Meta-Review of Metanalytic Studies with Repetitive Transcranial Magnetic Stimulation (rTMS) for the Treatment of Major Depression

Abstract

Background:Major Depression (MD) and treatment-resistant depression (TRD) are worldwide leading causes of disability and therapeutic strategies for these impairing and prevalent conditions include pharmacological augmentation strategies and brain stimulation techniques. In this perspective, repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique with a favorable profile of tolerability which, despite being recently approved by the Food and Drug Administration (FDA) for the treatment of patients with medication-refractory unipolar depression, still raises some doubts about most effective parameters of stimulation.Methods:A literature search was performed using PubMed for the years 2001 through February 2011 in order to review meta-analytic studies assessing efficacy and safety issues for rTMS in depressive disorders. Fifteen meta-analyses were identified and critically discussed in order to provide an updated and comprehensive overview of the topic with specific emphasis on potentially optimal parameters of stimulation.Results:First meta-analyses on the efficacy of rTMS for the treatment of MD and TRD have shown mixed results. On the other hand, more recent meta-analytic studies seem to support the antidepressant efficacy of the technique to a greater extent, also in light of longer periods of stimulation (e.g. > 2 weeks).Conclusion:rTMS seems to be an effective and safe brain stimulation technique for the treatment of medication refractory depression. Nevertheless, further studies are needed to better define specific stimulation-related issues, such as duration of treatment as well as durability of effects and predictors of response.

Evaluation of repetitive transcranial magnetic stimulation for treatment-resistant major depression and the impact of anxiety symptoms on outcome

“…This study also confirmed that rTMS is a safe stimulation method in terms of the side effect profile; however, transient headache was found to be the most common side effect, which is consistent with the current data [2,29].…”

Multiple sessions of transcranial direct current stimulation and upper extremity rehabilitation in stroke: A review and meta-analysis

“…However, it is usually assumed that multiple daily applications in stroke may lead to a build-up of effects that are larger and more persistent. The main evidence in favour of this comes from studies of rTMS to treat depression: a single session, or even 2 weeks daily treatment with rTMS has little effect on symptoms over and above placebo, whereas longer (>4 weeks) treatments can improve symptoms for several months (Dell'Osso et al, 2011;Galletly et al, 2012). Thus most recent clinical trials of tDCS have employed several days or weeks of repeated treatment with rehabilitation programmes in an attempt to maximise outcome (Lee and Chun, 2014;Viana et al, 2014).…”

Brief Cerebral Applications of Weak, Physiologically-patterned Magnetic Fields Decrease Psychometric Depression and Increase Frontal Beta Activity in Normal Subjects

“…The first involves the application of strong Tesla-level pulsed fields, TMS (Transcranial Magnetic Stimulation). There is strong evidence that the strategic application of these focal fields over discrete areas can affect cognition [1] and affective [2] behaviours. The mechanism by which these change occur is assumed to be a Faraday-like induction of relatively strong electric currents within populations of neurons.…”