Efficacy of repetitive transcranial magnetic stimulation (rTMS) adjunctive therapy for major depressive disorder (MDD) after two antidepressant treatment failures: meta-analysis of randomized sham-controlled trials

Abstract

Background Several meta-analyses demonstrated the efficacy of unilateral High-Frequency Left-sided (HFL) repetitive Transcranial Magnetic Stimulation (rTMS) for individuals with Major Depressive Disorder (MDD); however, results are contradictory due to heterogeneity of the included studies. Methods A systematic literature review (SLR) of English language articles published since 2000 was performed in March 2022 on PubMed and Scopus databases. Empirical evidence on the relative efficacy of rTMS treatment compared with standard pharmacotherapy in Treatment-Resistant Depression (TRD) were extracted. Random effects models were used to assess the effects of rTMS on response and remission rates. Results 19 randomized double-blinded sham-controlled studies were included for quantitative analysis for response (n = 854 patients) and 9 studies for remission (n = 551 patients). The risk ratio (RR) for response and remission are 2.25 and 2.78, respectively for patients after two treatment failures using rTMS as add-on treatment compared to standard pharmacotherapy. Cochrane’s Q test showed no significant heterogeneity. No publication bias was detected. Conclusions rTMS is significantly more effective than sham rTMS in TRD in response and remission outcomes and may be beneficial as an adjunctive treatment in patients with MDD after two treatment failures. This finding is consistent with previous meta-analyses; however, the effect size was smaller than in the formerly published literature.

Novel Approaches for the Treatment of Post-Traumatic Stress Disorder: A Systematic Review of Non-Invasive Brain Stimulation Interventions and Insights from Clinical Trials

“…Specifically, TMS directly and focally modulates the brain activity of specific areas by inducing rapid and repeated changes in the electromagnetic field through the application of a copper coil over the scalp [ 36 ]. This tool has been consistently employed in the field of psychiatry, showing reasonable efficacy in treating MDD [ 37 , 38 ], SUD [ 39 ], and obsessive compulsive disorder [ 40 ]. Contrary to TMS, TES does not directly evoke action potentials in cortical neurons but rather endurably modulates spontaneous cortical activity and neuronal excitability through the application of a continuous (direct) electrical current, presumably reaching the target areas, using electrodes placed on the scalp [ 41 ].…”

Impact of Repetitive Transcranial Magnetic Stimulation on Cognitive and Psychiatric Dysfunction in Patients with Fibromyalgia: A Double-Blinded, Randomized Clinical Trial

“…It has been shown to be beneficial for treating neuropathic pain [8,9], especially in cases where pharmacological treatment has failed, as well as for cognitive impairment in neurodegenerative diseases such as Alzheimer's, Parkinson's, and vascular dementia [10,11]. rTMS has been used to treat psychiatric disorders such as OCD and treatment-resistant depression (TRD) [12,13]. It may also be viewed as an adjunctive therapy to the standard course of care in a number of conditions [14,15].…”

Inappropriate study inclusion in meta-analysis of sham-controlled rTMS for treatment-resistant depression

“… Dr. Vida and colleagues have published an important meta-analysis on a critical topic in psychiatry: the efficacy of double-blind, sham-controlled rTMS in treatment-resistant depression (TRD) [ 1 ]. The primary reported finding was a significant effect of rTMS on remission and response (RR 2.25 and 2.78 respectively) compared to sham rTMS.…”