Prim Care Companion CNS Disord. 2015 Nov 05;17(6). doi: 10.4088/PCC.15r01807. eCollection 2015.
Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression in Adult and Youth Populations: A Systematic Literature Review and Meta-Analysis.
The primary care companion for CNS disorders
Laura E Leggett, Lesley J J Soril, Stephanie Coward, Diane L Lorenzetti, Gail MacKean, Fiona M Clement
Affiliations
Affiliations
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Institute of Health Economics, Edmonton, Alberta, Canada.
PMID: 27057417
PMCID: PMC4805418 DOI: 10.4088/PCC.15r01807
Abstract
BACKGROUND: Between 30% and 60% of individuals with major depressive disorder will have treatment-resistant depression (TRD): depression that does not subside with pharmaceutical treatment. Repetitive transcranial magnetic stimulation (rTMS) is an emerging treatment for TRD.
OBJECTIVE: To establish the efficacy and optimal protocol for rTMS among adults and youth with TRD.
DATA SOURCES: Two systematic reviews were conducted: one to determine the efficacy of rTMS for adults with TRD and another to determine the effectiveness of rTMS for youth with TRD. For adults, MEDLINE, Cochrane Central Register of Controlled Trials, PubMed, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews, and Health Technology Assessment Database were searched from inception until January 10, 2014 with no language restrictions. Terms aimed at capturing the target diagnosis, such as depression and depressive disorder, were combined with terms describing the technology, such as transcranial magnetic stimulation and rTMS. Results were limited to studies involving human participants and designed as a randomized controlled trial. For youth, the search was altered to include youth only (aged 13-25 years) and all study designs. When possible, meta-analysis of response and remission rates was conducted.
STUDY SELECTION: Seventy-three articles were included in this review: 70 on adult and 3 on youth populations.
RESULTS: Meta-analysis comparing rTMS and sham in adults found statistically significant results favoring rTMS for response (RR: 2.35 [95% CI, 1.70-3.25]) and remission (RR: 2.24 [95% CI, 1.53-3.27]). No statistically significant differences were found when comparing high- and low-frequency, unilateral and bilateral, low- and high-intensity rTMS or rTMS and electroconvulsive therapy (ECT). While meta-analysis of results from the youth literature was not possible, the limited evidence base suggests that rTMS may be effective for treating TRD in youth.
CONCLUSIONS: The evidence available on the use of rTMS for adults with TRD indicates that rTMS is approximately twice as effective as a sham procedure, although the optimal rTMS protocol remains unclear. Evidence also indicates that rTMS is as effective as ECT and appears promising as a treatment for youth with TRD; however, the evidence base is underdeveloped.
References
- Am J Psychiatry. 1999 Jun;156(6):946-8 - PubMed
- Am J Psychiatry. 2006 Jan;163(1):88-94 - PubMed
- Int J Neuropsychopharmacol. 2013 Oct;16(9):1975-84 - PubMed
- Psychol Med. 2013 Nov;43(11):2245-54 - PubMed
- Psychiatry Res. 1999 Nov 29;88(3):163-71 - PubMed
- J Clin Psychiatry. 2006 Dec;67(12):1870-6 - PubMed
- J Affect Disord. 2012 Feb;136(3):249-57 - PubMed
- Prog Neuropsychopharmacol Biol Psychiatry. 2010 Oct 1;34(7):1189-95 - PubMed
- Int J Neuropsychopharmacol. 2006 Dec;9(6):667-76 - PubMed
- Br J Psychiatry. 2004 Jun;184:541-2 - PubMed
- Am J Psychiatry. 2011 May;168(5):502-10 - PubMed
- Psychiatry Res. 2005 Nov 15;137(1-2):1-10 - PubMed
- Prog Neuropsychopharmacol Biol Psychiatry. 2012 Dec 3;39(2):364-70 - PubMed
- Arch Gen Psychiatry. 2008 Mar;65(3):268-76 - PubMed
- Biol Psychiatry. 2003 Apr 15;53(8):649-59 - PubMed
- J Epidemiol Community Health. 1998 Jun;52(6):377-84 - PubMed
- Psychol Med. 2012 May;42(5):981-8 - PubMed
- Biol Psychiatry. 2000 Feb 15;47(4):332-7 - PubMed
- Clin Neurophysiol. 2005 May;116(5):1062-71 - PubMed
- Neuropsychopharmacology. 2002 Oct;27(4):638-45 - PubMed
- J Affect Disord. 2012 Jul;139(2):193-8 - PubMed
- J ECT. 2012 Jun;28(2):84-6 - PubMed
- Aust N Z J Psychiatry. 2006 Sep;40(9):759-63 - PubMed
- Health Technol Assess. 2007 Jul;11(24):1-54 - PubMed
- Neuropsychiatr Dis Treat. 2006 Mar;2(1):85-94 - PubMed
- Int J Neuropsychopharmacol. 2006 Dec;9(6):655-66 - PubMed
- Psychol Med. 2003 Jan;33(1):33-40 - PubMed
- Depress Anxiety. 2004;19(1):59-62 - PubMed
- Neuropsychobiology. 2010;62(2):91-7 - PubMed
- Front Psychiatry. 2012 Mar 07;3:13 - PubMed
- J Clin Psychopharmacol. 2008 Feb;28(1):52-8 - PubMed
- J Affect Disord. 2009 Nov;118(1-3):94-100 - PubMed
- Nord J Psychiatry. 2006;60(4):282-5 - PubMed
- J ECT. 2011 Dec;27(4):310-4 - PubMed
- Depress Anxiety. 2000;12(3):118-23 - PubMed
- Neuropsychopharmacology. 2013 Mar;38(4):543-51 - PubMed
- Biol Psychiatry. 2002 Apr 15;51(8):659-67 - PubMed
- Neuropsychopharmacology. 2009 Apr;34(5):1255-62 - PubMed
- Pharmacopsychiatry. 2008 Mar;41(2):41-7 - PubMed
- Int J Neuropsychopharmacol. 2000 Jun;3(2):129-134 - PubMed
- J Affect Disord. 2009 Jun;115(3):386-94 - PubMed
- Psychol Med. 2011 Jun;41(6):1187-96 - PubMed
- Neuroscience. 2010 May 5;167(2):323-8 - PubMed
- Lancet. 1996 Jul 27;348(9022):233-7 - PubMed
- Arch Gen Psychiatry. 2003 Oct;60(10):1002-8 - PubMed
- Ann Clin Psychiatry. 2005 Jul-Sep;17(3):153-9 - PubMed
- Brain Stimul. 2009 Oct;2(4):188-200 - PubMed
- Neurology. 2002 Apr 23;58(8):1288-90 - PubMed
- Brain Stimul. 2010 Jul;3(3):140-52 - PubMed
- J Affect Disord. 2009 Oct;117 Suppl 1:S44-53 - PubMed
- J Affect Disord. 2001 May;64(2-3):271-5 - PubMed
- Biol Psychiatry. 2003 Feb 15;53(4):324-31 - PubMed
- Psychiatry Res. 2007 Mar 30;150(2):181-6 - PubMed
- J ECT. 2012 Jun;28(2):104-7 - PubMed
- J ECT. 2008 Jun;24(2):156-9 - PubMed
- J Nerv Ment Dis. 1999 Feb;187(2):114-7 - PubMed
- Psychiatry Res. 2010 Aug 15;178(3):467-74 - PubMed
- Biol Psychiatry. 2007 Dec 1;62(11):1208-16 - PubMed
- Depress Anxiety. 2004;19(1):24-30 - PubMed
- Australas Psychiatry. 2004 Sep;12(3):234-8 - PubMed
- Int J Neuropsychopharmacol. 2010 Feb;13(1):45-59 - PubMed
- J Clin Psychiatry. 2013 Feb;74(2):e122-9 - PubMed
- Neuropsychiatr Dis Treat. 2013;9:397-401 - PubMed
- Arch Gen Psychiatry. 2010 May;67(5):507-16 - PubMed
- Int Psychogeriatr. 2001 Jun;13(2):225-31 - PubMed
- Brain Stimul. 2014 Jan-Feb;7(1):36-41 - PubMed
- J Affect Disord. 2013 Jan 10;144(1-2):153-9 - PubMed
- Psychol Med. 2007 Mar;37(3):341-9 - PubMed
- J Affect Disord. 2013 Nov;151(2):625-31 - PubMed
- J Clin Psychiatry. 2014 May;75(5):477-89; quiz 489 - PubMed
- J Child Adolesc Psychopharmacol. 2012 Feb;22(1):56-64 - PubMed
- Neuropsychopharmacology. 2009 Jan;34(2):522-34 - PubMed
- Psychol Med. 2014 Jan;44(2):225-39 - PubMed
- Psychiatry Res. 2006 Jan 30;146(1):53-7 - PubMed
- Biol Psychiatry. 2006 Jan 15;59(2):187-94 - PubMed
- Psychiatry Res. 2002 Dec 30;113(3):245-54 - PubMed
- Psychiatry Res. 2004 Apr 30;126(2):123-33 - PubMed
- J Neuropsychiatry Clin Neurosci. 2007 Spring;19(2):179-86 - PubMed
- Depress Anxiety. 2009;26(3):229-34 - PubMed
- World J Biol Psychiatry. 2012 Sep;13(6):423-35 - PubMed
- Hum Psychopharmacol. 2002 Oct;17(7):353-6 - PubMed
- Brain Stimul. 2013 Jan;6(1):54-61 - PubMed
- J Clin Psychopharmacol. 2007 Oct;27(5):488-92 - PubMed
- J Clin Psychiatry. 2005 Jul;66(7):930-7 - PubMed
- Biol Psychiatry. 2004 Feb 15;55(4):398-405 - PubMed
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