Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression: A Systematic Review and Meta-Analysis

The Journal of Clinical Psychiatry (Impact Factor: 5.5). 05/2014; 75(5):477-489. DOI: 10.4088/JCP.13r08815
Source: PubMed


To evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in patients with major depressive disorder (MDD) and 2 or more prior antidepressant treatment failures (often referred to as treatment-resistant depression [TRD]). These patients are less likely to recover with medications alone and often consider nonpharmacologic treatments such as rTMS.

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    • "More generally, the dorsolateral prefrontal cortex (DLPFC) is involved in decision-making and emotion regulation (Ochsner & Gross, 2007) and has become a common target for neuromodulation-based interventions in psychiatric disorders . Repetitive transcranial magnetic stimulation (rTMS) to the left DLPFC (l-DLPFC) is reported to have clinical efficacy in the treatment of depression (Gaynes et al., 2014) and reduces craving in addictive disorders (Jansen et al., 2013). Given such findings, its effects on food cravings and in ED have also been investigated. "
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    ABSTRACT: Objectives: This case series examined the therapeutic potential of repetitive transcranial magnetic stimulation in five women with enduring anorexia nervosa. Methods: Participants received ~20 sessions of neuronavigated high-frequency repetitive transcranial magnetic stimulation to the left dorsolateral prefrontal cortex. Body mass index, eating disorder (ED) symptoms and mood were assessed pre-treatment and post-treatment, at 6-month and 12-month follow-up (FU). Qualitative feedback regarding the intervention was obtained from participants and carers. Results: From pre-treatment to post-treatment, ED and affective symptoms improved significantly, and body mass index remained stable. Further improvements in ED symptoms/mood were seen at 6-month FU with 3/5 and 2/5 participants deemed 'recovered' on the Eating Disorders Examination Questionnaire and Depression, Anxiety and Stress Scale, respectively. However, most participants had lost some weight, and therapeutic effects on psychopathology had waned by 12-month FU. Qualitative feedback regarding the intervention was encouraging. Discussion: Repetitive transcranial magnetic stimulation was well tolerated, and preliminary evidence is provided for its therapeutic potential in anorexia nervosa. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.
    European Eating Disorders Review 11/2015; DOI:10.1002/erv.2414 · 2.46 Impact Factor
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    • "In addition to its uses in cognitive neuroscience, the clinical applications of repetitive transcranial magnetic stimulation (rTMS) have rapidly expanded over the last few years. This non invasive technique was initially proposed and has been most thoroughly studied for the treatment of depression (Gaynes et al., 2014; George et al., 1995; Lefaucheur et al., 2014). However, rTMS may also be useful for the treatment of other psychiatric and neurological conditions, including negative symptoms of schizophrenia, chronic motor stroke, tinnitus and auditory hallucinations (Lefaucheur et al., 2014). "
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    ABSTRACT: Background: Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive technique that allows cortical stimulation. Recent studies have shown that rTMS of the primary motor cortex or dorsolateral prefrontal cortex decreases pain in various pain conditions. The aim of this review was to summarize the main characteristics of rTMS-induced analgesic effects and to analyse the current data on its mechanisms of action. Databases: Medline, PubMed and Web of Science were searched for studies on the analgesic effects and mechanisms of rTMS-induced analgesic effects. Studies on epidural motor cortex stimulation (EMCS) were also included when required, as several mechanisms of action are probably shared between both techniques. Results: Stimulation site and stimulation parameters have a major impact on rTMS-related analgesic effects. Local cortical stimulation is able to elicit changes in the functioning of distant brain areas. These modifications outlast the duration of the rTMS session and probably involve LTP-like mechanisms via its influence on glutamatergic networks. Analgesic effects seem to be correlated to restoration of normal cortical excitability in chronic pain patients and depend on pain modulatory systems, in particular endogenous opioids. Dopamine, serotonin, norepinephrine and GABAergic circuitry may also be involved in its effects, as well as rostrocaudal projections. Conclusions: rTMS activates brain areas distant from the stimulation site. LTP-like mechanisms, dependence on endogenous opioids and increase in concentration of neurotransmitters (monoamines, GABA) have all been implicated in its analgesic effects, although more studies are needed to fill in the still existing gaps in the understanding of its mechanisms of action.
    European journal of pain (London, England) 10/2015; DOI:10.1002/ejp.811 · 2.93 Impact Factor
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    • "The authors also underscored that dropouts and adverse event rates were low. In another recent meta-analysis presenting studies overlapping with the former meta-analysis, Gaynes et al. [136] investigated randomized clinical trials that recruited patients presenting a previous failure to two antidepressant drug treatments. The authors observed that active vs. sham rTMS was significantly more effective for the treatment of depression considering depressive (symptom's) improvement, response rate and remission rate. "

    Current Neuropharmacology 06/2015; 13(999):1-1. DOI:10.2174/1570159X13666150630173522 · 3.05 Impact Factor
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