Abstract
BackgroundThe current study aims to systematically assess and compare the antidepressant outcomes of repetitive transcranial magnetic stimulation (rTMS) with the figure-of-eight (F8)-coil and deep transcranial magnetic stimulation (DTMS) with the H1-coil in studies matched on stimulation frequency in unipolar major depressive disorder (MDD).MethodsElectronic search of Medline and PsycInfo identified 19 studies with stimulation frequency of 18–20 Hz using F8-coil (k = 8 randomised sham-controlled trials, RCTs, k = 3 open-label; n = 168 patients) or H1-coil (k = 1 RCT, k = 7 open-label; n = 200). Depression severity (the primary outcome) and response/remission rates (the secondary outcomes) were assessed at session 10.ResultsEffects pooled with random-effects meta-analysis showed a large reduction in depression severity, 29% response, and 15% remission rates after 10 sessions of active stimulation with either coil relative to baseline. Reduction in depression severity was greater in studies with younger patients using either coil. The comparison between coils showed a larger reduction in depression severity in H1-coil vs. F8-coil studies (independent of the study design or the concurrent pharmacotherapy) and a trend towards higher remission rates in F8-coil vs. H1-coils studies. These effects are based on a low volume of studies, are not controlled for placebo, and may not be clinically-relevant. The stimulation protocols differed systematically because stimulation was more focal but less intense (80–110% of the resting motor threshold, MT) in the F8-coil studies and less focal but more intense (120% MT) in the H1-coil studies. Two seizures occurred in the H1-coil studies relative to none in the F8-coil studies.ConclusionWhen matched on frequency, the higher-intensity and less focal stimulation with the H1-coil reduces depression more than the lower-intensity and more focal stimulation with the F8-coil. Head-to-head trials should compare the antidepressant outcomes of F8-coil and H1-coil to identify the most optimal stimulation protocols for acute and longer-lasting efficacy.
Highlights
The current study aims to systematically assess and compare the antidepressant outcomes of repetitive transcranial magnetic stimulation with the figure-of-eight (F8)-coil and deep transcranial magnetic stimulation (DTMS) with the H1-coil in studies matched on stimulation frequency in unipolar major depressive disorder (MDD)
10 daily sessions, 5) at least five patients with unipolar MDD according to DSM-IV, 6) any study designs (RCTs with inactive sham groups or open-label designs to allow for inclusion of all studies on DTMS so far, seven of which were open-label), 7) study published in a peer-reviewed academic journal
Outcome measures The current review focuses on the following outcomes: 1) primary outcome: depression severity defined as a standardised change in Hamilton Depression Rating Scale (HDRS) depression scores at session 10 relative to baseline, 2) secondary outcomes: a. response rates defined as at least 50% reduction in HDRS score from baseline, b. remission rates defined as scores of HDRS≤7 for HDRS-17 and HDRS≤10 for any other version of HDRS
Summary
The current study aims to systematically assess and compare the antidepressant outcomes of repetitive transcranial magnetic stimulation (rTMS) with the figure-of-eight (F8)-coil and deep transcranial magnetic stimulation (DTMS) with the H1-coil in studies matched on stimulation frequency in unipolar major depressive disorder (MDD). Non-invasive brain stimulation methods are established as viable treatment options for major depressive disorder (MDD) resistant to pharmacotherapy One of such most thoroughly investigated methods is the high-frequency repetitive transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex (DLPFC) commonly applied with a figure-of-eight (F8) coil. This treatment aims to ameliorate the hypoactivity of the DLPFC characteristic of MDD and has acute moderate to large antidepressant effects as well as acceptable tolerability [1,2,3,4]. The literature so far suggests that the H1-coil produces consistent short-term antidepressant effects in MDD [8, 9] and is FDA-approved for treatment-resistant unipolar MDD since 2013
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