Testing the efficacy of repetitive transcranial magnetic stimulation for acute depression
The systematic review and meta-analysis evaluated the response rate, acceptability and remission using different rTMS strategies for treatment of acute depression.
The analysis included 81 randomized trials that assessed rTMS modalities versus sham or another rTMS intervention. A total of 4,233 patients were included. The mean age of the subjects was 46 years and majority were women (59.1%).
Priming low-frequency, bilateral, high-frequency, low-frequency, and θ-burst rTMS were more effective than sham. Accelerated, synchronized, and deep rTMS were less effective than sham.
The rTMS modalities had similar remission response rates, except for θ-burst stimulation. Acceptability was similar for all rTMS interventions.
The most effective and acceptable rTMS strategies were priming low-frequency and bilateral methods.
The investigators concluded that the study results do not have high reliability due to lack of available trials for the different rTMS interventions except for than low-frequency, high-frequency, and bilateral methods.
It is suggested that larger RCTs should evaluate the usefulness of rTMS for treatment of major depressive disorder (MDD). Results also show that novel methods accelerated, synchronized, and deep rTMS may not be effective for MDD.