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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: muqiwen99@yahoo.com (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.

References

Ferrari, A.J.Charlson, F.J.Norman, R.E.Patten, S.B.Freedman, G.Murray, C.J.et al.Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Med 2013;10(11):e1001547.CrossRefGoogle ScholarPubMed
Mathew, S.J.Treatment-resistant depression: recent developments and future directions. Depress Anxiety 2008;25(12):989–992.CrossRefGoogle ScholarPubMed
Ustun, T.B.Ayuso-Mateos, J.L.Chatterji, S.Mathers, C.Murray, C.J.Global burden of depressive disorders in the year 2000. Br J Psychiatry 2004;184:386–392.CrossRefGoogle ScholarPubMed
Fitzgerald, P.B.Daskalakis, Z.J.A practical guide to the use of repetitive transcranial magnetic stimulation in the treatment of depression. Brain Stimul 2012;5(3):287–296.CrossRefGoogle ScholarPubMed
Pompili, M.Serafini, G.Innamorati, M.Venturini, P.Fusar-Poli, P.Sher, L.et al.Agomelatine, a novel intriguing antidepressant option enhancing neuroplasticity: a critical review. World J Biol Psychiatry 2013;14(6):412–431.CrossRefGoogle ScholarPubMed
Berlim, M.T.Turecki, G.Definition, assessment, and staging of treatment-resistant refractory major depression: a review of current concepts and methods. Can J Psychiatry 2007;52(1):46–54.CrossRefGoogle ScholarPubMed
Miniussi, C.Bonato, C.Bignotti, S.Gazzoli, A.Gennarelli, M.Pasqualetti, P.et al.Repetitive transcranial magnetic stimulation (rTMS) at high and low-frequency: an efficacious therapy for major drug-resistant depression?. Clin Neurophysiol 2005;116(5):1062–1071.CrossRefGoogle ScholarPubMed
Speer, A.M.Benson, B.E.Kimbrell, T.K.Wassermann, E.M.Willis, M.W.Herscovitch, P.et al.Opposite effects of high and low-frequency rTMS on mood in depressed patients: relationship to baseline cerebral activity on PET. J Affect Disord 2009;115(3):386–394.CrossRefGoogle ScholarPubMed
Kimbrell, T.A.Little, J.T.Dunn, R.T.Frye, M.A.Greenberg, B.D.Wassermann, E.M.et al.Frequency dependence of antidepressant response to left prefrontal repetitive transcranial magnetic stimulation (rTMS) as a function of baseline cerebral glucose metabolism. Biol Psychiatry 1999;46(12):1603–1613.CrossRefGoogle ScholarPubMed
Eschweiler, G.W.Wegerer, C.Schlotter, W.Spandl, C.Stevens, A.Bartels, M.et al.Left prefrontal activation predicts therapeutic effects of repetitive transcranial magnetic stimulation (rTMS) in major depression. Psychiatry Res 2000;99(3):161–172.CrossRefGoogle Scholar
George, M.S.Wassermann, E.M.Kimbrell, T.A.Little, J.T.Williams, W.E.Danielson, A.L.et al.Mood improvement following daily left prefrontal repetitive transcranial magnetic stimulation in patients with depression: a placebo-controlled crossover trial. Am J Psychiatry 1997;154(12):1752–1756.CrossRefGoogle ScholarPubMed
Fitzgerald, P.B.Daskalakis, Z.J.The use of repetitive transcranial magnetic stimulation and vagal nerve stimulation in the treatment of depression. Curr Opin Psychiatry 2008;21(1):25–29.CrossRefGoogle ScholarPubMed
Daskalakis, Z.J.Levinson, A.J.Fitzgerald, P.B.Repetitive transcranial magnetic stimulation for major depressive disorder: a review. Can J Psychiatry 2008;53(9):555–566.CrossRefGoogle ScholarPubMed
Janicak, P.G.Dokucu, M.E.Transcranial magnetic stimulation for the treatment of major depression. Neuropsychiatr Dis Treat 2015;11:1549–1560.CrossRefGoogle ScholarPubMed
Peng, H.Zheng, H.Li, L.Liu, J.Zhang, Y.Shan, B.et al.High-frequency rTMS treatment increases white matter FA in the left middle frontal gyrus in young patients with treatment-resistant depression. J Affect Disord 2012;136(3):249–257.CrossRefGoogle ScholarPubMed
Chen, J.Zhou, C.Wu, B.Wang, Y.Li, Q.Wei, Y.et al.Left versus right repetitive transcranial magnetic stimulation in treating major depression: a meta-analysis of randomised controlled trials. Psychiatry Res 2013;210(3):1260–1264.CrossRefGoogle ScholarPubMed
Berlim, M.T.Van den Eynde, F.Jeff Daskalakis, Z.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. Neuropsychopharmacology 2013;38(4):543–551.CrossRefGoogle ScholarPubMed
Higgins, J.P.Thompson, S.G.Deeks, J.J.Altman, D.G.Measuring inconsistency in meta-analyses. BMJ 2003;327(7414):557–560.CrossRefGoogle ScholarPubMed
Zheng, H.Jia, F.Guo, G.Quan, D.Li, G.Wu, H.et al.Abnormal anterior cingulate N-Acetylaspartate and executive functioning in treatment-resistant depression after rTMS therapy. Int J Neuropsychopharmacol 2015;18(11):pyv059.CrossRefGoogle ScholarPubMed
Zheng, H.Zhang, L.Li, L.Liu, P.Gao, J.Liu, X.et al.High-frequency rTMS treatment increases left prefrontal myo-inositol in young patients with treatment-resistant depression. Prog Neuropsychopharmacol Biol Psychiatry 2010;34(7):1189–1195.CrossRefGoogle ScholarPubMed
Bortolomasi, M.Minelli, A.Fuggetta, G.Perini, M.Comencini, S.Fiaschi, A.et al.Long-lasting effects of high-frequency repetitive transcranial magnetic stimulation in major depressed patients. Psychiatry Res 2007;150(2):181–186.CrossRefGoogle ScholarPubMed
Padberg, F.Zwanzger, P.Thoma, H.Kathmann, N.Haag, C.Greenberg, B.D.et al.Repetitive transcranial magnetic stimulation (rTMS) in pharmacotherapy-refractory major depression: comparative study of fast, slow and sham rTMS. Psychiatry Res 1999;88(3):163–171.CrossRefGoogle ScholarPubMed
Berman, R.M.Narasimhan, M.Sanacora, G.Miano, A.P.Hoffman, R.E.Hu, X.S.et al.A randomized clinical trial of repetitive transcranial magnetic stimulation in the treatment of major depression. Biol Psychiatry 2000;47(4):332–337.CrossRefGoogle ScholarPubMed
Herwig, U.Lampe, Y.Juengling, F.D.Wunderlich, A.Walter, H.Spitzer, M.et al.Add-on rTMS for treatment of depression: a pilot study using stereotaxic coil-navigation according to PET data. J Psychiatr Res 2003;37(4):267–275.CrossRefGoogle ScholarPubMed
Garcia-Toro, M.Mayol, A.Arnillas, H.Capllonch, I.Ibarra, O.Crespi, M.et al.Modest adjunctive benefit with transcranial magnetic stimulation in medication-resistant depression. J Affect Disord 642–32001 271–275.CrossRefGoogle ScholarPubMed
Boutros, N.N.Gueorguieva, R.Hoffman, R.E.Oren, D.A.Feingold, A.Berman, R.M.Lack of a therapeutic effect of a 2-week sub-threshold transcranial magnetic stimulation course for treatment-resistant depression. Psychiatry Res 2002;113(3):245–254.CrossRefGoogle ScholarPubMed
Mosimann, U.P.Schmitt, W.Greenberg, B.D.Kosel, M.Muri, R.M.Berkhoff, M.et al.Repetitive transcranial magnetic stimulation: a putative add-on treatment for major depression in elderly patients. Psychiatry Res 2004;126(2):123–133.CrossRefGoogle ScholarPubMed
Paillere Martinot, M.L.Galinowski, A.Ringuenet, D.Gallarda, T.Lefaucheur, J.P.Bellivier, F.et al.Influence of prefrontal target region on the efficacy of repetitive transcranial magnetic stimulation in patients with medication-resistant depression: a [(18)F]-fluorodeoxyglucose PET and MRI study. Int J Neuropsychopharmacol 2010;13(1):45–59.CrossRefGoogle Scholar
Rossini, D.Magri, L.Lucca, A.Giordani, S.Smeraldi, E.Zanardi, R.Does rTMS hasten the response to escitalopram, sertraline, or venlafaxine in patients with major depressive disorder? A double-blind, randomized, sham-controlled trial. J Clin Psychiatry 2005;66(12):1569–1575.CrossRefGoogle ScholarPubMed
Su, T.P.Huang, C.C.Wei, I.H.Add-on rTMS for medication-resistant depression: a randomized, double-blind, sham-controlled trial in Chinese patients. J Clin Psychiatry 2005;66(7):930–937.CrossRefGoogle ScholarPubMed
Padberg, F.Zwanzger, P.Keck, M.E.Kathmann, N.Mikhaiel, P.Ella, R.et al.Repetitive transcranial magnetic stimulation (rTMS) in major depression: relation between efficacy and stimulation intensity. Neuropsychopharmacology 2002;27(4):638–645.CrossRefGoogle ScholarPubMed
Huang, M.L.Luo, B.Y.Hu, J.B.Wang, S.S.Zhou, W.H.Wei, N.et al.Repetitive transcranial magnetic stimulation in combination with citalopram in young patients with first-episode major depressive disorder: a double-blind, randomized, sham-controlled trial. Aust N Z J Psychiatry 2012;46(3):257–264.CrossRefGoogle ScholarPubMed
Holtzheimer, P.E. 3rd. Russo, J.Claypoole, K.H.Roy-Byrne, P.Avery, D.H.Shorter duration of depressive episode may predict response to repetitive transcranial magnetic stimulation. Depress Anxiety 2004;19(1):24–30.CrossRefGoogle ScholarPubMed
Chen, S.J.Chang, C.H.Tsai, H.C.Chen, S.T.Lin, C.Superior antidepressant effect occurring 1 month after rTMS: add-on rTMS for subjects with medication-resistant depression. Neuropsychiatr Dis Treat 2013;9:397–401.CrossRefGoogle ScholarPubMed
Garcia-Toro, M.Pascual-Leone, A.Romera, M.Gonzalez, A.Mico, J.Ibarra, O.et al.Prefrontal repetitive transcranial magnetic stimulation as add-on treatment in depression. J Neurol Neurosurg Psychiatry 2001;71(4):546–548.CrossRefGoogle ScholarPubMed
Fitzgerald, P.B.Brown, T.L.Marston, N.A.Daskalakis, Z.J.De Castella, A.Kulkarni, J.Transcranial magnetic stimulation in the treatment of depression: a double-blind, placebo-controlled trial. Arch Gen Psychiatry 2003;60(10):1002–1008.Google ScholarPubMed
Mogg, A.Pluck, G.Eranti, S.V.Landau, S.Purvis, R.Brown, R.G.et al.A randomized controlled trial with 4-month follow-up of adjunctive repetitive transcranial magnetic stimulation of the left prefrontal cortex for depression. Psychol Med 2008;38(3):323–333.CrossRefGoogle ScholarPubMed
Triggs, W.J.Ricciuti, N.Ward, H.E.Cheng, J.Bowers, D.Goodman, W.K.et al.Right and left dorsolateral prefrontal rTMS treatment of refractory depression: a randomized, sham-controlled trial. Psychiatry Res 2010;178(3):467–474.CrossRefGoogle ScholarPubMed
George, M.S.Nahas, Z.Molloy, M.Speer, A.M.Oliver, N.C.Li, X.B.et al.A controlled trial of daily left prefrontal cortex TMS for treating depression. Biol Psychiatry 2000;48(10):962–970.CrossRefGoogle ScholarPubMed
Hernandez-Ribas, R.Deus, J.Pujol, J.Segalas, C.Vallejo, J.Menchon, J.M.et al.Identifying brain imaging correlates of clinical response to repetitive transcranial magnetic stimulation (rTMS) in major depression. Brain Stimul 2013;6(1):54–61.CrossRefGoogle Scholar
Avery, D.H.Holtzheimer, P.E. 3rd. Fawaz, W.Russo, J.Neumaier, J.Dunner, D.L.et al.A controlled study of repetitive transcranial magnetic stimulation in medication-resistant major depression. Biol Psychiatry 2006;59(2):187–194.CrossRefGoogle ScholarPubMed
Loo, C.K.Mitchell, P.B.Croker, V.M.Malhi, G.S.Wen, W.Gandevia, S.C.et al.Double-blind controlled investigation of bilateral prefrontal transcranial magnetic stimulation for the treatment of resistant major depression. Psychol Med 2003;33(1):33–40.CrossRefGoogle ScholarPubMed
Speer, A.M.Wassermann, E.M.Benson, B.E.Herscovitch, P.Post, R.M.Antidepressant efficacy of high and low-frequency rTMS at 110% of motor threshold versus sham stimulation over left prefrontal cortex. Brain Stimul 2014;7(1):36–41.CrossRefGoogle ScholarPubMed
Bretlau, L.G.Lunde, M.Lindberg, L.Unden, M.Dissing, S.Bech, P.Repetitive transcranial magnetic stimulation (rTMS) in combination with escitalopram in patients with treatment-resistant major depression: a double-blind, randomised, sham-controlled trial. Pharmacopsychiatry 2008;41(2):41–47.CrossRefGoogle ScholarPubMed
George, M.S.Lisanby, S.H.Avery, D.McDonald, W.M.Durkalski, V.Pavlicova, M.et al.Daily left prefrontal transcranial magnetic stimulation therapy for major depressive disorder: a sham-controlled randomized trial. Arch Gen Psychiatry 2010;67(5):507–516.CrossRefGoogle ScholarPubMed
Herwig, U.Fallgatter, A.J.Hoppner, J.Eschweiler, G.W.Kron, M.Hajak, G.et al.Antidepressant effects of augmentative transcranial magnetic stimulation: randomised multicentre trial. Br J Psychiatry 2007;191:441–448.CrossRefGoogle ScholarPubMed
Minmin, X.Jiang, W.Haibo, Y.Efficacy and safety of the Chinese herbal medicine shuganjieyu with and without adjunctive repetitive transcranial magnetic stimulation (rTMS) for geriatric depression: a randomized controlled trial. Shanghai Arch Psychiatry 2015;27(2):103.Google Scholar
Rumi, D.O.Gattaz, W.F.Rigonatti, S.P.Rosa, M.A.Fregni, F.Rosa, M.O.et al.Transcranial magnetic stimulation accelerates the antidepressant effect of amitriptyline in severe depression: a double-blind placebo-controlled study. Biol Psychiatry 2005;57(2):162–166.CrossRefGoogle ScholarPubMed
Kim, Y.K.Jung, J.H.Shin, S.H.A comparison of the effects of repetitive transcranial magnetic stimulation (rTMS) by number of stimulation sessions on hemispatial neglect in chronic stroke patients. Exp Brain Res 2015;233(1):283–289.CrossRefGoogle ScholarPubMed
Kalita, J.Laskar, S.Bhoi, S.K.Misra, U.K.Efficacy of single versus three sessions of high rate repetitive transcranial magnetic stimulation in chronic migraine and tension-type headache. J Neurol 2016;263(11):2238–2246.CrossRefGoogle ScholarPubMed
Schutter, D.J.Antidepressant efficacy of high-frequency transcranial magnetic stimulation over the left dorsolateral prefrontal cortex in double-blind sham-controlled designs: a meta-analysis. Psychol Med 2009;39(1):65–75.CrossRefGoogle ScholarPubMed
Berlim, M.T.van den Eynde, F.Tovar-Perdomo, S.Daskalakis, Z.J.Response, remission and dropout 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. Psychol Med 2014;44(2):225–239.CrossRefGoogle Scholar
Kedzior, K.K.Reitz, S.K.Azorina, V.Loo, C.Durability of the antidepressant effect of the high-frequency repetitive transcranial magnetic stimulation (rTMS) in the absence of maintenance treatment in major depression: a systematic review and meta-analysis of 16 double-blind, randomized, sham-controlled trials. Depress Anxiety 2015;32(3):193–203.CrossRefGoogle ScholarPubMed
Bakim, BUzun, UKaramustafalioglu, KOzcelik, BAlpak, GTankaya, O, et al.Combination of fast repetitive transcranial magnetic stimulation with antidepressant treatment in medication-resistant depression. Bull Clin Psychopharmacol 2006;2(1):85–94.Google Scholar
Platz, T.Rothwell, J.C.Brain stimulation and brain repair – rTMS: from animal experiment to clinical trials – what do we know?. Restor Neurol Neurosci 2010;28(4):387–398.Google ScholarPubMed
Loo, C.K.Mitchell, P.B.McFarquhar, T.F.Malhi, G.S.Sachdev, P.S.A sham-controlled trial of the efficacy and safety of twice-daily rTMS in major depression. Psychol Med 2007;37(3):341–349.CrossRefGoogle ScholarPubMed
Szuba, M.P.O’Reardon, J.P.Rai, A.S.Snyder-Kastenberg, J.Amsterdam, J.D.Gettes, D.R.et al.Acute mood and thyroid stimulating hormone effects of transcranial magnetic stimulation in major depression. Biol Psychiatry 2001;50(1):22–27.CrossRefGoogle ScholarPubMed
Mukherjee, P.Whalley, H.C.McKirdy, J.W.McIntosh, A.M.Johnstone, E.C.Lawrie, S.M.et al.Effects of the BDNF Val66Met polymorphism on neural responses to facial emotion. Psychiatry Res 2011;191(3):182–188.CrossRefGoogle ScholarPubMed
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