Deep transcranial magnetic stimulation (DTMS) in the treatment of major depression: An exploratory systematic review and meta-analysis

Abstract Background Deep transcranial magnetic stimulation (DTMS) is a relatively new, non-invasive method of stimulating larger and, presumably, deeper brain regions. The current study investigated if DTMS delivered with H-coils has acute antidepressant effects in major depression using a systemati...

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Bibliographic Details
Published in:	Journal of affective disorders Vol. 187; pp. 73 - 83
Main Authors:	Kedzior, Karina Karolina, Gellersen, Helena Marie, Brachetti, Anna Katharina, Berlim, Marcelo T
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier B.V 15-11-2015
Subjects:	Deep transcranial magnetic stimulation (DTMS) Depressive Disorder, Major - therapy Humans Major depressive disorder (MDD) Meta-analysis Psychiatry Research Design Systematic literature review Transcranial Magnetic Stimulation - methods Treatment Outcome Deep transcranial magnetic stimulation (DTMS) Major depressive disorder (MDD) Systematic literature review Meta-analysis
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Summary:	Abstract Background Deep transcranial magnetic stimulation (DTMS) is a relatively new, non-invasive method of stimulating larger and, presumably, deeper brain regions. The current study investigated if DTMS delivered with H-coils has acute antidepressant effects in major depression using a systematic literature review and a quantitative meta-analysis. Methods Seventeen studies on ‘DTMS or H-coil’ and ‘depression’ were identified on Medline, PsycInfo, and Google Scholar (until November 2014). Data from nine open-label studies were meta-analysed using a random-effects model with inverse-variance weights. The outcome measures were the standardised paired mean difference (Cohen's d ) in depression scores on Hamilton Depression Rating Scale (HDRS), response, remission, and dropout rates after acute DTMS treatment compared to baseline. Results There was a large antidepressant effect after 20 acute, high-frequency DTMS sessions compared to baseline according to HDRS change scores (overall mean weighted d =2.04, 95% confidence interval: 1.53–2.55; nine studies; 150 patients). Overall weighted response, remission, and dropout rates were 60%, 29%, and 18% respectively. HDRS change scores and response rates tended to be higher in four studies with 68 patients on concurrent antidepressants compared to two studies with 26 patients who received DTMS as a monotherapy. Limitations These results are based on data from a low number of open-label studies. Conclusion High-frequency DTMS appears to have acute antidepressant effects after 20 sessions in mostly unipolar and treatment-resistant patients. Concurrent treatment with antidepressants might enhance the efficacy of DTMS.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 ObjectType-Review-4 content type line 23 ObjectType-Undefined-3
ISSN:	0165-0327 1573-2517
DOI:	10.1016/j.jad.2015.08.033