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

Summary & key facts

Researchers pooled results from many controlled trials to see if adding repetitive transcranial magnetic stimulation, or rTMS, helps people with major depression who did not get better after two antidepressant tries. They looked at about 19 good-quality trials involving roughly 850 people for measuring symptom improvement, and found that adding rTMS roughly doubled to nearly tripled the chance of getting a strong response or full remission compared with a fake (sham) treatment. The results were consistent across studies, but the effect was smaller than in some earlier reviews and differences in how studies were done limit how broadly we can apply the findings.

Key facts:

• rTMS uses an electromagnetic pulse aimed at a part of the left front of the brain called the dorsolateral prefrontal cortex to change brain activity without surgery or drugs.
• The authors combined 19 randomized, double-blind, sham-controlled trials that measured response and found results from about 850 people.
• For remission, they pooled 9 trials that included roughly 550 people.
• People who received rTMS in addition to their usual antidepressants were about 2.25 times more likely to have a clinical response and about 2.8 times more likely to reach remission than those who received a sham (placebo-like) version of rTMS.
• Statistical checks showed the results were fairly consistent between studies and there was no clear sign that only positive studies were published.
• The authors note limitations: studies used different exact rTMS settings and different rules for what counts as remission, and the overall effect size was smaller than in some older reviews.
• The trials studied rTMS as an add-on treatment for people who met a common definition of treatment-resistant depression, meaning they did not respond to two adequate antidepressant trials.

Abstract

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.

Topics

Electroconvulsive Therapy Studies Pain Management and Treatment Transcranial Magnetic Stimulation Studies

Categories

Life Sciences Neurology Neuroscience

Tags

Adjunctive treatment Antidepressant Depression (economics) Economics Hippocampus Internal medicine Macroeconomics Major depressive disorder Medicine Meta-analysis Mood Pharmacotherapy Psychiatry Psychology Publication bias Randomized controlled trial Stimulation Transcranial magnetic stimulation Treatment-resistant depression

Conditions & symptoms

Depression Lack of energy or motivation Sadness or low mood