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Is repetitive Transcranial Magnetic Stimulation really effective in the treatment of major depression? – Results of a Meta-Analysis

Published online by Cambridge University Press:  01 September 2022

S. Kovacs ,
R. Vida ,
D. Erdosi ,
J. Jozwiak-Hagymasy ,
A. Zemplenyi ,
T. Tényi ,
V. Voros  and
P. Osvath
S. Kovacs
Affiliation:
University of Pécs, Faculty Of Pharmacy, Division Of Pharmacoeconomics, Pécs, Hungary
R. Vida
Affiliation:
University of Pécs, Faculty Of Pharmacy, Department Of Pharmaceutics, Pécs, Hungary
D. Erdosi
Affiliation:
University of Pécs, Faculty Of Pharmacy, Division Of Pharmacoeconomics, Pécs, Hungary
J. Jozwiak-Hagymasy
Affiliation:
University of Pécs, Faculty Of Pharmacy, Division Of Pharmacoeconomics, Pécs, Hungary
A. Zemplenyi
Affiliation:
University of Pécs, Faculty Of Pharmacy, Division Of Pharmacoeconomics, Pécs, Hungary
T. Tényi
Affiliation:
University of Pécs, Faculty Of Medicine, Department Of Psychiatry And Psychotherapy, Pécs, Hungary
V. Voros*
Affiliation:
University of Pécs, Faculty Of Medicine, Department Of Psychiatry And Psychotherapy, Pécs, Hungary
P. Osvath
Affiliation:
University of Pécs, Faculty Of Medicine, Department Of Psychiatry And Psychotherapy, Pécs, Hungary
*
*Corresponding author.

Abstract

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Introduction

Clinical studies demonstrated the efficacy of rTMS treatment in major depressive disorder. However, the results of meta-analyses are contradictory due to the heterogeneity of the included studies.

Objectives

The aim was to analyse the effectiveness of rTMS for treatment-resistant major depression.

Methods

A systematic literature review of English-language articles published in the last 10 years was performed on PubMed and Scopus databases according to PRISMA guideline principles. To assess the effects of rTMS on response and remission rates, random-effects model and inverse variance method were used.

Results

23 randomized double-blind sham-controlled studies met the inclusion criteria for quantitative analysis for response (n= 1020 patients) and 12 studies for remission (n= 846 patients). The relative risk for response and remission were 2.19 (95% CI: 1.68-2,86, p=0.000 n=912) and 2.65 (95% CI: 1.32-5,31, p=0.002, n=603), respectively using rTMS as add on treatment (in patients after two antidepressant treatment failures) compared to standard pharmacotherapy. I2analysis showed no considerable heterogeneity in the combined effect sizes neither for remission studies (I2=23.36%) nor for response studies (I2=0.00%).

Conclusions

Transcranial magnetic stimulation became an evidence-based, effective treatment for treatment-resistant major depressive disorder, either as a monotherapy or as an augmentation of pharmacotherapy. However, because of the lack of standardized protocol, a substantial methodological heterogeneity exists. According to our results, rTMS was significantly more effective than sham rTMS in both response and remission outcomes, which is consistent with previous meta-analyses, but the effect size was a bit smaller than what was reported previously.

Disclosure

No significant relationships.

Keywords

rTMSDepressionmetaanalysis
Type
Abstract
Information
European Psychiatry , Volume 65 , Special Issue S1: Abstracts of the 30th European Congress of Psychiatry , June 2022 , pp. S301
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the European Psychiatric Association
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