rTMS: old versus new trials

Blogging on Peer-Reviewed Research

A recent meta-analysis suggest that rTMS treatment for depression might have improved compared to a meta-analysis with studies published up until January 2002. Active treatment was significantly better than sham rTMS, there was no significant heterogeneity between trials. Clinical relevance of the significant difference is not discussed in this meta analysis.

Improvement could be due to:
1. better study design: better randomization in 3 of 5 publications, intention to treat analysis inm 3 of 5 publications, blinding comparable to the prior meta-analysis: single blind with external raters, the technician applying the stimulus is not blind, larger sample sizes.
2. more effective parameters of stimulation: more session

Future research questions
1. Is efficacy in patients ho are not refractory to antidepressants better?
2. Efficacy in children and adolescents?
3. Efficacy in the long term?
4. Efficacy when treatment duration is longer than 10 weeks?

Pubmed search-terms: “major depression”, “depression”, “transcranial
magnetic stimulation”, “rTMS”, “TMS”&
Period: Dez/2005-Nov/2006 (12 months)

70 studies of which 65 were exluded

Inclusion criteria:
1) Manuscript written in English
2) Use of rTMS given at any frequency (low and high frequency) and any
localization (left or right dorsolateral prefrontal cortex (DLPFC)
3) Mood effects assessed by a continuous mood scale-Hamilton Depression Rating
Scale, Beck Depression Inventory or Montgomery-Åsberg Depression Rating Scale
4) Randomized, double-blind studies with a sham rTMS group
5) Reporting of mean and standard deviation of the mood scores before and after
the treatment
6) Studies published in the past 12 months (from December/2005 to

5 studies included
3 studies included patients who were refractory to antidepressants.

Article discussed:

Acta Psychiatr Scand. 2007 Sep;116(3):165-73.

Has repetitive transcranial magnetic stimulation (rTMS) treatment for depression
improved? A systematic review and meta-analysis comparing the recent vs. the
earlier rTMS studies.

Gross M, Nakamura L, Pascual-Leone A, Fregni F.