从成人证据溯源：tACS干预青少年抑郁障碍的神经机制与参数优化

doi:10.3877/cma.j.issn.1674-0785.2025.11.012

青少年抑郁障碍（MDD）发病率逐年升高，已成为严重影响青少年心理健康和社会功能的重要公共卫生问题。传统治疗方法如药物和心理治疗虽具有一定疗效，但存在起效慢、依从性差及副作用等局限。近年来，作为一种新兴的非侵入性神经调控技术，经颅交流电刺激（tACS）在成人抑郁障碍中的研究取得了一定的进展。本文综述了tACS在青少年抑郁障碍中的潜在干预应用，重点探讨其临床证据、参数机制，并结合成人研究的经验与成果，提出未来研究的发展方向，以期为青少年抑郁障碍的干预提供新的理论与实践支持。

关键词: 经颅交流电刺激, 青少年, 抑郁障碍, 神经调控, 临床干预

The prevalence of major depressive disorder (MDD) among adolescents has been rising steadily, making it a serious public health issue that affects young people's psychological well-being and social functioning. Although traditional treatments such as pharmacotherapy and psychotherapy have demonstrated certain efficacy, they are often limited by delayed onset of action, poor adherence, and potential side effects. In recent years, transcranial alternating current stimulation (tACS), a novel non-invasive neuromodulation technique, has shown promising progress in the treatment of adult depressive disorders. This review summarizes the potential applications of tACS in adolescent MDD, with a focus on its clinical evidence and parameter mechanisms. Building on findings and insights from adult studies, it further proposes future research directions, aiming to provide new theoretical and practical perspectives for the intervention of adolescent depressive disorders.

Key words: Transcranial alternating current stimulation, Adolescent, Major depression disorder, Neural regulation, Clinical intervention

表1 tACS在成年人群的相关研究

作者，文献	样本特征	部位	干预方案	主要结局	安全性	可能机制
王红星等人^[34]	30名首发未服药成年	Fp1、Fpz、Fp2、每侧乳突区域	77.5 Hz，15 mA，40 min，4周vs sham	tACS组在第4周、8周的缓解率高于伪刺激组	脑鸣，2组无差异	NA
Wang等人^[35]	100名首发未服药成年	Fp1、Fpz、Fp2、每侧乳突区域	77.5 Hz，15 mA，40 min，4周vs sham	tACS组27人（54%）缓解，sham组9人（18%）缓解	耳鸣、脑鸣、不适、头痛和瘙痒，2组无差异	NA
Zhou等人^[36]	66名成年抑郁症患者，联合艾司西酞普兰	Fp1、Fpz、Fp2、每侧乳突区域	77.5 Hz，15 mA，40 min，4周vs sham	tACS组的缓解率（66.7%）显著高于伪刺激（33.3%）	tACS组报告一般副作用包括头痛、嗜睡和头晕	平衡左右额叶α不对称性
Carlton等人^[32]	30名服药稳定剂量的成年抑郁症患者	F4，C4，FCz	单次行为激活联合跨频率delta-beta，30 min vs sham	tACS组的治疗反应率（33.3%）显著高于伪刺激（13.%），tACS组缓解率（27%）显著高于伪刺激（6%）。	轻度刺痛/瘙痒	NA
Alexander等人^[23]	32名成年抑郁症患者	阳极：F3、F4阴极：Cz	10 Hz，1 mA，40 min，5 d vs 40 Hz，1 mA，40 min，5 d vs sham	干预完成后2周，与40 Hz-tACS组和sham组相比，10 Hz-tACS组有更多的反应者。	无不良事件报告	平衡左右额叶α不对称性
Wilkening等人^[30]	1名孕期抑郁症患者	两个背外侧前额叶皮层（F3-F4位置）	40 Hz，2 mA，20 min，9次	干预结束后，患者存在缓解。3个月后随访时，患者达到缓解。	无不良事件报告	NA
罗炯等人^[37]	62名抑郁症患者联合抗抑郁药物治疗	Fp1、Fpz、Fp2、每侧乳突区域	77.5 Hz，15mA，40 min，4周vs sham	tACS组在第4周、第8周HAMD减分率均高于sham组	无不良事件报告	NA
Gehrman等人^[33]	255名抑郁症患者合并药物治疗	两侧颧弓后部上方颞骨	20 min，一天2次，4周vs sham	tACS组患者在第1周有更显著的改善，在第4周末有更大的治疗反应。	皮肤不适	NA

表1 tACS在成年人群的相关研究

作者，文献	样本特征	部位	干预方案	主要结局	安全性	可能机制
王红星等人^[34]	30名首发未服药成年	Fp1、Fpz、Fp2、每侧乳突区域	77.5 Hz，15 mA，40 min，4周vs sham	tACS组在第4周、8周的缓解率高于伪刺激组	脑鸣，2组无差异	NA
Wang等人^[35]	100名首发未服药成年	Fp1、Fpz、Fp2、每侧乳突区域	77.5 Hz，15 mA，40 min，4周vs sham	tACS组27人（54%）缓解，sham组9人（18%）缓解	耳鸣、脑鸣、不适、头痛和瘙痒，2组无差异	NA
Zhou等人^[36]	66名成年抑郁症患者，联合艾司西酞普兰	Fp1、Fpz、Fp2、每侧乳突区域	77.5 Hz，15 mA，40 min，4周vs sham	tACS组的缓解率（66.7%）显著高于伪刺激（33.3%）	tACS组报告一般副作用包括头痛、嗜睡和头晕	平衡左右额叶α不对称性
Carlton等人^[32]	30名服药稳定剂量的成年抑郁症患者	F4，C4，FCz	单次行为激活联合跨频率delta-beta，30 min vs sham	tACS组的治疗反应率（33.3%）显著高于伪刺激（13.%），tACS组缓解率（27%）显著高于伪刺激（6%）。	轻度刺痛/瘙痒	NA
Alexander等人^[23]	32名成年抑郁症患者	阳极：F3、F4阴极：Cz	10 Hz，1 mA，40 min，5 d vs 40 Hz，1 mA，40 min，5 d vs sham	干预完成后2周，与40 Hz-tACS组和sham组相比，10 Hz-tACS组有更多的反应者。	无不良事件报告	平衡左右额叶α不对称性
Wilkening等人^[30]	1名孕期抑郁症患者	两个背外侧前额叶皮层（F3-F4位置）	40 Hz，2 mA，20 min，9次	干预结束后，患者存在缓解。3个月后随访时，患者达到缓解。	无不良事件报告	NA
罗炯等人^[37]	62名抑郁症患者联合抗抑郁药物治疗	Fp1、Fpz、Fp2、每侧乳突区域	77.5 Hz，15mA，40 min，4周vs sham	tACS组在第4周、第8周HAMD减分率均高于sham组	无不良事件报告	NA
Gehrman等人^[33]	255名抑郁症患者合并药物治疗	两侧颧弓后部上方颞骨	20 min，一天2次，4周vs sham	tACS组患者在第1周有更显著的改善，在第4周末有更大的治疗反应。	皮肤不适	NA

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Insights from adult evidence: neural mechanisms and parameter optimization of transcranial alternating current stimulation for adolescent depressive disorders

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Insights from adult evidence: neural mechanisms and parameter optimization of transcranial alternating current stimulation for adolescent depressive disorders