Abstract
BackgroundAccording to a narrative review of 13 meta-analyses (published up to 2010), repetitive transcranial magnetic stimulation (rTMS) has a moderate, short-term antidepressant effect in the treatment of major depression. The aim of the current study was to reanalyse the data from these 13 meta-analyses with a uniform meta-analytical procedure and to investigate predictors of such an antidepressant response.MethodsA total of 40 double-blind, randomised, sham-controlled trials with parallel designs, utilising rTMS of the dorsolateral prefrontal cortex in the treatment of major depression, was included in the current meta-analysis. The studies were conducted in 15 countries on 1583 patients and published between 1997–2008. Depression severity was measured using the Hamilton Depression Rating Scale, Beck Depression Inventory, or Montgomery Åsberg Depression Rating Scale at baseline and after the last rTMS. A random-effects model with the inverse-variance weights was used to compute the overall mean weighted effect size, Cohen’s d.ResultsThere was a significant and moderate reduction in depression scores from baseline to final, favouring rTMS over sham (overall d = −.54, 95% CI: −.68, −.41, N = 40 studies). Predictors of such a response were investigated in the largest group of studies (N = 32) with high-frequency (>1 Hz) left (HFL) rTMS. The antidepressant effect of HFL rTMS was present univariately in studies with patients receiving antidepressants (at stable doses or started concurrently with rTMS), with treatment-resistance, and with unipolar (or bipolar) depression without psychotic features. Univariate meta-regressions showed that depression scores were significantly lower after HFL rTMS in studies with higher proportion of female patients. There was little evidence for publication bias in the current analysis.ConclusionsDaily rTMS (with any parameters) has a moderate, short-term antidepressant effect in studies published up to 2008. The clinical efficacy of HFL rTMS may be better in female patients not controlling for any other study parameters.Electronic supplementary materialThe online version of this article (doi:10.1186/s40359-014-0039-y) contains supplementary material, which is available to authorized users.
Highlights
According to a narrative review of 13 meta-analyses, repetitive transcranial magnetic stimulation has a moderate, short-term antidepressant effect in the treatment of major depression
Double-blind Randomised-controlled trial (RCT) with an inactive sham group, parallel design, active repetitive transcranial magnetic stimulation (rTMS) and sham administered at the same Dorsolateral prefrontal cortex (DLPFC) location
According to the overall analysis, there was a significant reduction in the mean depression scores from baseline to final, favouring rTMS over sham, in N = 40 RCTs based on a total of 1583 patients (844 in the active rTMS and 739 in sham groups; for the forest plot see Additional file 1: Figure S1)
Summary
According to a narrative review of 13 meta-analyses (published up to 2010), repetitive transcranial magnetic stimulation (rTMS) has a moderate, short-term antidepressant effect in the treatment of major depression. According to a narrative review of 13 meta-analyses (published between 2001–2010), the clinically-meaningful effect of daily rTMS of the dorsolateral prefrontal cortex (DLPFC) was observed in doubleblind, randomised-controlled trials (RCTs) with inactive sham groups, published between 1995–2008 Regardless of such a high interest in this topic, the antidepressant effect of rTMS was found to be moderate and rTMS parameters of clinical relevance were only partially established in the past 13 meta-analyses (Dell’Osso et al 2011). There was no association between the antidepressant effect and the duration of treatment nor any other rTMS parameters, such as the frequency of stimulation, resting motor threshold, stimuli/session, or total stimuli/study (Herrmann and Ebmeier 2006; Holtzheimer et al 2001; Schutter 2009; Slotema et al 2010)
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