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. 2018 Sep 7:9:413.
doi: 10.3389/fpsyt.2018.00413. eCollection 2018.

Response and Remission Rates Following High-Frequency vs. Low-Frequency Repetitive Transcranial Magnetic Stimulation (rTMS) Over Right DLPFC for Treating Major Depressive Disorder (MDD): A Meta-Analysis of Randomized, Double-Blind Trials

Xu Cao  1   2 , Chunshan Deng  1 , Xiaolin Su  1 , Yi Guo  1
Affiliations

Response and Remission Rates Following High-Frequency vs. Low-Frequency Repetitive Transcranial Magnetic Stimulation (rTMS) Over Right DLPFC for Treating Major Depressive Disorder (MDD): A Meta-Analysis of Randomized, Double-Blind Trials

Xu Cao et al. Front Psychiatry. .

Abstract

Background: High-frequency (HF) repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (L-DLPFC) is the most widely applied treatment protocol for major depressive disorder (MDD), while low-frequency (LF) rTMS over the right DLPFC (R-DLPFC) also exhibits similar, if not better, efficacy for MDD. Therefore, a meta-analysis is warranted to compare the efficacy of the two protocols for MDD. Method: We searched the literature from 1990 through to August 1, 2017 using MEDLINE, and the literature from 1995 through to August 1, 2017 using EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials (CENTRAL), SCOPUS, and ProQuest Dissertations and Theses (PQDT). We included randomized controlled trials (RCT) comparing the efficacy of HF rTMS over the L-DLPFC and LF rTMS over the R-DLPFC for MDD, which used response and/or remission rates as the primary endpoints, with and without sham-controlled. Results: (1) The meta-analysis of the response rates was based on 12 studies, including 361 patients with MDD (175 for HF (> 5 Hz) over the L-DLPFC, and 186 for LF (<5 Hz) over the R-DLPFC; odds ratio = 1.08; 95%, confidence interval = 0.88-1.34). (2) The meta-analysis of the remission rate was based on 5 studies, including 131 MDD patients (64 for HF over the L-DLPFC and 67 for LF over the R-DLPFC; odds ratio = 1.29; 95% confidence interval = 0.54-3.10). Conclusion: Both HF rTMS over the L-DLPFC and LF over the R-DLPFC demonstrated similar therapeutic efficacy for the treatment of patients with MDD. The results suggested that further investigation on treatment efficacy indicators before/during treatment is necessary and helpful for optimizing a personalized protocol for patients.

Keywords: dorsal-lateral prefrontal cortex; major depression disorder; meta-analysis; transcranial magnetic stimulation; treatment.

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Figures

Figure 1
Figure 1
Selection of studies for inclusion. The 1,774 articles were excluded since most of them were other not research articles or not relevant to TMS treatment on depression. The 179 articles were excluded based on exclusion and inclusion criteria, including reviews and case reports, too few treatment sessions (<10 sessions), treatment protocols (compared rTMS with other treatments like transcranial direct current stimulation, non-random allocation, theta-burst stimulations), narrow diagnoses of depression, not reporting treatment efficacy, or rTMS not first time introduced to patients.
Figure 2
Figure 2
Meta-analysis of HF vs. LF-rTMS for MDD: response rate. HF, High Frequency; LF, Low Frequency; BD, Study in which more than one bipolar depressive patient involved.
Figure 3
Figure 3
Meta-analysis of HF vs. LF-rTMS for MDD: remission rate. HF, High Frequency; LF, Low Frequency; BD, Study in which more than one bipolar depressive patient involved.
See this image and copyright information in PMC

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