Highlights
- •rTMS is a durable treatment for depression up to 1 year after successful induction.
- •Studies including women report higher responder rates up to m6 after successful rTMS induction.
- •Maintenance rTMS may enhance the durability of the antidepressant effects of rTMS.
- •Maintenance rTMS should be systematically explored in future clinical trials.
Abstract
Background
The therapeutic options for treatment-resistant depression (TRD) encompass a range
of neuromodulatory techniques, including repetitive transcranial magnetic stimulation
(rTMS). While rTMS is safe and has documented short-term efficacy, durability of antidepressant
effects is poorly established.
Objective
Assess existing evidence regarding durability of rTMS-induced antidepressant response.
Methods
We performed a systematic review of studies reporting antidepressant outcome measures
collected three or more months after the end of an induction course of rTMS for depression.
Among responders to the induction course, we used a meta-analytic approach to assess
response rates at 3 (m3), 6 (m6) or 12 (m12) months after induction, and studied predictors
of responder rates using meta-regression.
Results
Nineteen studies published between 2002 and 2018 were included. Eighteen were eligible
for analysis at m3 (732 patients) and m6 (695 patients) and 9 at m12 (247 patients).
Among initial responders, 66.5% sustained response at m3 (95% CI = 57.1–74.8%, I2 = 27.6%), 52.9% at m6 (95% CI = 40.3–65%, I2 = 0%), and 46.3% at m12 (95% CI = 32.6–60.7%, I2 = 0%), in the absence of any major bias. Random-effects meta-regressions further
demonstrated that a higher proportion of women, as well as receipt of maintenance
treatment, predicted higher responder rates at specific time-points.
Conclusions
rTMS is a durable treatment for depression, with sustained responder rates of 50%
up to 1 year after a successful induction course of treatment. Maintenance treatment
may enhance the durability of the antidepressant effects of rTMS, and should be considered
in clinical practice, as well as systematically explored in future clinical trials.
Keywords
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Article Info
Publication History
Published online: October 03, 2018
Accepted:
October 1,
2018
Received in revised form:
September 21,
2018
Received:
April 5,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
