Antidepressant outcomes of high-frequency repetitive transcranial magnetic stimulation (rTMS) with F8-coil and deep transcranial magnetic stimulation (DTMS) with H1-coil in major depression: a systematic review and meta-analysis

Abstract

Background The current study aims to systematically assess and compare the antidepressant outcomes of repetitive transcranial magnetic stimulation (rTMS) with the figure-of-eight (F8)-coil and deep transcranial magnetic stimulation (DTMS) with the H1-coil in studies matched on stimulation frequency in unipolar major depressive disorder (MDD). Methods Electronic search of Medline and PsycInfo identified 19 studies with stimulation frequency of 18–20 Hz using F8-coil ( k = 8 randomised sham-controlled trials, RCTs, k = 3 open-label; n = 168 patients) or H1-coil ( k = 1 RCT, k = 7 open-label; n = 200). Depression severity (the primary outcome) and response/remission rates (the secondary outcomes) were assessed at session 10. Results Effects pooled with random-effects meta-analysis showed a large reduction in depression severity, 29% response, and 15% remission rates after 10 sessions of active stimulation with either coil relative to baseline. Reduction in depression severity was greater in studies with younger patients using either coil. The comparison between coils showed a larger reduction in depression severity in H1-coil vs. F8-coil studies (independent of the study design or the concurrent pharmacotherapy) and a trend towards higher remission rates in F8-coil vs. H1-coils studies. These effects are based on a low volume of studies, are not controlled for placebo, and may not be clinically-relevant. The stimulation protocols differed systematically because stimulation was more focal but less intense (80–110% of the resting motor threshold, MT) in the F8-coil studies and less focal but more intense (120% MT) in the H1-coil studies. Two seizures occurred in the H1-coil studies relative to none in the F8-coil studies. Conclusion When matched on frequency, the higher-intensity and less focal stimulation with the H1-coil reduces depression more than the lower-intensity and more focal stimulation with the F8-coil. Head-to-head trials should compare the antidepressant outcomes of F8-coil and H1-coil to identify the most optimal stimulation protocols for acute and longer-lasting efficacy. Electronic supplementary material The online version of this article (10.1186/s12888-019-2106-7) contains supplementary material, which is available to authorized users.

Effectiveness of noninvasive brain stimulation in the treatment of anxiety disorders: a meta-analysis of sham or behaviour-controlled studies

“…Recently, in addition to tDCS and rTMS, deep TMS has gained ground in treating the symptoms of obsessivecompulsive disorder 161,162 and MDD (see Gellersen and Kedzior 163 for a meta-analysis), and it has received US Food and Drug Administration clearance for both treatments. This technique uses the principles of TMS but delivers current through a specially designed H-coil that can modulate cortical excitability up to 6 cm in depth, reaching not only cerebral cortex activity but also the activity of deeper neural circuits.…”

Non-invasive brain stimulation effectiveness in anxiety disorder treatment: a meta-analysis on sham/behavior-controlled studies

“…Recently, besides tDCS and rTMS, deep TMS gained ground in treating OCD 159, 160 and MDD symptoms (see 161 for a meta-analysis), receiving FDA clearance for both treatments. This technique used the same principles of TMS but delivers current through a specially designed H-coil, that can modulate cortical excitability up to 6 cm of depth, therefore reaching not only cerebral cortex activity but also the activity of deeper neural circuits 162 .…”

An Update of a Meta-Analysis on the Clinical Outcomes of Deep Transcranial Magnetic Stimulation (DTMS) in Major Depressive Disorder (MDD)

“…In addition to the previous meta-analysis (Kedzior, Gellersen, Brachetti, et al, 2015), we have attempted to assess the longer-term clinical outcomes of DTMS beyond the daily stimulation phases in unipolar MDD. In general, evidence from mixed samples with unipolar and bipolar MDD as well as from case studies indicates that the antidepressant outcomes of DTMS remain beyond the acute treatment phases for up to 12 months (Gellersen & Kedzior, 2015). Conventional rTMS studies with F8-coils show that the acute clinical benefits decrease over time if maintenance (continuation) treatment is not offered (Kedzior, Reitz, Azorina, & Loo, 2015).…”