Repetitive Transcranial Magnetic Stimulation for the Acute Treatment of Major Depressive Episodes: A Systematic Review With Network Meta-analysis
Abstract
Importance Although several strategies of repetitive transcranial magnetic stimulation (rTMS) have been investigated as treatment of major depressive disorder (MDD), their comparative efficacy and acceptability is unknown. Objective To establish the relative efficacy and acceptability of the different modalities of rTMS used for MDD by performing a network meta-analysis, obtaining a clinically meaningful treatment hierarchy. Data sources PubMed/MEDLINE, EMBASE, PsycInfo, and Web of Science were searched up until October 1, 2016. Study selection Randomized clinical trials that compared any rTMS intervention with sham or another rTMS intervention. Trials performing less than 10 sessions were excluded. Data extraction and synthesis Two independent reviewers used standard forms for data extraction and quality assessment. Random-effects, standard pairwise, and network meta-analyses were performed to synthesize data. Main outcomes and measures Response rates and acceptability (dropout rate). Remission was the secondary outcome. Effect sizes were reported as odds ratios (ORs) with 95% CIs. Results Eighty-one studies (4233 patients, 59.1% women, mean age of 46 years) were included. The interventions more effective than sham were priming low-frequency (OR, 4.66; 95% CI, 1.70-12.77), bilateral (OR, 3.96; 95% CI, 2.37-6.60), high-frequency (OR, 3.07; 95% CI, 2.24-4.21), θ-burst stimulation (OR, 2.54; 95% CI, 1.07-6.05), and low-frequency (OR, 2.37; 95% CI, 1.52-3.68) rTMS. Novel rTMS in…
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The decision to compare TBS with standard bilateral TMS rather than sham was based on network meta-analytic findings supporting bilateral standard TMS over sham treatment and the widespread use of bilateral standard TMS in the community setting.
“The decision to compare TBS with standard bilateral TMS rather than sham was a recognition of network meta-analytic findings supporting bilateral standard TMS over sham treatment34,35 as well as the widespread use of bilateral standard TMS in the community setting.37”
Standard bilateral rTMS has been shown to be efficacious in multiple clinical trials and was one of the most effective rTMS protocols in 2 recent network meta-analyses.
“Standard bilateral rTMS has been shown to be efficacious in multiple clinical trials and was one of the most effective rTMS protocols in 2 recent network meta-analyses.34,35”
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- Authors
- Brunoni, A. R., Chaimani, A., Moffa, A. H., Razza, L. B., Gattaz, W. F., Daskalakis, Z. J., & Carvalho, A. F.
- Affiliations
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, Laboratory of Neurosciences (LIM-27), University of São Paulo, São Paulo, Brazil2Interdisciplinary Center for Applied Neuromodulation University Hospital, University of São Paulo, São Paulo, Brazil
- University of Ioannina (GR)
- Universidade de São Paulo (BR)
- Interdisciplinary Center for Applied Neuromodulation University Hospital, University of São Paulo, São Paulo, Brazil
- University of Toronto (CA)
- Universidade Federal do Ceará (BR)
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2017-02-01
- Volume
- 74
- Issue
- 2
- Pages
- 143
- ISSN
- 2168-622X (ISSN-L)
- OpenAlex
- W2562220447
- Cited by
- 520
- References
- 18
- Citations by year
- 2026: 55 · 2025: 66 · 2024: 62 · 2023: 47 · 2022: 73 · 2021: 57 · 2020: 42 · 2019: 68 · 2018: 34 · 2017: 16
- FWCI
- 21.55
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Keywords
- repetitive transcranial magnetic stimulation, major depressive disorder, acute treatment, low-frequency rTMS, high-frequency rTMS, theta burst stimulation, treatment response, remission, treatment acceptability, dropout rates, treatment hierarchy
- MeSH terms
- Acute Disease, Adult, Major Depressive Disorder, Female, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Randomized Controlled Trials as Topic, Treatment Outcome, Transcranial Magnetic Stimulation
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