evidence remains inconclusive for BDE.
A 4-week, double-blind, randomised, parallel-group, sham-controlled
study (
trial ID ISRCTN77188420) explored the benefits of 10 Hz MRI-guided right ventrolateral (RVL) rTMS and left dorsolateral (LDL) rTMS as add-on treatments for BDE. Outcome measures included changes in the Montgomery-Åsberg Depression Rating Scale (MADRS) score, self-assessment, response and remission rates, and side effects.
Sixty patients were randomly assigned to
study groups, and forty-six completed the double-blind phase. The mean change from baseline to Week 4 in MADRS was greater in both active groups compared to the sham, yet differences did not achieve significance (RVL vs sham: -4.50, 95%CI -10.63 to 1.64, p = 0.3; LDL vs sham: -4.07, 95%CI -10.24 to 2.10, p = 0.4). None of the other outcome measures yielded significant results.
While not demonstrating the superiority of either 10 Hz rTMS over sham, with the limited sample size, we can not rule out a moderate yet clinically meaningful effect. Further well-powered studies are essential to elucidate the role of rTMS in managing BDE.