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Advances in the Application of Repetitive Transcranial Magnetic Stimulation for Acute and Maintenance Treatment of Major Depressive Disorder
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摘要:
抑郁障碍(major depressive disorder，MDD)是一种常见的精神障碍，具有较高的患病率和复发率。重复经颅磁刺激(repetitive transcranial magnetic stimulation，rTMS)在MDD急性期治疗中得到了广泛应用，同时在维持治疗中展现出一定潜力。然而，rTMS在急性期治疗中的疗效影响因素以及长期疗效的可持续性尚未完全明确，其维持治疗方案亦未达成共识。本文对近年来应用于MDD的急性和维持性rTMS研究证据进行梳理，旨在总结当前研究进展，为rTMS在临床实践中的进一步推广和应用提供参考。
Abstract:Major depressive disorder (MDD) is a prevalent psychiatric condition characterized by high rates of prevalence and recurrence. Repetitive transcranial magnetic stimulation (rTMS) has been widely utilized in the acute phase treatment of MDD and has shown potential in maintenance therapy. However, the factors influencing the efficacy of rTMS during the acute phase and the sustainability of its long-term therapeutic effects remain incompletely understood. Additionally, a consensus on the optimal maintenance treatment protocol has yet to be established. This article reviews recent evidence on the application of rTMS in both acute and maintenance treatment of MDD, aiming to summarize current research progress and provide insights for the further promotion and application of rTMS in clinical practice.
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作者贡献：李明珠负责论文构思和初稿撰写；阎浩负责选题设计、修订和审核论文。利益冲突：所有作者均声明不存在利益冲突
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图 1 rTMS在抑郁障碍治疗中的应用
rTMS：同表 1
Figure 1. The application of rTMS in the treatment of depressive disorders
表 1 rTMS维持治疗抑郁障碍的专家推荐意见
Table 1 Expert recommendations for the use of maintenance rTMS in depressive disorders
作者 发表年份 具体内容 许毅等[67] 2018 临床推荐1：rTMS高频刺激左侧DLPFC或低频刺激右侧DLPFC，用于抑郁症急性期疗效肯定，连续4~6周，必要时可延长治疗时间。(一级一致证据) 临床推荐2：rTMS可用于先前急性期rTMS治疗受益，目前复发的患者。(一级一致证据) 临床推荐3：rTMS可作为急性期治疗获益患者的后续或维持治疗。(一级一致证据) 临床推荐4：rTMS可单独或联合抗抑郁药或其他精神类药物使用。(二级一致证据) Perera等[66] 2016 建议1：推荐rTMS作为急性期治疗手段，用于缓解适用患者群体的抑郁症症状。(A级) 建议2：既往从急性治疗疗程(药物或其他治疗)中获益且抑郁复发的患者，建议将rTMS疗法作为后续治疗选择。(A级) 建议3：rTMS治疗可与抗抑郁药/其他精神药物同时使用，也可单独使用。(B级) 建议4：对于从急性治疗中获益的患者，可使用rTMS延续治疗或维持治疗。(A级) 建议5：对rTMS急性治疗有反应后抑郁复发的患者，可重新引入rTMS治疗。(B级) rTMS(repetitive transcranial magnetic stimulation)：重复经颅磁刺激；DLPFC(dorsolateral prefrontal cortex)：背外侧前额叶皮质 
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