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

ArticleinThe Journal of Clinical Psychiatry 75(5):477-489 · May 2014with37 Reads
DOI: 10.4088/JCP.13r08815 · Source: PubMed
Abstract
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.
    • "Similarly, CBT is neither always practicable nor always effective (Vogel et al., 2006). For these reasons, alternatives to classical therapies would be very helpful, and neuromodulation techniques offer very promising perspectives for OCD treatment, as they do for depression (Bais et al., 2014; Gaynes et al., 2014). Deep brain stimulation has shown very encouraging results in refractory patients, but this invasive method is not appropriate for larger scale use because of significant surgical risks. "
    [Show abstract] [Hide abstract] ABSTRACT: Repetitive transcranial magnetic stimulation has been explored in patients with obsessive-compulsive disorder, but with negative or conflicting results. This randomized double-blind study was designed to assess the efficacy of 1-Hz repetitive transcranial magnetic stimulation over the presupplementary area.METHODS:Forty medication-resistant patients were assigned to 4 weeks of either active or sham repetitive transcranial magnetic stimulation targeting the presupplementary area with the help of a neuronavigation system.RESULTS:According to the Yale-Brown obsessive-compulsive scale, the baseline-week 4 evolution showed no significant differences between groups. Responder rates at week 4 were not different between groups (repetitive transcranial magnetic stimulation 10.5% vs sham 20%; P=.63).CONCLUSION:Low-frequency repetitive transcranial magnetic stimulation applied to the presupplementary area seems ineffective for the treatment of obsessive-compulsive disorder patients, at least in severe and drug-refractory cases such as those included in this study. Further research is required to determine profiles of responder patients and appropriate repetitive transcranial magnetic stimulation parameters for obsessive-compulsive disorder.
    Full-text · Article · Apr 2016
    • "De nombreux travaux ont pu mettre en évidence l'efficacité de la stimulation magnétique transcrânienne répétitive (rTMS) dans la dépression, chez une population de patients insuffisamment répondeurs à un premier traitement ou résistants [24]. Une étude française multicentrique récente, portant sur 170 patients, a comparé la combinaison rTMS et venlafaxine par rapport à un bras rTMS avec médicament placebo, et un bras venlafaxine avec stimulation sham [25]. "
    Article · Feb 2016 · BMC Psychiatry
    • "Although numerous systematic reviews and/or metaanalyses have been published and proved that rTMS was an effective treatment for depressive patients5253545556, there were few reviews addressing the combined therapy Note: Ctr represents control group; Exp experimental group, HRSD Hamilton rating scale for depression, MV mean values, N number of subjects involved in the systematic review, s.d. standard deviation; wk, week of rTMS with other antidepressant treatments. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Sleep deprivation (SD) and repetitive transcranial magnetic stimulation (rTMS) have been commonly used to treat depression. Recent studies suggest that co-therapy with rTMS and SD may produce better therapeutic effects than either therapy alone. Therefore, this study was to review the current findings to determine if rTMS can augment the therapeutic effects of SD on depression. Methods: Embase, JSTOR, Medline, PubMed, ScienceDirect, and the Cochrane Central Register of Controlled Trials were searched for clinical studies published between January 1985 and March 2015 using the search term "rTMS/repetitive transcranial magnetic stimulation AND sleep deprivation AND depress*". Only randomized and sham-controlled trials (RCTs) involving the combined use of rTMS and SD in depression patients were included in this systematic review. The scores of the Hamilton Rating Scale for Depression were extracted as primary outcome measures. Results: Three RCTs with 72 patients that met the inclusion criteria were included for the systematic review. One of the trials reported skewed data and was described alone. The other two studies, which involved 30 patients in the experimental group (SD + active rTMS) and 22 patients in the control group (SD + sham rTMS), reported normally distributed data. The primary outcome measures showed different results among the three publications: two of which showed great difference between the experimental and the control subjects, and the other one showed non-significant antidepressant effect of rTMS on SD. In addition, two of the included studies reported secondary outcome measures with Clinical Global Impression Rating Scale and a self-reported well-being scale which presented good improvement for the depressive patients in the experiment group when compared with the control. The follow-up assessments in two studies indicated maintained results with the immediate measurements. Conclusions: From this study, an overview of the publications concerning the combined use of rTMS and SD is presented, which provides a direction for future research of therapies for depression. More studies are needed to confirm whether there is an augmentative antidepressant effect of rTMS on SD.
    Full-text · Article · Dec 2015
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