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

Background:

Deep transcranial magnetic stimulation (dTMS) is a relatively new, non-invasive method ofstimulating larger and, presumably, deeper brain regions.

Objective:

This study investigated whether dTMSdelivered 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 standardized 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 comparedto baseline according to HDRS change scores (overall mean weightedd=2.04, 95% confidence interval:1.53–2.55; nine studies; 150 patients). Overall weighted response, remission, and dropout rates were60%, 29%, and 18% respectively. HDRS change scores and response rates tended to be higher in fourstudies with 68 patients on concurrent antidepressants compared to two studies with 26 patients whoreceived dTMS as a monotherapy.

Conclusions:

High-frequency dTMS appears to have acute antidepressant effects after 20 sessions inmostly unipolar and treatment-resistant patients. Concurrent treatment with antidepressants mightenhance the efficacy of dTMS.

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