Couturier JL. Efficacy of rapid-rate repetitive transcranial magnetic stimulation in the treatment of depression: a systematic review and meta-analysis. J Psychiatry Neurosci JPN 30: 83

Department of Psychiatry, University of Western Ontario, London, Ont.
Journal of psychiatry & neuroscience: JPN (Impact Factor: 5.86). 04/2005; 30(2):83-90.
Source: PubMed


To systematically review the literature pertaining to rapid-rate repetitive transcranial magnetic stimulation (rTMS) compared with sham therapy for the treatment of a major depressive episode in order to arrive at qualitative and quantitative conclusions about the efficacy of rapid-rate rTMS.
MEDLINE, the Cochrane Library, the metaRegister of Controlled Trials and abstracts from scientific meetings were searched for the years 1966 until July 2003. The search terms "transcranial magnetic stimulation" and "transcranial magnetic stimulation AND depression" were used. Eighty-seven randomized controlled trials investigating the efficacy of rTMS were referenced on MEDLINE. Nineteen of these involved treatment of a major depressive episode, and these were reviewed. Six met more specific inclusion criteria including the use of rapid-rate stimulation, application to the left dorsolateral prefrontal cortex, evaluation with the 21-item Hamilton Rating Scale for Depression (HAM-D) and use of an intent-to-treat analysis. Scores on the 21-item HAM-D after treatment and standard deviations were extracted from each article for treatment and control subjects. A random-effects model was chosen for the meta-analysis, and the weighted mean difference was used as a summary measure.
Six studies that met the inclusion criteria were identified and included in the meta-analysis. Two of these reported a significantly greater improvement in mood symptoms in the treatment versus the sham group. When combined in the meta-analysis, the overall weighted mean difference was -1.1 (95% confidence interval -4.5 to 2.3), and the results of a test for heterogeneity were not significant (chi2(5) = 5.81, p = 0.33).
This meta-analysis suggests that rapid-rate rTMS is no different from sham treatment in major depression; however, the power within these studies to detect a difference was generally low. Randomized controlled trials with sufficient power to detect a clinically meaningful difference are required.

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    • "In most meta-analyses, rTMS is superior to sham control (Burt, Lisanby, and Sackeim, 2002; Holtzheimer, Russo, and Avery, 2001; Kozel and George, 2002; Lam, Chan, Wilkins- Ho, and Yatham, 2008; Loo and Mitchell, 2005; McNamara, Ray, Arthurs, and Boniface, 2001; Schutter, 2009). In one exception, however, Couturier (2005) reported in his metaanalysis in 2005 that there were no significant differences between rTMS and sham control (Couturier, 2005). This negative finding might be due to the inclusion of only a small number of trials, resulting in insufficient statistical power. "
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    DESCRIPTION: Transcranial magnetic stimulation (TMS) was introduced as a novel method of brain stimulation in 1985, and now it is widely used in research of cortical excitability, neuronal connectivity and plasticity, and also is applied to the treatment of various neurological and psychiatric conditions. This review is written with the purpose of introducing the brief conspectus and area of therapeutic application of TMS. The techniques, equipment and treatment modalities of TMS are continuously developing, and its area of therapeutic application is being extended. For determining the form of the optimal therapeutic application of TMS in various clinical conditions, more data from controlled studies should be obtained.
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    • "T he most common stimulation site in MDD is the dorsolateral pre-frontal cortex (DLPFC) due to evidence suggesting dysregulation in this brain region [12] [19], and meta-analyses of randomized controlled trials have demonstrated efficacy for both high-[7] and low-frequency [5] protocols in MDD.rT MS is a resource inten-sive intervention requiring significant material and human capital, in addition to extended daily time commitments on the part of patients. While effective for MDD, response to rT MS is difficult to predict and there are several negative placebocontrolled trials in the literature [9] [15] [18] [27] [28]. In light of this, improved prognostication may lead to better allocation of rT MS resources. "
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    ABSTRACT: Prognostication is poor in repetitive transcranial magnetic stimulation (rTMS) treatment for major depressive disorder (MDD). Personality traits, particularly extraversion and neuroticism, have attracted increasing attention for both trait- and state-dependent characteristics in predicting response to pharmacotherapy, psychotherapy, and more recently to therapeutic neuromodulation for MDD. The advent of deep rTMS (DTMS) allows stimulation of deeper cortical regions, and we aimed to prospectively characterize personality dimensions and antidepressant response to DTMS in treatment-resistant MDD. A convenience sample of 15 patients with treatment-resistant MDD received four weeks of daily sessions of DTMS (20Hz, 3,000 pulses/session) of the left dorsolateral prefrontal cortex (DLFPC). At baseline and at the conclusion of treatment, patients completed the Big Five Inventory, a five-factor assessment of major personality dimensions. Clinical response was measured using the 21-item Hamilton Depression Rating Scale. Four weeks of DTMS treatment was not associated with changes in personality measures. Clinical remission was associated with higher baseline levels of agreeableness (score ≥ 29: 100% sensitive and 72.7% specific) and conscientiousness (score ≥ 30: 75% sensitive and 81.8% specific). Levels of agreeableness and extraversion were linearly associated with antidepressant response. Neuroticism was not associated with the antidepressant effects of DTMS in this cohort. Five-factor personality assessment may have prognostic value in DTMS for resistant MDD. Agreeableness, extraversion, and conscientiousness are associated with decreases in depressive symptoms during treatment with DTMS.
    Neuroscience Letters 01/2014; 563. DOI:10.1016/j.neulet.2014.01.037 · 2.03 Impact Factor
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    • "The overall difference between active and sham treatment was not large, though statistically significant, and the authors concluded that there was “no strong evidence to support the benefit of rTMS as an antidepressant treatment.” Only one meta-analysis, which included 6 trials, found a negative result for high-frequency prefrontal DLPF rTMS compared to sham [20]. "
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    ABSTRACT: The field of non-pharmacological therapies for treatment resistant depression (TRD) is rapidly evolving and new somatic therapies are valuable options for patients who have failed numerous other treatments. A major challenge for clinicians (and patients alike) is how to integrate the results from published clinical trials in the clinical decision-making process. We reviewed the literature for articles reporting results for clinical trials in particular efficacy data, contraindications and side effects of somatic therapies including electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), vagal nerve stimulation (VNS) and deep brain stimulation (DBS). Each of these devices has an indication for patients with different level of treatment resistance, based on acuteness of illness, likelihood of response, costs and associated risks. ECT is widely available and its effects are relatively rapid in severe TRD, but its cognitive adverse effects may be cumbersome. TMS is safe and well tolerated, and it has been approved by FDA for adults who have failed to respond to one antidepressant, but its use in TRD is still controversial as it is not supported by rigorous double-blind randomized clinical trials. The options requiring surgical approach are VNS and DBS. VNS has been FDA-approved for TRD, however it is not indicated for management of acute illness. DBS for TRD is still an experimental area of investigation and double-blind clinical trials are underway.
    Biology of Mood and Anxiety Disorders 08/2012; 2(1):14. DOI:10.1186/2045-5380-2-14
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