Efficacy and tolerability of repetitive transcranial magnetic stimulation for late-life depression: A systematic review and meta-analysis

Min Zhang; Junjian Mo; Huiying Zhang; Yaoyin Tang; Kaiheng Guo; Xinyue OuYang; Linghua Huang; Xiaomei Zhong; Yuping Ning

doi:10.1016/j.jad.2022.11.027

Efficacy and tolerability of repetitive transcranial magnetic stimulation for late-life depression: A systematic review and meta-analysis

J Affect Disord. 2023 Feb 15:323:219-231. doi: 10.1016/j.jad.2022.11.027. Epub 2022 Nov 21.

Authors

Min Zhang¹, Junjian Mo², Huiying Zhang², Yaoyin Tang², Kaiheng Guo², Xinyue OuYang², Linghua Huang², Xiaomei Zhong¹, Yuping Ning³

Affiliations

¹ The Affiliated Brain Hospital of Guangzhou Medical University, China.
² Guangzhou Medical University, China.
³ The Affiliated Brain Hospital of Guangzhou Medical University, China; The first School of Clinical Medicine, Southern Medical University, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, China. Electronic address: ningjeny@126.com.

PMID: 36410454
DOI: 10.1016/j.jad.2022.11.027

Abstract

Background: Repetitive transcranial magnetic stimulation (rTMS) is a widely available treatment for major depression, but its efficacy and tolerability are uncertain for patients with late-life depression (LLD). To assess the existing evidence of rTMS for LLD treatment, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) according to PRISMA guidelines.

Methods: We retrieved RCTs from four databases published between 1 January 2000 and 10 September 2021 comparing the effects of active and sham stimulation in LLD patients. We performed subgroup analyses to examine the impact of different parameters. The primary outcomes were the response and discontinuation rates of rTMS for LLD patients, representing for efficacy and tolerability, respectively. Secondary outcomes were remission and dropout rates. Discontinuation referred to patients who withdrew for any reason, while dropout referred to participants who withdrew early because of adverse events.

Results: Nine articles describing 11 studies (two articles each contained two studies) met the eligibility criteria. All outcomes were analyzed using a random-effects model. The summary analysis of nine suitable RCTs revealed a cumulative response rate of 2.86 (95 % confidence interval (95 % CI), 1.87-4.37) and a remission rate of 4.02 (95 % CI, 1.83-8.81) in the active group compared to the sham group. The pooled odds ratios (ORs) for discontinuation and dropout rates were not significantly different between the two groups. In addition, some rTMS parameters were associated with better efficacy.

Conclusions: The meta-analysis suggested that rTMS is an effective, well-tolerated treatment for patients with LLD. Future efforts should enhance study methodologies to improve their efficacy and increase the homogeneity of rTMS parameters to promote comparability between studies.

Keywords: Efficacy; Late life depression; Meta-analysis; Systematic review; Tolerability; Transcranial magnetic stimulation.

Publication types

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

MeSH terms

Depression
Depressive Disorder, Major* / etiology
Depressive Disorder, Major* / therapy
Humans
Odds Ratio
Transcranial Magnetic Stimulation* / adverse effects
Transcranial Magnetic Stimulation* / methods
Treatment Outcome