帕金森氏病的病理生理学涉及在一个名为“黑质的大脑区域”中释放多巴胺神经元的变性。多巴胺也被确定为抗抑郁药的靶标。这共享路径使患有运动和抑郁症状的帕金森患者的治疗变得复杂。难以以充分缓解抑郁症的方式平衡药物治疗，这促使我们探索了替代治疗选择。
One promising alternative, currently being used in the general population, istranscranial magnetic stimulation (TMS)。该治疗方法是将类似头盔的装置放在患者头上，并在大脑的特定区域施加无痛的冲动。从策略上定位非侵入性线圈会产生一个磁场，该磁场会引起电流，从而影响特定皮质区域内的神经元。
Many studies用TMS治疗后显示出显着降低抑郁症状。除了明显的心理变化之外，还注意到生理变化。特别是，已经显示出高频TMS稳定功能连接在抑郁症患者的大脑中。为了进一步加强这些发现，对可能的安慰剂作用的早期怀疑已经存在平息。
鉴于TMS在普通人群中取得成功，我们试图确定这种方法是否可以帮助帕金森氏症人群中的抑郁症患者。在our meta-analysiswe identified a handful of studies that begin to address this question.
When all studies were combined, a very large effect was observed when applying stimulation to patients with Parkinson’s and concomitant depression.
首先,我们确定了七个研究1)工作with a Parkinson’s population, 2) included patients with clinically identified depression, 3) applied TMS to patients, and 4) reported pre- and post-TMS depression scores (using one of three widely accepted inventories). Obtaining depression levels prior to and following treatment allowed us to quantify any potential effect that TMS had on patients’ psychological symptoms.
Next steps involved categorizing the studies based on experimental design, assessment method, and treatment parameters (ie. stimulation site and frequency). As part of this initial analysis, we looked at effect size (Hedge’s G) and significance (p-value) for individual experimental groups within each study. With the exception of one study, our results showed that all groups applying stimulation yielded very large effect sizes (>1.20), not due to chance (p<0.05). Put simply, all but one study reported decreases in depression after TMS treatment.
最后，我们在所有这些研究中进行了总加权平均效应大小。该值考虑了每个研究组的样本量，差异程度以及整个组的平均变化。值得注意的是，当所有研究合并时，在对帕金森氏症和伴随抑郁症患者施加刺激时会观察到非常大的效果。
这项荟萃分析的发现表明，TMS可能是治疗帕金森氏病难治性抑郁症的有效方法。尽管标准化TMS协议还有很长的路要走，但在药物不起作用时，它仍然是一种有希望的非侵入性替代方法。
临床医生和科学家在治疗复杂的耐药性疾病过程时遭受临床医生和科学家的责任。震颤和抑郁症都可以将患者捕获到自己的身体中，因此，重要的是要继续寻找现有选择的安全有效替代方案。此外，我们希望这项研究鼓励考虑所有疾病方面的考虑 - 在坚定不移的努力下照顾患者。
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