Clinically-RelevantOutcomesof DeepTranscranialMagnetic Stimulation (dTMS) in Unipolar Major Depression: ASystematicReviewandMeta-Analysis

Background:

Deep transcranial magnetic stimulation (dTMS) is a non-invasive brain stimulation method approved by the FDA as a therapy for treatment-resistant major depressive disorder.

Objective:

The aim of this study was to evaluate the clinically-relevant outcomes of daily dTMStreatment in unipolar major depression using a systematic review and meta-analysis.

Methods:

Following a systematic literature search of PsycInfo and Medline(any date till 24.06.2016),k=9 studies (k=8 open-label andk=1 double-blind randomised controlled trial, RCT, with an inactive sham group) wereincluded in the current study. The outcomes were standardised changescores (Hedges’g) in depression severity on Hamilton Depression RatingScale (HDRS), response, remission, and dropout rates, and several cognitivefunctions after daily dTMS compared to baseline. Effect sizes were pooledaccording to a random-effects meta-analysis with inverse-varianceweights.

Results:

The nine studies included229 patients with treatment-resistant unipolar major depression (according to DSM-IV) at baseline (n=128in open-label studies andn=101 in RCT/active dTMS group only). dTMSwas administered with H1-coil as a high-frequency (18-20Hz) and highintensity (120% of the resting motor threshold) stimulation with 33,600-60,000 stimuli over 20 daily sessions. dTMS significantly reduceddepression severity ink=8 open-label studies (Hedges’g=1.74, 95%CI:1.35-2.13). The pooled response, remission, and dropout rates were 56%,30%, and 21% respectively ink=8 open-label studies, and 38%, 33%, and 8%, respectively in the RCT (active dTMS group only). Of the 44 dropouts, twopatients reported suicidal ideation and two patients experienced a seizure.Visuospatial memory improved significantly after dTMS relative to base-line in two out of three open-label studies with cognitive data.

Conclusions:

High-frequency dTMS appears to improve clinical symptoms and some cognitive functions in treatment-resistant unipolar major depression. Future head-to-head studies are required to compare the clinical efficacy of dTMS with other brain stimulation methods.

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