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Gibt es eine differentielle Indikation für die antidepressive präfrontale repetitive transkranielle Magnetstimulation (RTMS)?

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Die therapeutische Vielfalt in der Depressionsbehandlung

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Zusammenfassung

Die repetitive transkranielle Magnetstimulation (RTMS) über dem präfrontalen Kortex ist ein experimentelles therapeutisches Verfahren, das in der letzten Dekade entwickelt wurde. RTMS über dem dorsolateralen präfrontalen Kortex (DLPFC) führte in fünf von sieben offenen und sieben von acht plazebokontrollierten publizierten Studien mit insgesamt mehr als 300 Patienten zu einer signifikanten klinischen Besserung bei depressiven Patienten. Diese klinische Besserungsraten nach ein- bis zweiwöchiger werktäglicher Anwendung streuten jedoch zwischen 6% und 60% Verbesserung in der Hamilton- Depressions-Skala (HAMD). Diese Varianz ist wahrscheinlich durch unterschiedliche Behandlungsmodalitäten, aber auch durch genetische, psychopathologische und neuropsychologische Merkmale der Patienten sowie den funktionellen Zustand des stimulierten Kortexareals zu Beginn der Behandlung bedingt.

Inzwischen bilden sich verschiedene positive Prädiktoren für eine antidepressive Wirksamkeit von präfrontaler RTMS heraus, wie jüngeres Alter, somatische Zeichen der Angst, fehlende kortikale Hyperaktivierung unter Spule bei hochfrequenter Stimulation (<10 Hz) und Hypermetabolismus unter der 1-Hz-gepulsten Spule. Negative Prädiktoren für die antidepressive Wirksamkeit waren bei einer präfrontalen RTMS höheres Alter, frontale Hirnatrophie, geringe mentale Leistungen im Bereich frontaler Leistungen, psychotische Merkmale, kortikale Hyperaktivierung bei Hochfrequenzstimulation und fehlende Wirksamkeit der Elektrokrampftherapie.

Die RTMS hat somit eine moderate antidepressive Wirksamkeit und ist sehr gut verträglich. Sie ist als antidepressive Therapie insbesondere bei jüngeren, nicht kognitiv beeinträchtigten und ängstliche Patienten indiziert. Ein weitere bisher nicht untersuchte potentielle Gruppe sind schwangere und stillende Frauen, die vom lokalen Wirkmechanismus profitieren könnten. Die präfrontale RTMS ist somit wahrscheinlich kein Ersatz, sondern eine Ergänzung zur Pharmakotherapie oder Elektrokrampftherapie der Depression.

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  1. G. W. Eschweiler
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  1. Universitätsklinik für Psychiatrie und Psychotherapie, Osianderstr. 24, 72076, Tübingen, Deutschland

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Eschweiler, G.W. (2001). Gibt es eine differentielle Indikation für die antidepressive präfrontale repetitive transkranielle Magnetstimulation (RTMS)?. In: Batra, A., Buchkremer, G. (eds) Die therapeutische Vielfalt in der Depressionsbehandlung. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-59494-6_6

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  • DOI: https://doi.org/10.1007/978-3-642-59494-6_6

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