Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2005 Mar;30(2):83-90.

Efficacy of rapid-rate repetitive transcranial magnetic stimulation in the treatment of depression: a systematic review and meta-analysis

Jennifer L Couturier  1
Affiliations
Meta-Analysis

Efficacy of rapid-rate repetitive transcranial magnetic stimulation in the treatment of depression: a systematic review and meta-analysis

Jennifer L Couturier. J Psychiatry Neurosci. 2005 Mar.

Abstract
in English, French

Objective: To systematically review the literature pertaining to rapid-rate repetitive transcranial magnetic stimulation (rTMS) compared with sham therapy for the treatment of a major depressive episode in order to arrive at qualitative and quantitative conclusions about the efficacy of rapid-rate rTMS.

Methods: MEDLINE, the Cochrane Library, the metaRegister of Controlled Trials and abstracts from scientific meetings were searched for the years 1966 until July 2003. The search terms "transcranial magnetic stimulation" and "transcranial magnetic stimulation AND depression" were used. Eighty-seven randomized controlled trials investigating the efficacy of rTMS were referenced on MEDLINE. Nineteen of these involved treatment of a major depressive episode, and these were reviewed. Six met more specific inclusion criteria including the use of rapid-rate stimulation, application to the left dorsolateral prefrontal cortex, evaluation with the 21-item Hamilton Rating Scale for Depression (HAM-D) and use of an intent-to-treat analysis. Scores on the 21-item HAM-D after treatment and standard deviations were extracted from each article for treatment and control subjects. A random-effects model was chosen for the meta-analysis, and the weighted mean difference was used as a summary measure.

Results: Six studies that met the inclusion criteria were identified and included in the meta-analysis. Two of these reported a significantly greater improvement in mood symptoms in the treatment versus the sham group. When combined in the meta-analysis, the overall weighted mean difference was -1.1 (95% confidence interval -4.5 to 2.3), and the results of a test for heterogeneity were not significant (chi2(5) = 5.81, p = 0.33).

Conclusions: This meta-analysis suggests that rapid-rate rTMS is no different from sham treatment in major depression; however, the power within these studies to detect a difference was generally low. Randomized controlled trials with sufficient power to detect a clinically meaningful difference are required.

Objectif: Recenser systématiquement les publications qui traitent de la magnétostimulation transcrânienne répétitive (MSTr) rapide comparativement à une thérapie simulée pour traiter un épisode dépressif majeur afin de tirer des conclusions qualitatives et quantitatives sur l'efficacité de la MSTr rapide.

Méthodes: On a recherché dans MEDLINE, la Cochrane Library, le metaRegister of Controlled Trials et des résumés de réunions scientifiques de 1966 jusqu'à juillet 2003 les expressions «transcranial magnetic stimulation» et «transcranial magnetic stimulation AND depression». MEDLINE contenait des références sur 87 essais contrôlés randomisés portant sur l'efficacité de la MSTr. Dix-neuf de ces études portaient sur le traitement d'un épisode dépressif majeur et ont été analysées. Six satisfaisaient à des critères d'inclusion plus spécifiques, y compris la stimulation rapide, l'application au cortex préfrontal dorsolatéral gauche, l'évaluation au moyen de l'échelle de dépression de Hamilton à 21 questions et l'utilisation d'une analyse de l'intention de traiter. Pour chaque article, on a extrait des résultats de l'échelle de dépression de Hamilton à 21 questions après le traitement et les écarts types pour les sujets traités et les sujets témoins. Un modèle d'effets aléatoires a été retenu pour la méta-analyse et la différence moyenne pondérée a servi de mesure sommaire.

Résultats: Six études satisfaisaient aux critères d'inclusion et ont été incluses dans la méta-analyse. Deux de ces études ont signalé une amélioration beaucoup plus marquée des symptômes thymiques chez les sujets traités par rapport à ceux qui ont reçu la thérapie stimulée. Combinée à la méta-analyse, la différence moyenne pondérée globale s'est établie à –1,1 (intervalle de confiance à 95 % –4,5 à 2,3) et les résultats d'un essai d'hétérogénéité n'étaient pas significatifs (χ25 = 5,81, p = 0,33).

Conclusions: Cette méta-analyse indique que la MSTr rapide n'est pas différente du traitement simulé dans des cas de dépression majeure, mais la capacité de ces études à détecter une différence était généralement faible. Des essais contrôlés randomisés comportant une capacité suffisante pour détecter une différence cliniquement significative s'imposent.

PubMed Disclaimer

Figures

None
Fig. 1: Meta-analysis using a random-effects model and the weighted mean difference (WMD) of the efficacy of repetitive transcranial magnetic stimulation (rTMS) versus placebo as a treatment for depression measured with the Hamilton Rating Scale for Depression (HAM-D).
See this image and copyright information in PMC

Comment in

References

    1. Hasey G. Transcranial magnetic stimulation in the treatment of mood disorder: a review and comparison with electroconvulsive therapy. Can J Psychiatry 2001;46:720-7. - PubMed
    1. Pascual-Leone A, Wasserman EM, Grafman J, Hallett M. The role of the dorsolateral prefrontal cortex in implicit procedural learning. Exp Brain Res 1996;107:479-85. - PubMed
    1. Paus T, Jech R, Thompson CJ, Comeau R, Peters T, Evans A. Transcranial magnetic stimulation during positron emission tomography: a new method for studying connectivity of the human cerebral cortex. J Neurosci 1997;17:3178-84. - PMC - PubMed
    1. Cohen LG, Sato S, Rose D, Kufta C, Bandinelli S, Hallett M. Correlation of transcranial magnetic stimulation (TCMS), direct cortical stimulation (DCS) and somatosensory evoked potentials (SEP) for mapping of hand motor representation area (HMRA) [abstract]. Neurology 1989;39(Suppl 1):375.
    1. Pascual-Leone A, Houser CM, Reese K, Shotland LI, Grafman J, Sato S, et al. Safety of rapid-rate transcranial magnetic stimulation in normal volunteers. Electroenceph Clin Neurophysiol 1993;89:120-30. - PubMed

MeSH terms