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High-frequency repetitive transcranial magnetic stimulation over the left DLPFC for major depression: Session-dependent efficacy: A meta-analysis

Published online by Cambridge University Press:  03 February 2017

S. Teng ,
Z. Guo ,
H. Peng ,
G. Xing ,
H. Chen ,
B. He ,
M.A. McClure  and
Q. Mu
S. Teng
Affiliation:
The Department of Imaging & Imaging Institute of Rehabilitation and Development of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, 637000Nanchong, China
Z. Guo
Affiliation:
The Department of Imaging & Imaging Institute of Rehabilitation and Development of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, 637000Nanchong, China
H. Peng
Affiliation:
The Department of Imaging & Imaging Institute of Rehabilitation and Development of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, 637000Nanchong, China
G. Xing
Affiliation:
The Department of Imaging & Imaging Institute of Rehabilitation and Development of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, 637000Nanchong, China Lotus Biotech.com LLC., John Hopkins University-MCC, Rockville, Maryland, USA
H. Chen
Affiliation:
The Department of Imaging & Imaging Institute of Rehabilitation and Development of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, 637000Nanchong, China
B. He
Affiliation:
The Department of Imaging & Imaging Institute of Rehabilitation and Development of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, 637000Nanchong, China
M.A. McClure
Affiliation:
The Department of Imaging & Imaging Institute of Rehabilitation and Development of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, 637000Nanchong, China
Q. Mu*
Affiliation:
The Department of Imaging & Imaging Institute of Rehabilitation and Development of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, 637000Nanchong, China
*
⁎Corresponding author at: Imaging Institute of Rehabilitation and Development of Brain Function, The Second Clinical College of North Sichuan Medical College Nanchong Central Hospital, No. 97 South Renmin Road, Shunqing District, Nanchong, 637000 Sichuan, China. Tel.: +86 0817 2260 993. E-mail address: [email protected] (Q. Mu).
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Abstract

Background

Depression is a major debilitating psychiatric disorder. Current antidepressant drugs are often associated with side effects or treatment resistance. The aim of this meta-analysis was to evaluate therapeutic effects of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) in major depression (MD).

Methods

The medical data bases of PubMed, Medline, Embase and Cochrane Central Register were searched for randomized controlled trials (RCTs) reporting the therapeutic effects of high-frequency rTMS for depression, which were published in English between January 1990 and June 2016. The index terms were “depress*”, “depression” and “transcranial magnetic stimulation”. Depression outcome data of different sessions (5, 10, 15, and 20 sessions of rTMS treatment) were extracted and synthesized by calculating standardized mean difference (SMD) with 95% confidence intervals (CI) by using a random-effect model. Within each session group, the subgroup analyses based on the number of pulses (≤ 1000, 1200–1500, 1600–1800, and 2000–3000) were also conducted.

Results

Thirty RCTs with a total of 1754 subjects including 1136 in the rTMS group and 618 in the sham group were included in this meta-analysis. rTMS had a significant overall therapeutic effect on depression severity scores (SMD = −0.73, P < 0.00001). The five, 10, 15, 20 sessions of rTMS treatments yielded the significant mean effect sizes of −0.43, −0.60, −1.13, and −2.74, respectively. In the four groups (5, 10, 15, 20 sessions), the maximal mean effect size was all obtained in the subgroup of 1200–1500 pulses per day (−0.97, −1.14, −1.91, −5.47; P < 0.05).

Conclusions

The increasing of HF-rTMS sessions is associated with the increased efficacy of HF-rTMS in reducing depressed patients’ symptom severity. A total number of pulses of 1200–1500 per day appear to deliver the best antidepressant effects of HF-rTMS.

Keywords

Repetitive transcranial magnetic stimulationUnipolar depressionSessionPulseMeta-analysis
Type
Review
Information
European Psychiatry , Volume 41 , Issue 1 , March 2017 , pp. 75 - 84
Copyright
Copyright © European Psychiatric Association 2017

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Footnotes

1

Shuai Teng and Zhiwei Guo contributed equally to this work.

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