Zusammenfassung
Aufgrund des erheblichen Anteils depressiver Patienten, der nicht ausreichend auf pharmakologische und psychotherapeutische Maßnahmen reagiert, besteht starkes Interesse an neuen Behandlungsstrategien. Aktuell steht ein ganzes Spektrum von Hirnstimulationsverfahren zur Verfügung, die für die antidepressive Behandlung infrage kommen. Darunter sind konvulsive und nichtkonvulsive transkranielle (Elektrokonvulsionstherapie [EKT], Magnetkonvulsionstherapie [MKT], transkranielle Magnetstimulation [TMS], transkranielle Gleichstromstimulation [tDCS]) sowie invasive Verfahren (tiefe Hirnstimulation [THS], Vagusnervstimulation [VNS], epidurale kortikale Stimulation [ECS]). Jede Methode repräsentiert einen spezifischen Ansatz zur Modulation depressionsassoziierter neuronaler Aktivität. Die EKT hat sich seit langem als bislang effektivstes Verfahren bewährt. Die Behandlung mit TMS erreicht das höchste Evidenzniveau unter den neuen antidepressiven Hirnstimulationsverfahren und wird bereits klinisch eingesetzt. Aufgrund des rasant wachsenden Wissens zur Pathophysiologie depressiver Störungen werden Hirnstimulationsverfahren mit hoher Wahrscheinlichkeit das Spektrum antidepressiver Therapiemethoden in naher Zukunft wesentlich erweitern.
Summary
Considering the substantial proportion of depressed patients which does not sufficiently benefit from antidepressant pharmacotherapy or psychotherapy, there is increasing interest in non-pharmacological antidepressant strategies. Thus, a whole array of stimulation approaches has been developed as potential new antidepressant interventions. These methods include transcranial convulsive and non-convulsive approaches, e.g. electroconvulsive therapy (ECT), magnetic seizure therapy (MST), transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) as well as invasive techniques, e.g. deep brain stimulation (DBS), vagus nerve stimulation (VNS) and epidural cortical stimulation (ECS). Each method represents a specific therapeutic approach with distinct targets within neural networks involved in the pathophysiology of depression. The ECT procedure is an established treatment with the highest efficacy of all antidepressant interventions and TMS reaches the highest level of evidence among the novel neurostimulation approaches and may be clinically used. However, the field yields a promising rapid development which may substantially enrich the armamentarium of antidepressant interventions in the near future.
Literatur
Kessler RC et al (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:593–602
World Health Organization (2001) Chapter 2: burden of mental and behavioral disorders. In:WHOreport 2001: mental health: new understanding, new hope. World Health Organization, Geneva
Ressler KJ, Mayberg HS (2007) Targeting abnormal neural circuits in mood and anxiety disorders: from the laboratory to the clinic. Nat Neurosci 10:1116–1124
George MS, Aston-Jones G (2010) Noninvasive techniques for probing neurocircuitry and treating illness: vagus nerve stimulation (VNS), transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). Neuropsychopharmacology 35:301–316
Lisanby SH (2007) Electroconvulsive therapy for depression. N Engl J Med 357:1939–1945
Husain MM, Rush AJ, Fink M et al (2004) Speed of response and remission in major depressive disorder with acute electroconvulsive therapy (ECT): a consortium for research in ECT (CORE) report. J Clin Psychiatry 65:485–491
Padberg F, George MS (2009) Repetitive transcranial magnetic stimulation of the prefrontal cortex in depression. Exp Neurol 219:2–13
Slotema CW, Blom JD, Hoek HW, Sommer IE (2010) Should we expand the toolbox of psychiatric treatment methods to include Repetitive Transcranial Magnetic Stimulation (rTMS)? A meta-analysis of the efficacy of rTMS in psychiatric disorders. J Clin Psychiatry 71:873–884
O’Reardon JP, Solvason HB, Janicak PG et al (2007) Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial. Biol Psychiatry 62:1208–1216
George MS, Lisanby SH, Avery D et al (2010) Daily left prefrontal transcranial magnetic stimulation therapy for major depressive disorder: A sham-controlled randomized trial. Arch Gen Psychiartry 67:507–516
Herwig U, Fallgatter AJ, Höppner J et al (2007) Antidepressant effects of augmentative transcranial magnetic stimulation: randomised multicentre trial. Br J Psychiatry 191:441–448
Rossi S, Hallett M, Rossini PM, Pascual-Leone A (2009) Safety of TMS Consensus Group. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol 120:2008–2039
Huang YZ, Edwards MJ, Rounis E et al (2005) Theta burst stimulation of the human motor cortex. Neuron 45:201–206
Holzer M, Padberg F (2010) Intermittent theta burst stimulation (iTBS) ameliorates therapy-resistant depression: a case series. Brain Stimul 3:181–183
Fitzgerald PB, Hoy K, McQueen S et al (2009) A randomized trial of rTMS targeted with MRI based neuro-navigation in treatment-resistant depression. Neuropsychopharmacology 34:1255–1262
Harel EV, Rabany L, Deutsch L et al (2012) H-coil repetitive transcranial magnetic stimulation for treatment resistant major depressive disorder: an 18-week continuation safety and feasibility study. World J Biol Psychiatry (Im Druck)
Priori A (2003) Brain polarization in humans: a reappraisal of an old tool for prolonged non-invasive modulation of brain excitability. Clin Neurophysiol 114:589–595
Nitsche MA, Paulus W (2000) Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. J Physiol 527:633–639
Wassermann EM, Grafman J (2005) Recharging cognition with DC brain polarization. Trends Cogn Sci 9:503–505
Keeser D, Meindl T, Bor J et al (2011) Prefrontal transcranial direct current stimulation (tDCS) changes activity of resting-state networks during functional magnetic resonance imaging (fMRI). J Neurosci 31:15284–15293
Palm U, Schiller C, Fintescu Z et al (2011) Transcranial direct current stimulation in treatment resistant depression: a randomized double-blind, placebo-controlled study. Brain Stimul [Epub ahead of print]
Loo CK, Alonzo A, Martin D et al (2012) Transcranial direct current stimulation for depression: 3-week, randomised, sham-controlled trial. Br J Psychiatry 200:52–59
Lisanby SH, Luber B, Schlaepfer TE, Sackeim HA (2003) Safety and feasibility of magnetic seizure therapy (MST) in major depression: randomized within-subject comparison with electroconvulsive therapy. Neuropsychopharmacology 28:1852–1865
Kirov G, Ebmeier KP, Scott AI et al (2008) Quick recovery of orientation after magnetic seizure therapy for major depressive disorder. Br J Psychiatry 193:152–155
Kayser S, Bewernick BH, Grubert C et al (2011) Antidepressant effects, of magnetic seizure therapy and electroconvulsive therapy, in treatment-resistant depression. J Psychiatr Res 45:569–576
Holtzheimer PE, Kelley ME, Gross RE et al (2012) Subcallosal cingulate deep brain stimulation for treatment-resistant unipolar and bipolar depression. Arch Gen Psychiatry 69:150–158
Bewernick BH, Kayser S, Sturm V, Schlaepfer TE (2012) Long-term effects of nucleus accumbens deep brain stimulation in treatment-resistant depression: evidence for sustained efficacy. Neuropsychopharmacology [Epub ahead of print]
Nahas Z, Anderson BS, Borckardt J et al (2010) Bilateral epidural prefrontal cortical stimulation for treatment-resistant depression. Biol Psychiatry 67:101–109
Grimm S, Bajbouj M (2010) Efficacy of vagus nerve stimulation in the treatment of depression. Expert Rev Neurother 10:87–92
Fallgatter AJ, Neuhauser B, Herrmann MJ et al (2003) Far field potentials from the brain stem after transcutaneous vagus nerve stimulation. J Neural Transm 110:1437–1443
Rot M aan het, Mathew SJ, Charney DS (2009) Neurobiological mechanisms in major depressive disorder. CMAJ 180:305–313
Interessenkonflikt
Der korrespondierende Autor weist für sich und seinen Koautor auf folgende Beziehungen hin: C. Plewnia erhält Unterstützung für Forschungsprojekte von inomed Medizintechnik, Emmendingen. F. Padberg erhält Unterstützung für Forschungsprojekte von neuroConn GmbH, Ilmenau und Brainsway Inc., Jerusalem.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Plewnia, C., Padberg, F. Transkranielle und invasive Hirnstimulationsverfahren bei Depression. Nervenarzt 83, 1006–1012 (2012). https://doi.org/10.1007/s00115-012-3573-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00115-012-3573-y