The association between sample and treatment characteristics and the efficacy of repetitive transcranial magnetic stimulation in depression: A meta-analysis and meta-regression of sham-controlled trials

Iris Dalhuisen; Suzanne van Bronswijk; Jeanine Bors; Filip Smit; Jan Spijker; Indira Tendolkar; Henricus G Ruhé; Philip van Eijndhoven

doi:10.1016/j.neubiorev.2022.104848

The association between sample and treatment characteristics and the efficacy of repetitive transcranial magnetic stimulation in depression: A meta-analysis and meta-regression of sham-controlled trials

Neurosci Biobehav Rev. 2022 Oct:141:104848. doi: 10.1016/j.neubiorev.2022.104848. Epub 2022 Aug 30.

Authors

Iris Dalhuisen¹, Suzanne van Bronswijk², Jeanine Bors³, Filip Smit⁴, Jan Spijker⁵, Indira Tendolkar⁶, Henricus G Ruhé⁶, Philip van Eijndhoven⁶

Affiliations

¹ Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands; Donders Institute for Brain Cognition and Behavior, Centre for Neuroscience, Nijmegen, the Netherlands. Electronic address: iris.dalhuisen@radboudumc.nl.
² Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands; Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, the Netherlands.
³ Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands.
⁴ Department of Clinical Psychology and Department of Epidemiology and Biostatistics, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands; Department of Mental Health and Prevention, Trimbos Institute - Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
⁵ Depression Expertise Centre, Pro Persona Mental Health Care, Nijmegen, the Netherlands; Behavioral Science Institute, Radboud University, Nijmegen, the Netherlands.
⁶ Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands; Donders Institute for Brain Cognition and Behavior, Centre for Neuroscience, Nijmegen, the Netherlands.

PMID: 36049675
DOI: 10.1016/j.neubiorev.2022.104848

Abstract

Background: Repetitive transcranial magnetic stimulation (rTMS) is a form of non-invasive neuromodulation that is increasingly used to treat major depressive disorder (MDD). However, treatment with rTMS could be optimized by identifying optimal treatment parameters or characteristics of patients that are most likely to benefit. This meta-analysis and meta-regression aims to identify sample and treatment characteristics that are associated with change in depressive symptom level, treatment response and remission.

Methods: The databases PubMed, Embase, Web of Science and Cochrane library were searched for randomized controlled trials (RCTs) reporting on the therapeutic efficacy of high-frequent, low-frequent, or bilateral rTMS for MDD compared to sham. Study and sample characteristics as well as rTMS parameters and outcome variables were extracted. Effect sizes were calculated for change in depression score and risk ratios for response and remission.

Results: Sixty-five RCTs with a total of 2982 subjects were included in this meta-analysis. Active rTMS resulted in a larger depressive symptom reduction than sham protocol (Hedges' g = -0.791 95% CI -0.977; -0.605). Risk ratios for response and remission were 2.378 (95% CI 1.882; 3.005) and 2.450 (95% CI 1.779; 3.375), respectively. We found no significant association between sample and treatment parameters and rTMS efficacy.

Conclusions: rTMS is an efficacious treatment for MDD. No associations between sample or treatment characteristics and efficacy were found, for which we caution that publication bias, heterogeneity and lack of consistency in the definition of remission might bias these latter null findings. Our results are clinically relevant and support the use of rTMS as a non-invasive and effective treatment option for depression.

Keywords: Depression; Meta-analysis; RTMS.

Publication types

Meta-Analysis
Review
Research Support, Non-U.S. Gov't

MeSH terms

Depression / therapy
Depressive Disorder, Major* / therapy
Humans
Odds Ratio
Randomized Controlled Trials as Topic
Transcranial Magnetic Stimulation* / methods
Treatment Outcome