Efficacy of rapid-rate repetitive transcranial magnetic stimulation in the treatment of depression: A systematic review and meta-analysis

Department of Psychiatry, University of Western Ontario, London, Ont.
Journal of psychiatry & neuroscience: JPN (Impact Factor: 7.49). 04/2005; 30(2):83-90.
Source: PubMed

ABSTRACT 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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    • "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 · 2.06 Impact Factor
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    • "The heterogeneity of the study groups, of the stimulation protocol, and of the methodology employed to administer rTMS, limits the significance of these studies. However, only one meta-analysis concluded that significant evidence for the efficacy of rTMS was lacking (Couturier, 2005). On the other hand, five studies found clear evidence of efficacy. "
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    ABSTRACT: Late-life depression (LLD) is a frequent complication of the ageing process, occurring in up to 5% of community-dwelling elderly and in a higher proportion of subjects with coexistent medical illnesses. Its presence has been consistently associated with cognitive impairment, greater disability and increased mortality. Approximately half of patients with LLD have evidence of subcortical ischaemic damage in prefrontal circuits revealed by MRI. This might constitute the biological substrate of the cardinal symptoms of depression and of executive dysfunction. An important proportion of patients with LLD do not achieve remission of their depressive symptoms in spite of adequate pharmacological and psychotherapeutic treatment. In addition, a group of LLD patients progress to further impairment and disability in the form of a dementing disorder. There is an imperative need to develop new treatment strategies for LLD. Non-invasive brain stimulation techniques such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are safe and efficacious interventions that might be used in combination with other therapeutic options to improve treatment outcomes. However, there are still questions regarding the optimal way in which rTMS and dTCS should be delivered as well as to the way in which we may identify the subjects who will benefit the most from these interventions.
    International Review of Psychiatry 10/2011; 23(5):437-44. DOI:10.3109/09540261.2011.633501 · 1.80 Impact Factor
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    • "Advances in brain stimulation techniques have raised new hopes for BPD treatment. Repetitive transcranial magnetic stimulation (rTMS) has proven effective, and was recently given FDA approval as a treatment for unipolar depression (Holtzheimer et al. 2001, McNamara et al. 2001, Burt et al. 2002, Kozel and George 2002, Aarre et al. 2003, Martin et al. 2003, Couturier 2005, O'Reardon et al. 2007). Surprisingly, very few rTMS studies and case reports have been conducted with patients who suffer from bipolar depression. "
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