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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

Published online by Cambridge University Press:  18 March 2013

M. T. Berlim ,
F. van den Eynde ,
S. Tovar-Perdomo  and
Z. J. Daskalakis
M. T. Berlim*
Affiliation:
Neuromodulation Research Clinic, Douglas Mental Health University Institute and McGill University, Montréal, Québec, Canada Depressive Disorders Program, Douglas Mental Health University Institute and McGill University, Montréal, Québec, Canada
F. van den Eynde
Affiliation:
Neuromodulation Research Clinic, Douglas Mental Health University Institute and McGill University, Montréal, Québec, Canada
S. Tovar-Perdomo
Affiliation:
Neuromodulation Research Clinic, Douglas Mental Health University Institute and McGill University, Montréal, Québec, Canada
Z. J. Daskalakis
Affiliation:
Brain Stimulation Treatment and Research Program, Centre for Addiction and Mental Health and University of Toronto, Ontario, Canada
*
*Address for correspondence: M. T. Berlim M.D., M.Sc., Douglas Mental Health University Institute, 6875 LaSalle Blvd, FBC-3 Pavilion, Montréal, Québec, Canada, H4H 1R3. (Email: [email protected])
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Abstract

Background

Meta-analyses have shown that high-frequency (HF) repetitive transcranial magnetic stimulation (rTMS) has antidepressant properties when compared with sham rTMS. However, its overall response and remission rates in major depression (MD) remain unclear. Thus, we have systematically and quantitatively assessed the efficacy of HF-rTMS for MD based on randomized, double-blind and sham-controlled trials (RCTs).

Method

We searched the literature from 1995 through to July 2012 using MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, SCOPUS, and ProQuest Dissertations & Theses. We used a random-effects model, odds ratios (ORs) and the number needed to treat (NNT).

Results

Data from 29 RCTs were included, totaling 1371 subjects with MD. Following approximately 13 sessions, 29.3% and 18.6% of subjects receiving HF-rTMS were classified as responders and remitters, respectively (compared with 10.4% and 5% of those receiving sham rTMS). The pooled OR was 3.3 (p < 0.0001) for both response and remission rates (with associated NNTs of 6 and 8, respectively). Furthermore, we found HF-rTMS to be equally effective as an augmentation strategy or as a monotherapy for MD, and when used in samples with primary unipolar MD or in mixed samples with unipolar and bipolar MD. Also, alternative stimulation parameters were not associated with differential efficacy estimates. Moreover, baseline depression severity and drop-out rates at study end were comparable between the HF-rTMS and sham rTMS groups. Finally, heterogeneity between the included RCTs was not statistically significant.

Conclusions

HF-rTMS seems to be associated with clinically relevant antidepressant effects and with a benign tolerability profile.

Keywords

Acceptabilityefficacymajor depressionmeta-analysisrepetitive transcranial magnetic stimulation
Type
Review Article
Information
Psychological Medicine , Volume 44 , Issue 2 , January 2014 , pp. 225 - 239
Copyright
Copyright © Cambridge University Press 2013 

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