Repetitive Transcranial Magnetic Stimulation for the Treatment of Resistant Depression: A Scoping Review

Abstract

Treatment-resistant depression (TRD) is associated with significant disability, and due to its high prevalence, it results in a substantive socio-economic burden at a global level. TRD is the inability to accomplish and/or achieve remission after an adequate trial of antidepressant treatments. Studies comparing repetitive transcranial magnetic stimulation (rTMS) with electroconvulsive therapy (ECT) and pharmacotherapy have revealed evidence of the therapeutic efficacy of rTMS in TRD. These findings suggest a crucial role for rTMS in the management of TRD. This article aims to conduct a comprehensive scoping review of the current literature concerning the use of rTMS and its therapeutic efficacy as a treatment modality for TRD. PubMed, PsycINFO, Medline, Embase, and Cinahl were used to identify important articles on rTMS for TRD. The search strategy was limited to English articles within the last five years of data publication. Articles were included if they reported on a completed randomized controlled trial (RCT) of rTMS intervention for TRD. The exclusion criteria involved studies with rTMS for the treatment of conditions other than TRD, and study and experimental protocols of rTMS on TRD. In total, 17 studies were eligible for inclusion in this review. The search strategy spanned studies published in the last five years, to the date of the data search (14 February 2022). The regional breakdown of the extracted studies was North American (n = 9), European (n = 5), Asian (n = 2) and Australian (n = 1). The applied frequencies of rTMS ranged from 5 Hz to 50 Hz, with stimulation intensities ranging from 80% MT to 120% MT. Overall, 16 out of the 17 studies suggested that rTMS treatment was effective, safe and tolerated in TRD. For patients with TRD, rTMS appears to provide significant benefits through the reduction of depressive symptoms, and while there is progressive evidence in support of the same, more research is needed in order to define standardized protocols of rTMS application in terms of localization, frequency, intensity, and pulse parameters.

Treatment‐resistant depression: definition, prevalence, detection, management, and investigational interventions

“…Results from systematic reviews and meta‐analyses consistently support the efficacy of rTMS in TRD 233 . Results also indicate that greater severity at baseline and higher number of prior antidepressant failures are associated with attenuated rTMS efficacy 239‐243 .…”

“…Neurostimulatory treatments evaluated in TRD include vagus nerve stimulation (VNS), ECT, rTMS, magnetic seizure therapy, deep brain stimulation, and transcranial direct current stimulation [227][228][229][230][231][232][233] .…”

Personalized repetitive transcranial magnetic stimulation (prtms®) for post-traumatic stress disorder (ptsd) in military combat veterans

“…2 b the percent not showing improvement after four weeks is about 17% which corresponds almost exactly to the percentage of patients with less than 5% PCL-5 improvement, i.e., no treatment response, with PrTMS. Interestingly, a recent (2022) retrospective literature meta-analysis of rTMS in depression indicated that a 4–6 week treatment duration yields tangible results, and Carpenter and co-workers (2017) reported that significant antidepressant effects were obtained after 4 weeks of rTMS [ 102 , 103 ].…”

Physiotherapy for patients with depression: Recent research progress

“…Subsequently, other researchers modified the treatment technology based on problems encountered during the development process. They elaborated a treatment method called repetitive TMS (rTMS) that transmits TMS with repetitive pulses at short intervals[ 18 ]. In the past five years, researchers have used rTMS to treat many neurological and mental health conditions to study and evaluate its therapeutic effect[ 19 - 21 ].…”