Transcranial Magnetic Stimulation in the Management of Mood Disorders

Abstract

Background: Many trials of transcranial magnetic stimulation (TMS) have used small samples and, therefore, lack power. Here we present an up-to-date meta-analysis of TMS in the treatment of depression. Methods: We searched Medline and Embase from 1996 until 2008 for randomized sham-controlled trials, with patients and investigators blinded to treatment, and outcome measured using a version of the Hamilton Depression Rating Scale (or similar). We identified 1,789 studies. Thirty-one were suitable for inclusion, with a cumulative sample of 815 active and 716 sham TMS courses. Results: We found a moderately sized effect in favour of TMS [Random Effects Model Hedges’ g = 0.64, 95% confidence interval (95% CI) = 0.50–0.79]. The corresponding Pooled Peto Odds Ratio for treatment response (≤50% reduction in depression scores) was 4.1 (95% CI = 2.9–5.9). There was significant variability between study effect sizes. Meta-regressions with relevant study variables did not reveal any predictors of treatment efficacy. Nine studies included follow-up data with an average follow-up time of 4.3 weeks; there was no mean change in depression severity between the end of treatment and follow-up (Hedges’ g = –0.02, 95% CI = –0.22 to +0.18) and no heterogeneity in outcome. Discussion: TMS appears to be an effective treatment; however, at 4 weeks’ follow-up after TMS, there had been no further change in depression severity. Problems with finding a suitably blind and ineffective placebo condition may have confounded the published effect sizes. If the TMS effect is specific, only further large double-blind randomized controlled designs with systematic exploration of treatment and patient parameters will help to define optimum treatment indications and regimen.

Clinically Meaningful Efficacy and Acceptability of Low-Frequency Repetitive Transcranial Magnetic Stimulation (rTMS) for Treating Primary Major Depression: A Meta-Analysis of Randomized, Double-Blind and Sham-Controlled Trials

“…We identified articles for inclusion in this meta-analysis by ' Screening the bibliography of the previous meta-analyses on rTMS for MD (Allan et al, 2011;Burt et al, 2002;Couturier, 2005;Gross et al, 2007;Herrmann and Ebmeier, 2006;Kozel and George, 2002;Lam et al, 2008;Martin et al, 2002;Martin et al, 2003;McNamara et al, 2001;Schutter, 2009;Slotema et al, 2010), of the only meta-analysis on LF-rTMS for MD published to date (Schutter, 2010) The search procedures (including syntaxes, parameters, and results) are described in detail in the Supplementary Material.…”

Response, remission and drop-out rates following high-frequency repetitive transcranial magnetic stimulation (rTMS) for treating major depression: a systematic review and meta-analysis of randomized, double-blind and sham-controlled trials

“…(1) Screening the bibliographies of all meta-analyses on rTMS for MD published to date (McNamara et al 2001;Burt et al 2002;Kozel & George, 2002;Martin et al 2002Martin et al , 2003Couturier, 2005;Herrmann & Ebmeier, 2006;Gross et al 2007;Lam et al 2008;Schutter, 2009Schutter, , 2010Slotema et al 2010;Allan et al 2011) …”

A systematic review and meta-analysis on the efficacy and acceptability of bilateral repetitive transcranial magnetic stimulation (rTMS) for treating major depression

“…(1) Screening the bibliographies of all meta-analyses on rTMS for MD published to date (McNamara et al 2001 ;Burt et al 2002 ;Kozel & George, 2002 ;Martin et al 2002Martin et al , 2003Couturier, 2005 ;Herrmann & Ebmeier, 2006 ;Gross et al 2007 ;Lam et al 2008 ;Schutter, 2009Schutter, , 2010Slotema et al 2010 ;Allan et al 2011) The search procedures (including syntaxes, parameters and results) are described in detail in the Supplementary online material.…”