憂鬱症治療方案－穿顱磁刺激

Transcranial Magnetic Stimulation as Antidepressive Therapy

10.3966/156092512015060062005

周育如(Yu-Ju Chou)

憂鬱症 ； 穿顱磁刺激 ； 前額葉 ； 抗鬱成效 ； depression ； Transcranial Magnetic Stimulation ； prefrontal cortex ； antidepressant effect

應用心理研究

62期（2015 / 06 / 01）

163 - 210

繁體中文

穿顱磁刺激於2008年底通過美國認可，獲准使用在用藥無效的重鬱症患者，成為最新的憂鬱症治療方法之一。然而，國內臨床專業人員對此療法雖然有興趣，卻缺乏全面瞭解的管道。本文目的即在介紹穿顱磁刺激治療方案的原理與臨床實施方法，希望增進相關專業人員對其認識。本文首先介紹穿顱磁刺激治療方案的優勢，以及發展此技術的必要性。第一部份回顧憂鬱症之種類、多種致病成因，以及前額葉異常活動假說、現行的治療方法；第二部份介紹穿顱磁刺激之原理，以及臨床治療潛力；第三部份呈現以穿顱磁刺激治療憂鬱症的臨床實施方法，包含受試者篩檢標準、完整的磁波參數、如何精準地控制磁波以透過顱骨直接刺激前額葉，與如何評估憂鬱症狀之緩解；第四部份則探討磁刺激的安全性、研究至今所累積的抗鬱成效、方案檢討、與磁刺激後的大腦活動追蹤；最後，本文提出應加入具敏感度的認知功能追蹤評估，以偵測與認知功能高相關的前額葉功能變化，並呈現穿顱磁刺激的最新進展。

TMS therapy has been cleared by the United States as a noninvasive depression treatment. It is meant for adult patients who do not achieve satisfactory improvement from prior antidepressant medication. However, people who are interested in learning how TMS works rarely have an opportunity to see the whole picture. The present article aims to enhance their understanding on TMS treatment by reviewing current knowledge concerning TMS from theoretical bases to clinical interventions. This article provides an overview of the benefits of TMS and the importance of developing the technique for treatment against depression. In the first part, the study reviews the five subtypes and various causes of depression, metabolic abnormalities within the frontal lobe, and contemporary possible professional interventions. The second part of the article introduces the bases of TMS and its therapeutic potential for psychiatric disorders. Next, there is a clinical demonstration presenting the criteria and selection of participants, the settings of TMS parameters, the precise control of TMS interference to the prefrontal cortex, and the assessment of depressive symptoms. The fourth section discusses safety restrictions of TMS, its antidepressant efficacy accumulated to the present, and the follow-up studies of brain activations after treatment. Additionally, the article suggests a pre- and post-treatment cognitive assessment to be added to monitor subsequent changes of cognitive functioning closely related to the prefrontal cortex. Lastly, the article presents the most up-to-date developments of TMS.

1. 阮啟弘、呂岱樺、陳巧雲(2005)。跨顱磁刺激在認知神經科學研究的角色。應用心理研究，28，51-74。
   連結：
2. American Psychiatric Association(2000).Diagnostic and statistical manual of mental disorders (DSM-IV-TR).Washington, DC:American Psychiatric Publishing.
3. Barker, A. T.,Jalinous, R.,Freeston, I. L.(1985).Non-invasive magnetic stimulation of human motor cortex.The Lancet,1,1106-1107.
4. Beck, A. T.,Steer, R. A.,Garbin, M. G.(1988).Psychometric properties of the Beck depression inventory: Twenty-five years of evaluation.Clinical Psychology Review,8,77-100.
5. Beckham, E. E.(Ed.),Leber, W. R.(Ed.)(1995).Handbook of depression.New York, NY:Guilford.
6. Brakemeier, E. L.,Luborzewski, A.,Danker-Hopfe, H.,Kathmann, N.,Bajbouj, M.(2007).Positive predictors for antidepressive response to prefrontal repetitive transcranial magnetic stimulation (rTMS).Journal of Psychiatric Research,41(5),395-403.
7. Burt, T.,Lisanby, S. H.,Sackeim, H. A.(2002).Neuropsychiatric applications of transcranial magnetic stimulation: A meta-analysis.The International Journal of Neuropsychopharmacology,5,73-103.
8. Chae, J. H.,Nahas, Z.,Wassermann, E.,Li, X.,Sethuraman, G.(2004).A pilot safety study of repetitive transcranial magnetic stimulation (rTMS) in Tourette's Syndrome.Cognitive and Behavioral Neurology,17(2),109-117.
9. Chistyakov, A.,Rubicsek, O.,Kaplan, B.,Zaaroor, M.,Klein, E.(2010).P11-8 antidepressant effects of different schedules of theta-burst TMS in patients with major depression.Clinical Neurophysiology,121,167.
10. Chou, Y. J.(2005).Depression and the technique of transcranial magnetic stimulation.workshop of East Taiwan- 2005 Trauma, healing and psychological recovery,Hualien, Taiwan:
11. Chou, Y. J.,Jackson, S.(2004).Transcranial magnetic stimulation of FEF, LIP and MT/V5 areas during a spatial remapping task.6th International Congress of Psychology,Beijing, China:
12. Clark, D. A.,Beck, A. T.,Alford, B. A.(1999).Scientific foundations of cognitive theory and therapy of depression.New York, NY:Wiley.
13. Coben, R.(Ed.),Evans, J. R.(Ed.)(2010).Neurofeedback and neuromodulation techniques and applications.San Diego, CA:Elsevier.
14. Collette, F.,Salmon, E.,Van der Linden, M.,Chicherio, C.,Belleville, S.,Dequeldre, C.,Delfiore, G.,Franck, G.(1999).Regional brain activity during tasks devoted to the central executive of working memory.Cognitive Brain Research,7,411-417.
15. Collette, F.,Van der Linden, M.(2002).Brain imaging of the central executive component of working memory.Neuroscience and Biobehavioral Reviews,26,105-125.
16. Collette, F.,Van der Linden, M.,Laureys, S.,Arigoni, F.,Delfiore, G.,Degueldre, C.,Luxen, A.,Salmon, E.(2007).Mapping the updating process: Common and specific brain activations across different versions of the running span task.Cortex,43,146-158.
17. Collette, F.,Van der Linden, M.,Laureys, S.,Delfiore, G.,Degueldre, C.,Luxen, A.,Salmon, E.(2005).Exploring the unity and diversity of the neural substrates of executive functioning.Human Brain Mapping,25,409-423.
18. Conca, A.,Koppi, S.,Konig, P.,Swoboda, E.,Krecke, N.(1996).Transcranial magnetic stimulation: A novel antidepressive strategy?.Neuropsychobiology,34,204-207.
19. Couturier, J. L.(2005).Efficacy of rapid-rate repetitive transcranial magnetic stimulation in the treatment of depression: A systematic review and meta-analysis.Journal of Psychiatry & Neuroscience,30,83-90.
20. Curtis, C.E.,D'Esposito, M.(2003).Persistent activity in the prefrontal cortex during working memory.Trends in Cognitive Science,7,415-423.
21. Davidson, R. J.(Ed.),Hugdahl, K.(Ed.)(1995).Brain asymmetry.Cambridge, MA:MIT Press.
22. Fregni, F.,Marcolin, M. A.,Myczkowski, M.,Amiaz, R.,Hasey, G.,Rumi(2006).Predictors of antidepressant response in clinical trials of transcranial magnetic stimulation.International Journal of Neur opsychopharmacology,9(6),641-654.
23. Garcia-Toro, M.,Pascual-Leone, A.,Romera, M.,Gonzalez, A.,Mico, J.,Ibarra, O.,Arnillas, H.,Capllonch, I.,Mayol, A.,Tormos, J. M.(2001).Prefrontal repetitive transcranial magnetic stimulation as add on treatment in depression.Journal of Neurology, Neurosurgery & Psychiatry,71,546-548.
24. George, M. S.,Wassermann, E. M.(1994).Rapid-rate transcranial magnetic stimulation (rTMS) and ECT.Convulsive Therapy,10,251-253.
25. George, M. S.,Wassermann, E. M.,William, W. A.,Callahan, A.,Ketter, T. A.,Besser, P.(1995).Daily repetitive transcranial magnetic stimulation (rTMS) improves mood in depression.NeuroReport,6,1853-1856.
26. Gershon, A. A.,Dannon, P. N.,Grunhaus, L.(2003).Transcranial magnetic stimulation in the treatment of depression.American Journal of Psychiatry,160,835-845.
27. Hausmann, A.,Kemmler, G.,Walpoth, M.,Mechtcheriakov, S.,Kramer-Reinstadler, K.,Lechner, T.,Conca, A.(2004).No benefit derived from repetitive transcranial magnetic stimulation in depression: A prospective, single centre, randomised, double blind, sham controlled "add on" trial.Journal of Neurology Neurosurgery & Psychiatry,75,320-322.
28. Hausmann, A.,Weis, C.,Marksteiner, J.,Hinterhuber, H.,Humpel, C.(2000).Chronic repetitive transcranial magnetic stimulation enhances c-fos in the parietal cortex and hippocampus.Molecular Brain Research,76,355-362.
29. Henriques, J. B.,Davidson, R. J.(1991).Left frontal hypoactivation in depression.Journal of Abnormal Psychology,100,535-45.
30. Holtzheimer, P. E.,Russo, J.,Avery, D. H.(2001).A meta-analysis of repetitive transcranial magnetic stimulation in the treatment of depression.Psychopharmacology Bulletin,35,149-169.
31. Huang, Y. Z.,Edwards, M. J.,Rounis, E.,Bhatia, K. P.,Rothwell, J. C.(2005).Theta burst stimulation of the human motorc.Neuron,45,201-206.
32. Huemmeke, M.,Eysel, U.,Mittmann, T.(2002).Metabotropic glutamate receptors mediate expression of LTP in slices of rat visual cortex.Eur J Neur osci,15,1641-1645.
33. Kimbrell, T. A.,Dunn, R. T.,George, M. S.,Danielson, A. L.,Willis, M. W.,Repella, J. D.,Wassermann, E. M.(2002).Left prefrontal-repetitive transcranial magnetic stimulation (rTMS) and regional cerebral glucose metabolism in normal volunteers.Psychiatry Research: Neuroimaging,115,101-113.
34. Kimbrell, T. A.,George, M. S.,Parekh, P. I.,Ketter, T. A.,Podell, D. M.,Danielson, A. L.,Post, R. M.(1999).Regional brain activity during transient self-induced anxiety and anger in healthy adults.Biological Psychiatry,46,454-465.
35. Kimbrell, T. A.,Little, J. T.,Dunn, R. T.,Frye, M. A.,Greenberg, B. D.,Wassermann, E. M.(1999).Frequency dependence of antidepressant response to left prefrontal repetitive transcranial magnetic stimulation (rTMS) as a function of baseline cerebral glucose metabolism. Biological Psychiatry.Biological Psychiatry,46(12),1603-1613.
36. Kozel, F. A.,George, M. S.(2002).Meta-analysis of left prefrontal repetitive transcranial magnetic stimulation (rTMS) to treat depression.Journal of Psychiatric Practice,8,270-275.
37. Li, X.,Nahas, Z.,Kozel, F. A.,Anderson, B.,Bohning, D. E.,George, M. S.(2004).Acute left prefrontal transcranial magnetic stimulation in depressed patients is associated with immediately increased activity in prefrontal cortical as well as subcortical regions.Biological Psychiatry,55,882-890.
38. Li, X.,Teneback, C. C.,Nahas, Z.,Kozel, F. A.,Large, C.,Cohn, J.,George, M. S.(2002).Lamotrigine inhibits the functional magnetic resonance imaging response to transcranial magnetic stimulation in healthy adults.Biological Psychiatry,51,567.
39. Liddle, E.,Chou, Y. J.,Jackson, S.(2009).Perisaccadic mislocalization in dyslexia.Neuropsychologia,47,77-82.
40. Loo, C. K.,Sachdev, P. S.,Haindl, W.,Wen, W.,Mitchell, P. B.,Croker, V. M.,Malhi, G. S.(2003).High (15 Hz) and low (1 Hz) frequency transcranial magnetic stimulation have different acute effects on regional cerebral blood flow in depressed patients.Psychological Medicine,33,997-1006.
41. Mark, S. G.,Robert, H. B.(2007).Transcranial Magnetic Stimulation in clinical psychiatry.Washington, DC:American Psychiatric Publishing.
42. Martin, J. L.,Barbanoj, M. J.,Schlaepfer, T. E.,Clos, S.,Perez, V.,Kulisevsky, J.,Gironell, A.(2002).Transcranial magnetic stimulation for treating depression.Cochrane Database of Systematic Reviews,2,CD003493.
43. Mayberg, H. S.,Brannan, S. K.,Mahurin, R. K.,Jerabek, P. A.,Brickman, J. S.,Tekell, J. L.,Fox, P. T.(1997).Cingulate function in depression: A potential predictor of treatment response.NeuroReport,8,1057-1061.
44. Montgomery, S. A.,Asberg, M.(1979).A new depression scale designed to be sensitive to change.The British Journal of Psychiatry,134,382-389.
45. Mottaghy, F. M.,Keller, C. E.,Gangitano, M.,Ly, J.,Thall, M.,Parker, J. A.,Pascual-Leone, A.(2002).Correlation of cerebral blood flow and treatment effects of repetitive transcranial magnetic stimulation in depressed patients.Psychiatry Research: Neuroimaging,115,1-14.
46. Nobler, M. S.,Oquendo, M. A.,Kegeles, L. S.,Malone, K. M.,Campbell, C. C.,Sackeim, H. A.,Mann, J. J.(2001).Decreased regional brain metabolism after ECT.American Journal of Psychiatry,158,305-308.
47. Nobler, M. S.,Pelton, G. H.,Sackeim, H. A.(1999).Cerebral blood flow and metabolism in late-life depression and dementia.Journal of Geriatric Psychiatry and Neur ology,12,118-127.
48. Nobler, M. S.,Roose, S. P.,Prohovnik, I.,Moeller, J. R.,Louie, J.,Van Heertum, R. L.,Sackeim, H. A.(2000).Regional cerebral blood flow in mood disorders, V.: Effects of antidepressant medication in late-life depression.American Journal of Geriatric Psychiatry,8,289-296.
49. Nobler, M. S.,Sackeim, H. A.,Prohovnik, I.,Moeller, J. R.,Mukherjee, S.,Schnur, D. B.,Devanand, D. P.(1994).Regional cerebral blood flow in mood disorders, III. Treatment and clinical response.Archives of General Psychiatry,51,884-897.
50. Nobler, M. S.,Teneback, C. C.,Nahas, Z.,Bohning, D. E.,Shastri, A.,Kozel, F. A.,George, M. S.(2000).Structural and functional neuroimaging of electroconvulsive therapy and transcranial magnetic stimulation.Depress and Anxiety,12,144-156.
51. Pascual-Leone, A.,Tarazona, F.,Keenan, J.,Tormos, J. M.,Hamilton, R.,Catala, M. D.(1999).Transcranial magnetic stimulation and neuroplasticity.Neuropsychologia,37(2),207-217.
52. Paulus, W.(2005).Toward establishing a therapeutic window for rTMS by theta burst stimulation.Neuron,45(2),181-183.
53. Paus, T.,Castro-Alamancos, M. A.,Petrides, M.(2001).Corticocortical connectivity of the human mid-dorsolateral frontal cortex and its modulation by repetitive transcranial magnetic stimulation.European Journal of Neur oscience,14,1405-1411.
54. Paykel, E. S.(Ed.)(1992).Handbook of affective disorders.New York, NY:Guilford.
55. Rounis, E.,Yarrow, K.,Rothwell, J. C.(2007).Effects of rTMS conditioning over the fronto-parietal network on motor versus visual attention.Journal of Cognitive Neuroscience,19,513-524.
56. Rumi, D. O.,Gattaz, W. F.,Rigonatti, S. P.,Rosa, M. A.,Fregni, F.,Rosa, M. O.,Marcolin, M. A.(2005).Transcranial magnetic stimulation accelerates the antidepressant effect of amitriptyline in severe depression: A double-blind placebo-controlled study.Biological Psychiatry,57,162-166.
57. Sackeim, H. A.,Luber, B.,Katzman, G. P.,Moeller, J. R.,Prudic, J.,Devanand, D. P.,Nobler, M. S.(1996).The effects of electroconvulsive therapy on quantitative electroencephalograms- Relationship to clinical outcome.Archives of General Psychiatry,53,814-824.
58. Speer, A. M.,Kimbrell, T. A.,Wassermann, E. M.,Repella, D.,Willis, M. W.,Herscovitch, P.,Post, R. M.(2000).Opposite effects of high and low frequency rTMS on regional brain activity in depressed patients.Biological Psychiatry,48,1133-1141.
59. Stagg, C. J.,Wylezinska, M.,Matthews, P. M.,Johansen-Berg, H.,Jezzard, P.,Rothwell, J. C.(2009).Neurochemical effects of theta burst stimulation as assessed by magnetic resonance spectroscopy.Journal of Neur ophysiology,101(6),2872-2877.
60. Su, T. P.,Huang, C. C.,Wei, I. H.(2005).Add-on rTMS for medication-resistant depression: A randomized, double-blind, shamcontrolled trial in Chinese patients.Journal of Clinical Psychopharmacology,66,930-937.
61. Teneback, C. C.,Nahas, Z.,Speer, A. M.,Molloy, M.,Stallings, L. E.,Spicer, K.,George, M. S.(1999).Changes in prefrontal cortex and paralimbic activity in depression following two weeks of daily left prefrontal TMS.Journal of Neuropsychiatry Clinical Neurosciences,11,426-435.
62. Terao,Y.,Ugawa, Y.,Sakai, K.,Miyauchi, S.,Fukuda, H.,Sasaki, Y.,Kanazawa, I.(1998).Localizing the site of magnetic brain stimulation by functional MRI.Experiment Brain Research,121,145-152.
63. Wager, T. D.,Smith, E. E.(2003).Neuroimaging studies of working memory: Ameta-analysis.Cognitive Affective and Behavioral Neuroscience,3,255-274.
64. Weber, M. & Eisen, A. A.(2002).Magnetic stimulation of the central and peripheral nervous systems.Muscle and Nerve,25,160-175.
65. Wu, J. C.,Gillin, J. C.,Buchsbaum, M. S.,Hershey, T.,Johnson, J. C.,Bunney, W. E.(1992).Effect of sleep deprivation on brain metabolism of depressed patients.The American Journal of Psychiatry,149,538-543.
66. Zangen, A.,Roth, Y.,Voller, B.,Hallett, M.(2005).Transcranial magnetic stimulation of deep brain regions: Evidence for efficacy of the H-coil.Clinical Neurophysiology,116(4),775-779.
67. 周育如、樂可天(2012)。應用工作記憶理論促進學習成效。慈濟大學教育研究學刊，9，33-68。
68. 柯慧貞、陸汝斌(1990)。迪皮醇壓抑測驗與內因性憂鬱症關係之回顧。中華精神醫學，4，241-247。