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Durability of antidepressant response to repetitive transcranial magnetic stimulation: Systematic review and meta-analysis

  • Author Footnotes
    1 equally contributing authors.
    Suhan Senova
    Footnotes
    1 equally contributing authors.
    Affiliations
    Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Lisboa, Portugal

    Neurosurgery and PePsy Departments, Assistance Publique-Hôpitaux de Paris (APHP), Groupe Henri-Mondor Albert-Chenevier, Créteil, France

    Equipe 14, U955 INSERM, Institut Mondor de Recherche Biomedicale and Faculté de Médecine, Université Paris Est, Créteil, France
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  • Author Footnotes
    1 equally contributing authors.
    Gonçalo Cotovio
    Footnotes
    1 equally contributing authors.
    Affiliations
    Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Lisboa, Portugal

    Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal

    NOVA Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal

    Champalimaud Research, Champalimaud Centre for the Unknown, Lisboa, Portugal
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  • Alvaro Pascual-Leone
    Affiliations
    Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Institut Guttmann de Neurorehabilitación, Universitat Autonoma de Barcelona, Badalona, Barcelona, Spain
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  • Albino J. Oliveira-Maia
    Correspondence
    Corresponding author. Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Avenida Brasília, 1400-038, Lisboa, Portugal.
    Affiliations
    Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Lisboa, Portugal

    Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal

    NOVA Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal

    Champalimaud Research, Champalimaud Centre for the Unknown, Lisboa, Portugal
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  • Author Footnotes
    1 equally contributing authors.
Published:October 03, 2018DOI:https://doi.org/10.1016/j.brs.2018.10.001

      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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