Efficacy of repetitive transcranial magnetic stimulation in treatment-resistant depression: the evidence thus far

Abstract

Depression is a common mental disorder, which attributes to significant morbidity, disability and burden of care. A significant number of patients with depression still remain symptomatic after adequate trials of antidepressant treatment as well as psychotherapy, which is often referred to as treatment-resistant depression. Neuromodulation techniques—like electroconvulsive therapy, vagus nerve stimulation, transcranial magnetic stimulation (TMS) and transcranial direct current stimulation, may be useful augmenting techniques in depression, mostly recommended for treatment-resistant cases. Robust evidence exists regarding the efficacy of electroconvulsive therapy in the management of treatment-resistant depression; however, other techniques are understudied. TMS has been increasingly studied in various psychiatric disorders including depression. It has been approved by the US Food and Drug Administration for use in major depressive disorder. Over the past two decades, TMS has been studied in diverse groups of the population with depression using several research designs. This article gives an overview of the efficacy of repetitive TMS in treatment-resistant depression with the recent evidence.

A happiness magnet? Reviewing the evidence for repetitive transcranial magnetic stimulation in major depressive disorder

“…Response and remission rates appear higher for ECT than rTMS, particularly for the psychotically depressed patient. 9,29 rTMS has fewer side effects than ECT, is preferred by patients and is cheaper. 37 rTMS is therefore a good first step for stable patients with TRD.…”

“…ECT is currently advised for psychotic/suicidal patients. 9 Maintaining remission is challenging. Strategies include continued psychotherapy and pharmacotherapy.…”

Experimental Therapeutics in Treatment-Resistant Major Depressive Disorder

“…A newer modality of rTMS is theta burst stimulation in which relatively greater amounts of stimulation can be delivered to the brain in a shorter span of time and the latest research finds this modality to be non-inferior to rTMS when used in TRD. 85 …”

Improving Mental Health Services: A 50-Year Journey from Randomized Experiments to Artificial Intelligence and Precision Mental Health

“…Repetitive transcranial magnetic stimulation (rTMS) has been found to be an effective treatment for several mental illnesses, especially treatment-resistant depression (Mutz et al 2019 ; Somani and Kar 2019 ; Voigt et al 2019 ). While the literature is not clear on how rTMS produces its effect (Noda et al 2015 ; Peng et al 2018 ), I was curious about its relationship to neuroinflammation.…”