Deep Transcranial Magnetic Stimulation (Deep TMS) in the Treatment of Major Depression: An Exploratory Systematic Review and Meta-analysis

Journal: Journal of Affective Disorders 187:73-83 (2015)

Authors: K.K Kedzior, H.M Gellersen, A.K Brachetti, M.T Berlim

Background:

Deep transcranial magnetic stimulation (Deep TMS™) is a relatively new, non-invasive method of stimulating larger and, presumably, deeper brain regions.

Objective:

This study investigated whether Deep TMS 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 ‘Deep TMS 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 Deep TMS treatment compared to baseline.

Results:

There was a large antidepressant effect after 20 acute, high-frequency Deep TMS sessions comparedto baseline according to HDRS change scores (overall mean weighted=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 Deep TMS as a monotherapy.

Conclusions:

High-frequency Deep TMS 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 Deep TMS.

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