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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Brain Stimulation: Basic, Translational, and Clinical Research in NeuromodulationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Task Force on Unipolar Depressive Disorders. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for biological treatment of unipolar depressive disorders, part 1: update 2013 on the acute and continuation treatment of unipolar depressive disorders.World J Biol Psychiatr. 2013; 14: 334-385
- Transcranial direct current stimulation for acute major depressive episodes: meta-analysis of individual patient data.Br J Psychiatr. 2016; 208: 522-531
- Effectiveness and safety of vagus nerve stimulation for severe treatment-resistant major depression in clinical practice after FDA approval: outcomes at 1 year.J Clin Psychiatr. 2011; 72: 1376-1382
- Short-term efficacy of repetitive transcranial magnetic stimulation (rTMS) in depression-reanalysis of data from meta-analyses up to 2010.BMC psychology. 2014; 2: 39
- Deep brain stimulation for treatment-resistant depression.Neuron. 2005; 45: 651-660
- Treatment of adults with treatment-resistant depression: electroconvulsive therapy plus antidepressant or electroconvulsive therapy alone? Evidence from an indirect comparison meta-analysis.Medicine. 2015; 94 (e1052)
- Long-term outcome of episodes of major depression: clinical and public health significance.J Am Med Assoc. 1984; 252: 788-792
- Initial response to transcranial magnetic stimulation treatment for depression predicts subsequent response.J Neuropsychiatr Clin Neurosci. 2016; 29: 179-182
- Repetitive transcranial magnetic stimulation for the acute treatment of major depressive episodes: a systematic review with network meta-analysis.JAMA psychiatry. 2017; 74: 143-152
- More female patients and fewer stimuli per session are associated with the short-term antidepressant properties of repetitive transcranial magnetic stimulation (rTMS): a meta-analysis of 54 sham-controlled studies published between 1997–2013.Neuropsychiatric Dis Treat. 2014; 10: 727-756
- A systematic review of the clinical relevance of repetitive transcranial magnetic stimulation.Acta Psychiatr Scand. 2014; 130: 326-341
- Repetitive transcranial magnetic stimulation as an augmentative strategy for treatment-resistant depression, a meta-analysis of randomized, double-blind and sham-controlled study.BMC Psychiatr. 2014; 14: 342
- Clinically meaningful efficacy and acceptability of low-frequency repetitive transcranial magnetic stimulation (rTMS) for treating primary major depression: a meta-analysis of randomized, double-blind and sham-controlled trials.Neuropsychopharmacology. 2013; 38: 543-551
- High-frequency repetitive transcranial magnetic stimulation accelerates and enhances the clinical response to antidepressants in major depression: a meta-analysis of randomized, double-blind, and sham-controlled trials.J Clin Psychiatr. 2013; 74: e122-e129
- Neuropsychiatric applications of transcranial magnetic stimulation: a meta analysis.Int J Neuropsychopharmacol. 2002; 5: 73-103
- Factors modifying the efficacy of transcranial magnetic stimulation in the treatment of depression: a review.J Clin Psychiatr. 2006; 67: 1870-1876
- Should we expand the toolbox of psychiatric treatment methods to include Repetitive Transcranial Magnetic Stimulation (rTMS)? A meta-analysis of the efficacy of rTMS in psychiatric disorders.J Clin Psychiatr. 2010; 71: 873
- A controlled study of repetitive transcranial magnetic stimulation in medication-resistant major depression.Biol Psychiatry. 2006; 59: 187-194
- Antidepressant effects of high and low frequency repetitive transcranial magnetic stimulation to the dorsolateral prefrontal cortex: a double-blind, randomized, placebo-controlled trial.J Neuropsychiatry. 2007; 19: 179-186
- Repetitive transcranial magnetic stimulation versus electroconvulsive therapy for major depression: a meta-analysis of stimulus parameter effects.Neurol Res. 2013; 35: 1084-1091
- Transcranial magnetic stimulation in the management of mood disorders.Neuropsychobiology. 2011; 64: 163-169
- Durability of the antidepressant effect of the high-frequency repetitive transcranial magnetic stimulation (rTMS) in the absence of maintenance treatment in major depression: a systematic review and meta-analysis of 16 double-blind, randomized, sham-controlled trials.Depress Anxiety. 2015; 32: 193-203
- Repetitive transcranial magnetic stimulation for the treatment of depression.Br J Psychiatr. 2003; 182: 480-491
- Deep brain stimulation of the subcallosal cingulate gyrus for depression: anatomical location of active contacts in clinical responders and a suggested guideline for targeting: clinical article.J Neurosurg. 2009; 111: 1209-1215
- Subcallosal cingulate gyrus deep brain stimulation for treatment-resistant depression.Biol Psychiatry. 2008; 64: 461-467
- Five-year follow-up of bilateral epidural prefrontal cortical stimulation for treatment-resistant depression.Brain stimulation. 2016; 9: 897-904
- A multisite, naturalistic, observational study of transcranial magnetic stimulation for patients with pharmacoresistant major depressive disorder: durability of benefit over a 1-year follow-up period.J Clin Psychiatr. 2014; 75: 1394-1401
- Long-term maintenance therapy for major depressive disorder with rTMS.J Clin Psychiatr. 2005; 66: 1524-1528
- Maintenance deep transcranial magnetic stimulation sessions are associated with reduced depressive relapses in patients with unipolar or bipolar depression.Front Neurol. 2015; 6: 16
- Relapse following successful electroconvulsive therapy for major depression: a meta-analysis.Neuropsychopharmacology. 2013; 38: 2467-2474
- Transcranial magnetic stimulation: clinical applications for psychiatric practice.American Psychiatric Pub, 2017
- A review of the safety of repetitive transcranial magnetic stimulation as a clinical treatment for depression.Int J Neuropsychopharmacol. 2008; 11: 131-147
- Can medication free, treatment-resistant, depressed patients who initially respond to TMS Be maintained off medications? A prospective, 12-month multisite randomized pilot study.Brain stimulation. 2016; 9: 251-257
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.PLoS Med. 2009; 6 (e1000097)
- Newcastle-Ottawa quality assessment scale cohort studies.2014
- Definition, assessment, and staging of treatment—resistant refractory major depression: a review of current concepts and methods.Can J Psychiatr. 2007; 52: 46-54
- When at first you don't succeed: sequential strategies for antidepressant nonresponders.J Clin Psychiatr. 1997; 58: 23-29
- A randomized, sham-controlled study of maintenance rTMS for treatment-resistant depression (TRD).Psychiatr Res. 2017; 258: 226-233
- Lack of a therapeutic effect of a 2-week sub-threshold transcranial magnetic stimulation course for treatment-resistant depression.Psychiatr Res. 2002; 113: 245-254
- Transcranial magnetic stimulation for refractory depression.Am J Psychiatry. 2005; 162 (193-193)
- Three and six-month outcome following courses of either ECT or rTMS in a population of severely depressed individuals—preliminary report.Biol Psychiatry. 2002; 51: 687-690
- Long-term efficacy after acute augmentative repetitive transcranial magnetic stimulation in bipolar depression: a 1-year follow-up study.J ECT. 2011; 27: 141-144
- A multisite, naturalistic, observational study of transcranial magnetic stimulation for patients with pharmacoresistant major depressive disorder: durability of benefit over a 1-year follow-up period.J Clin Psychiatr. 2014; 75: 1394-1401
- A randomized, controlled trial with 6-month follow-up of repetitive transcranial magnetic stimulation and electroconvulsive therapy for severe depression.Am J Psychiatry. 2007; 164: 73-81
- An open label trial of clustered maintenance rTMS for patients with refractory depression.Brain stimulation. 2013; 6: 292-297
- H-coil repetitive transcranial magnetic stimulation for treatment resistant major depressive disorder: an 18-week continuation safety and feasibility study.World J Biol Psychiatr. 2014; 15: 298-306
- Durability of clinical benefit with transcranial magnetic stimulation (TMS) in the treatment of pharmacoresistant major depression: assessment of relapse during a 6-month, multisite, open-label study.Brain stimulation. 2010; 3: 187-199
- Can left prefrontal rTMS be used as a maintenance treatment for bipolar depression?.Depress Anxiety. 2004; 20: 98-100
- Eficacia de la estimulación magnética transcraneal en depresión. Estudio naturalístico.Actas Esp Psiquiatr. 2010; 38: 87-93
- Long-term efficacy of repeated daily prefrontal transcranial magnetic stimulation (TMS) in treatment-resistant depression.Depress Anxiety. 2012; 29: 883-890
- Antidepressant effectiveness of deep transcranial magnetic stimulation (dTMS) in patients with major depressive disorder (MDD) with or without alcohol use disorders (AUDs): a 6-month, open label, follow-up study.J Affect Disord. 2015; 174: 57-63
- Maintenance transcranial magnetic stimulation reduces depression relapse: a propensity-adjusted analysis.J Affect Disord. 2013; 151: 129-135
- Effectiveness of a second deep TMS in depression: a brief report.Prog Neuro Psychopharmacol Biol Psychiatr. 2011; 35: 1041-1044
- Risk factors for relapse after remission with repetitive transcranial magnetic stimulation for the treatment of depression.Depress Anxiety. 2009; 26: 682-688
- Effectiveness of transcranial magnetic stimulation in clinical practice post-FDA approval in the United States: results observed with the first 100 consecutive cases of depression at an academic medical center.J Clin Psychiatr. 2012; 73: e567-e573
- A 3-month, follow-up, randomized, placebo-controlled study of repetitive transcranial magnetic stimulation in depression.J Clin Psychiatr. 2004; 65: 1323-1328
- Efficacy and safety of deep transcranial magnetic stimulation for major depression: a prospective multicenter randomized controlled trial.World Psychiatr. 2015; 14: 64-73
- A randomized controlled trial with 4-month follow-up of adjunctive repetitive transcranial magnetic stimulation of the left prefrontal cortex for depression.Psychol Med. 2008; 38: 323-333
- Observational research methods. Research design II: cohort, cross sectional, and case-control studies.Emerg Med J. 2003; 20: 54-60
- CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials.BMC Med. 2010; 8: 18
- Therapeutic efficacy of neurostimulation for depression: techniques, current modalities, and future challenges.Neuroscience bulletin. 2016; 32: 115-126
- Vagus nerve stimulation (VNS) for major depressive episodes: one year outcomes.Biol Psychiatry. 2002; 51: 280-287
- Deep brain stimulation of the ventral capsule/ventral striatum for treatment-resistant depression.Biol Psychiatry. 2009; 65: 267-275
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.
