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. 2002;2002(2):CD003493.
doi: 10.1002/14651858.CD003493.

Transcranial magnetic stimulation for treating depression

J L Martin  1 , M J Barbanoj, T E Schlaepfer, S Clos, V Perez, J Kulisevsky, A Gironell
Affiliations

Transcranial magnetic stimulation for treating depression

J L Martin et al. Cochrane Database Syst Rev. 2002.

Abstract

Background: Transcranial magnetic stimulation can either excite or inhibit cortical areas of the brain, depending on whether the speed of the repetitive stimulation is applied at high or low frequencies. It has been used for physiological studies and it has also been proposed as a treatment for depression.

Objectives: To assess the clinical efficacy and safety of transcranial magnetic stimulation for treating depression.

Search strategy: An electronic search was performed including the Cochrane Collaboration Depression, Neurosis and Anxiety Review Group trials register (last searched June, 2001), the Cochrane Controlled Trials Register (Issue 2, 2001), MEDLINE (1966-2001), EMBASE (1974-2001), PsycLIT (1980-2001), and bibliographies from reviewed articles. Unpublished data and grey literature were searched through personal communications with researchers.

Selection criteria: Randomised controlled trials assessing the therapeutic efficacy and safety of transcranial magnetic stimulation for depression.

Data collection and analysis: All reviewers independently extracted the information and verified it by cross-checking. Disagreements were resolved through discussion. Continuous data: When similar studies were grouped, the overall standardised mean difference was calculated under a fixed effect model weighted by the inverse variance method with 95% confidence intervals. (In the presence of statistical heterogeneity, a random effects model was to be used.)

Main results: Sixteen trials were included in the review and fourteen contained data in a suitable form for quantitative analysis. Most comparisons did not show differences between rTMS and other interventions. No difference was seen between rTMS and sham TMS using the Beck Depression Inventory or the Hamilton Depression Rating Scale, except for one time period (after two weeks of treatment) for left dorsolateral prefrontal cortex and high frequency; and also for right dorsolateral prefrontal cortex and low frequency, both in favour of rTMS and both using the Hamilton scale. Comparison of rTMS (left dorsolateral prefrontal cortex and high frequency) with electroconvulsive therapy showed no difference except for psychotic patients after two weeks treatment, using the Hamilton scale, which indicated that electroconvulsive therapy was more effective than rTMS.

Reviewer's conclusions: The information in this review suggests that there is no strong evidence for benefit from using transcranial magnetic stimulation to treat depression, although the small sample sizes do not exclude the possibility of benefit.

PubMed Disclaimer

Conflict of interest statement

Dr Schlaepfer is involved in one of the two ongoing included studies in the review.

Figures

1.1
1.1. Analysis
Comparison 1 rTMS (left and high) vs Sham TMS, Outcome 1 Symptoms (Hamilton Scale).
1.2
1.2. Analysis
Comparison 1 rTMS (left and high) vs Sham TMS, Outcome 2 Symptoms (Beck Scale).
1.3
1.3. Analysis
Comparison 1 rTMS (left and high) vs Sham TMS, Outcome 3 Clinical Global Improvement.
2.1
2.1. Analysis
Comparison 2 rTMS (left and low) vs Sham TMS, Outcome 1 Symptoms (Hamilton Scale).
3.1
3.1. Analysis
Comparison 3 rTMS (right and low) vs Sham TMS, Outcome 1 symptoms (Hamilton Scale).
3.2
3.2. Analysis
Comparison 3 rTMS (right and low) vs Sham TMS, Outcome 2 Clinical Global Impression.
4.1
4.1. Analysis
Comparison 4 rTMS (left and high) vs rTMS (left and low), Outcome 1 Symptoms (Hamilton Scale).
5.1
5.1. Analysis
Comparison 5 rTMS (mt + 0.3 Tesla) vs rTMS (mt ‐ 0.3 Tesla), Outcome 1 Symptoms (Hamilton Scale).
5.2
5.2. Analysis
Comparison 5 rTMS (mt + 0.3 Tesla) vs rTMS (mt ‐ 0.3 Tesla), Outcome 2 Clinical Global Impression.
6.1
6.1. Analysis
Comparison 6 rTMS (left and high) vs ECT, Outcome 1 Symptoms (Hamilton Scale) all patients.
6.2
6.2. Analysis
Comparison 6 rTMS (left and high) vs ECT, Outcome 2 Symptoms (Hamilton Scale) Non‐psychotic patients.
6.3
6.3. Analysis
Comparison 6 rTMS (left and high) vs ECT, Outcome 3 Symptoms (Hamilton Scale) psychotic patients.
6.4
6.4. Analysis
Comparison 6 rTMS (left and high) vs ECT, Outcome 4 Functioning (GAS) all patients.
6.5
6.5. Analysis
Comparison 6 rTMS (left and high) vs ECT, Outcome 5 Functioning (GAS) non‐psychotic patients.
6.6
6.6. Analysis
Comparison 6 rTMS (left and high) vs ECT, Outcome 6 Functioning (GAS) psychotic patients.
7.1
7.1. Analysis
Comparison 7 Acceptability of treatment (rTMS any method of application) vs Sham TMS, Outcome 1 Leaving study early for any reason.
8.1
8.1. Analysis
Comparison 8 Baseline scores for Hamilton Depression, Outcome 1 rTMS vs Sham.
See this image and copyright information in PMC

References

References to studies included in this review

Avery 1999 {published data only}
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George 2000 a {published data only}
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Kimbrell 1999 {published and unpublished data}
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Kimbrell 1999b {published data only}
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Loo 1999 {published and unpublished data}
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Padberg 1999b {published data only}
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References to studies excluded from this review

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Clark 2000 {published data only}
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Conca 2000 {published data only}
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d'Alfonso 2000 {published data only}
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George 1998 {published data only}
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Koppi 1997 DELETE {published data only}
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Kozel 2000 DELETE {published data only}
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Krystal 2000 {published data only}
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Loo 2000 {published data only}
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Loo 2001 DELETE {published data only}
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Markwort 1997 {published data only}
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McConnell 2001 {published data only}
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Menkes 1999 {published data only}
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Mosimann 2000 {published data only}
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Nahas 1999 {published data only}
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Nahas 2000 {published data only}
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Pascual‐Leone 1996b {published data only}
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Pridmore 1999a {published data only}
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Pridmore 1999b {published data only}
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Pridmore 1999c {published data only}
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Pridmore 2000 a {published data only}
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Reid 1999 {published data only}
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Schouten 1999 {published data only}
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Speer 1999 {published data only}
    1. Little JT, Kimbrell TA, Wassermann EM, Grafman J, Figueras S, Dunn RT, et al. Cognitive effects of 1‐ and 20‐ hertz repetitive transcranial magnetic stimulation in depression: Preliminary report. Neuropsychiatry, Neuropsychology, and Behavioral Neurology 2000;13(2):119‐24. - PubMed
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Stikhina 1999 {published data only}
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Szuba 2000 {published data only}
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Teneback 1999 {published data only}
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Tormos 1999 {published data only}
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Triggs 1999 {published data only}
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Turnier‐Shea 1999 {published data only}
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Walter 2001 {published data only}
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Zheng 2000 {published data only}
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References to studies awaiting assessment

Pascual‐Leone 1996 {published data only}
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Speer 2000 {published data only}
    1. Speer AS, Kimbrell TA, Wassermann EM, Repella JD, Willis MW, Herscovitch P, et al. Opposite effects of high and low frequency rTMS on regional brain activity in depressed patients. Biological Psychiatry 2000;48(12):1133‐41. - PubMed

References to ongoing studies

Adsersen‐1 {unpublished data only}
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Avery‐1 {unpublished data only}
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D'Alfonso‐1 {unpublished data only}
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Ebmeier‐1 {unpublished data only}
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Eckert‐1 {unpublished data only}
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Greenberg‐1 {unpublished data only}
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McLoughlin‐1 {unpublished data only}
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Paradiso‐1 {unpublished data only}
    1. Paradiso. The Avery‐George‐Hotzheimer database of rTMS depression studies. http://www.ists.unibe.ch/ists/TMSAvery.htm. - PubMed
Pascual‐Leone‐1 {unpublished data only}
    1. Pascual‐Leone. The Avery‐George‐Hotzheimer database of rTMS depression studies. http://www.ists.unibe.ch/ists/TMSAvery.htm. - PubMed
Pascual‐Leone‐2 {unpublished data only}
    1. Pascual‐Leone. The Avery‐George‐Hotzheimer database of rTMS depression studies. http://www.ists.unibe.ch/ists/TMSAvery.htm. - PubMed
Sackeim‐1 {unpublished data only}
    1. Sackeim. The Avery‐George‐Hotzheimer database of rTMS depression studies. http://www.ists.unibe.ch/ists/TMSAvery.htm. - PubMed
Schaepfer‐1 {unpublished data only}
    1. Schaepfer. The Avery‐George‐Hotzheimer database of rTMS depression studies. http://www.ists.unibe.ch/ists/TMSAvery.htm. - PubMed
Shajahan‐1 {unpublished data only}
    1. Shajahan P. The treatment of partial remission in depression using transcranial magnetic stimulation (TMS): Open pilot trial followed by randomised placebo controlled cross‐over study. National Research Register 2000, issue 3.
Szuba‐1 {unpublished data only}
    1. Szuba. The Avery‐George‐Hotzheimer database of rTMS depression studies. http://www.ists.unibe.ch/ists/TMSAvery.htm. - PubMed
Weber‐1 {unpublished data only}
    1. Weber. The Avery‐George‐Hotzheimer database of rTMS depression studies. http://www.ists.unibe.ch/ists/TMSAvery.htm. - PubMed
Woodruff‐1 {unpublished data only}
    1. Woodruff P. Cost effectiveness of transcranial magnetic stimulation and electro‐convulsive treatment in severe depression (TRANSECT). National Research Register 2000, issue 3.

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