Objective

Treatment for major depressive disorder (MDD) have evolved, although there is still a strong unmet need for more effective and tolerable options. The present study summarizes and discusses recent evidence regarding the non-transcranial magnetic stimulation (non-TMS) neurostimulation treatment for MDD.

Methods

The authors reviewed non-TMS neurostimulation clinical trials for MDD between 2010 and 2020. Electroconvulsive therapy was not included in this review. A systematic review was performed in MEDLINE database through PubMed, the Cochrane Collaboration's Clinical Trials Register (CENTRAL), PsycINFO and Thomson Reuters's Web of Science.

Results

Only 20 articles met the inclusion criteria. Randomized controlled trials demonstrated efficacy of transcranial direct current stimulation (tDCS) in five of seven trials. tDCS augmented with sertraline, fluoxetine, citalopram and escitalopram was superior to placebo and to tDCS only. A comparative trial demonstrated that the duration of tDCS sessions can modulate the effectiveness of this treatment. Open trials indicated that deep brain stimulation, epidural cortical stimulation, trigeminal nerve stimulation, magnetic seizure therapy and vagus nerve stimulation may be effective in treatment-resistant depression.

Conclusion

This review confirmed the efficacy of tDCS in MDD. Despite new evidence showing effectiveness for other non-TMS neurostimulation, their effectiveness is still unclear. Non-TMS neurostimulation RCTs with large samples and head-to-head studies comparing non-TMS neurostimulation and gold standard pharmacological treatments are still lacking.

中文翻译：

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非 TMS 神经刺激在抑郁症中的临床疗效：2010 年至 2020 年的临床试验

客观的

重度抑郁症 (MDD) 的治疗已经发展，尽管对更有效和可耐受的选择仍有强烈的未满足需求。本研究总结并讨论了有关 MDD 的非经颅磁刺激 (non-TMS) 神经刺激治疗的最新证据。

方法

作者回顾了 2010 年至 2020 年期间 MDD 的非 TMS 神经刺激临床试验。电惊厥治疗未包括在该评价中。通过 PubMed、Cochrane Collaboration 的临床试验注册中心 (CENTRAL)、PsycINFO 和 Thomson Reuters 的 Web of Science 在 MEDLINE 数据库中进行了系统评价。

结果

只有 20 篇文章符合纳入标准。随机对照试验在七项试验中的五项中证明了经颅直流电刺激 (tDCS) 的功效。用舍曲林、氟西汀、西酞普兰和依他普仑增强的 tDCS 优于安慰剂和仅 tDCS。一项比较试验表明，tDCS 会话的持续时间可以调节这种治疗的有效性。公开试验表明，深部脑刺激、硬膜外皮层刺激、三叉神经刺激、磁性癫痫发作疗法和迷走神经刺激可能对难治性抑郁症有效。

结论

本综述证实了 tDCS 在 MDD 中的疗效。尽管有新证据显示其他非 TMS 神经刺激的有效性，但它们的有效性仍不清楚。仍然缺乏大样本的非 TMS 神经刺激 RCT 和比较非 TMS 神经刺激和金标准药物治疗的头对头研究。