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Academic Journal
META-ANALYSIS
| Title: |
Quantitative review of the efficacy of slow-frequency magnetic brain stimulation in major depressive disorder
| | Date: | 2010 | | Author(s): |
Schutter DJLG
| | Source: | Psychological Medicine | | Abstract: |
Background. Slow-frequency repetitive transcranial magnetic stimulation (rTMS) to the frontal cortex has been suggested as a safer and better tolerable alternative to fast-frequency rTMS in the treatment of major depressive disorder (MDD). The aim of the present study was to examine the efficacy of slow-frequency rTMS to the frontal cortex in MDD.
Method. A literature search was carried out in the databases PubMed and Web of Science in the period between January 1994 and July 2009 with the search terms ‘ depression ’ and ‘ transcranial magnetic stimulation ’. Nine doubleblind sham-controlled parallel intention-to-treat studies (252 patients) fulfilled inclusion criteria and were entered in a random-effects meta-analysis.
Results. The test for heterogeneity was not significant (QT=9.63, p=0.38). An overall weighted moderate mean effect size (d=0.63, 95% confidence interval=0.03–1.24) for active treatment was observed.
Conclusions. The findings suggest that slow-frequency rTMS to the frontal cortex is more effective than sham treatment and may be equally effective as fast-frequency rTMS in the treatment of MDD.
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| | Title: |
Should we expand the toolbox of psychiatric treatment methods to include rTMS? A meta-analysis of efficacy of rTMS in psychiatric disorders
| | Date: | 2010 | | Author(s): |
Slotema CW, Blom JD, Hoek HW, Sommer IE.
| | Source: | Journal of Clinical Psychiatry | | Abstract: |
OBJECTIVE: Repetitive transcranial magnetic stimulation (rTMS) is a safe treatment method with few side effects. However, efficacy for various psychiatric disorders is currently not clear. DATA SOURCES: A literature search was performed from 1966 through October 2008 using PubMed, Ovid Medline, Embase Psychiatry, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, and PsycINFO. The following search terms were used: transcranial magnetic stimulation, TMS, repetitive TMS, psychiatry, mental disorder, psychiatric disorder, anxiety disorder, attention-deficit hyperactivity disorder, bipolar disorder, catatonia, mania, depression, obsessive-compulsive disorder, psychosis, posttraumatic stress disorder, schizophrenia, Tourette's syndrome, bulimia nervosa, and addiction. STUDY SELECTION: Data were obtained from randomized, sham-controlled studies of rTMS treatment for depression (34 studies), auditory verbal hallucinations (AVH, 7 studies), negative symptoms in schizophrenia (7 studies), and obsessive-compulsive disorder (OCD, 3 studies). Studies of rTMS versus electroconvulsive treatment (ECT, 6 studies) for depression were meta-analyzed. DATA EXTRACTION: Standardized mean effect sizes of rTMS versus sham were computed based on pretreatment-posttreatment comparisons. DATA SYNTHESIS: The mean weighted effect size of rTMS versus sham for depression was 0.55 (P < .001). Monotherapy with rTMS was more effective than rTMS as adjunctive to antidepressant medication. ECT was superior to rTMS in the treatment of depression (mean weighted effect size -0.47, P = .004). In the treatment of AVH, rTMS was superior to sham treatment, with a mean weighted effect size of 0.54 (P < .001). The mean weighted effect size for rTMS versus sham in the treatment of negative symptoms in schizophrenia was 0.39 (P = .11) and for OCD, 0.15 (P = .52). Side effects were mild, yet more prevalent with high-frequency rTMS at frontal locations. CONCLUSIONS: It is time to provide rTMS as a clinical treatment method for depression, for auditory verbal hallucinations, and possibly for negative symptoms. We do not recommend rTMS for the treatment of OCD.
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| | Title: |
Antidepressant efficacy of high-frequency transcranial magnetic stimulation over the left dorsolateral prefrontal cortex in double-blind sham-controlled designs: a meta-analysis
| | Date: | 2009 | | Author(s): |
D. J. L. G. Schutter
| | Source: | Psychological Medicine | | Keywords: | Depression, dorsolateral prefrontal cortex, meta-analysis, transcranial magnetic stimulation, treatment. | | Abstract: |
Background For more than a decade high-frequency repetitive transcranial magnetic stimulation (rTMS) has been applied to the left dorsolateral prefrontal cortex (DLPFC) in search of an alternative treatment for depression. The aim of this study was to provide an update on its clinical efficacy by performing a meta-analysis involving double-blind sham-controlled studies.
Method A literature search was conducted in the databases PubMed and Web of Science in the period between January 1980 and November 2007 with the search terms ‘depression’ and ‘transcranial magnetic stimulation’. Thirty double-blind sham-controlled parallel studies with 1164 patients comparing the percentage change in depression scores from baseline to endpoint of active versus sham treatment were included. A random effects meta-analysis was performed to investigate the clinical efficacy of fast-frequency rTMS over the left DLPFC in depression.
Results The test for heterogeneity was not significant (QT=30.46, p=0.39). A significant overall weighted mean effect size, d=0.39 [95% confidence interval (CI) 0.25–0.54], for active treatment was observed (z=6.52, p<0.0001). Medication resistance and intensity of rTMS did not play a role in the effect size.
Conclusions These findings show that high-frequency rTMS over the left DLPFC is superior to sham in the treatment of depression. The effect size is robust and comparable to at least a subset of commercially available antidepressant drug agents. Current limitations and future prospects are discussed.
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