抑郁症作为全球范围内致残的主要因素之一，其临床治疗长期面临着治疗药物应答率低和副作用显著等关键难题。在此背景下，重复性经颅磁刺激（rTMS）作为一种非侵入性的治疗技术，其核心原理是通过电磁脉冲调控大脑皮层神经元活动，避免了药物代谢带来的全身性影响从而在抑郁症治疗领域展现出其独特的优势。虽然现有研究系统评估了不同刺激参数的治疗方案，但是目前临床应用仍面临着机制解释不足、神经可塑性改变分子通路不明确等困境。外泌体作为一种至关重要的细胞间信息传递的信使，近年来多项研究均证实了其携带的特异性miRNA谱与突触重塑过程存在高度显著的关联，这种天然的信息传递系统可能为解释rTMS诱导的持续性神经改变提供帮助。本文通过综述rTMS治疗抑郁症的临床研究进展与外泌体在疾病中的作用，进而探讨二者相互作用的潜在机制，以期为抑郁症的治疗提供新的视角。

Depression disorder, as one of the main factors causing disability worldwide, has long been confronted with key challenges in clinical treatment, such as low response rates to therapeutic drugs and significant side effects. Against this backdrop, repetitive transcranial magnetic stimulation (rTMS), as a non-invasive treatment technique, has demonstrated unique advantages in the treatment of depression. At its core, rTMS utilizes electromagnetic pulses to regulate the activity of neurons in the cerebral cortex, avoiding the systemic effects brought by drug metabolism. Although existing research has systematically evaluated treatment regimens with different stimulation parameters, current clinical applications still face predicaments such as insufficient mechanism explanation and unclear molecular pathways underlying neural plasticity changes. Exosomes, as a crucial messenger for intercellular information transmission, have seen a highly significant association between the specific miRNA spectra that they carry and the synaptic remodeling process confirmed by multiple studies in recent years. This natural information transmission system may help explain the sustained neuroplastic changes induced by rTMS. This article reviews clinical advances in rTMS for depression treatment and the role of exosomes in the disease, and further explores the potential mechanism of their interaction, with the aim of providing a new perspective for the treatment of depression.