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Meta-Analysis
. 2019 Mar:273:770-781.
doi: 10.1016/j.psychres.2018.12.041. Epub 2018 Dec 7.

Accelerated TMS for Depression: A systematic review and meta-analysis

A Irem Sonmez  1 , Deniz Doruk Camsari  1 , Aiswarya L Nandakumar  1 , Jennifer L Vande Voort  1 , Simon Kung  1 , Charles P Lewis  1 , Paul E Croarkin  2
Affiliations
Meta-Analysis

Accelerated TMS for Depression: A systematic review and meta-analysis

A Irem Sonmez et al. Psychiatry Res. 2019 Mar.

Abstract

Repetitive transcranial magnetic stimulation (TMS) is now widely available for the clinical treatment of depression, but the associated financial and time burdens are problematic for patients. Accelerated TMS (aTMS) protocols address these burdens and attempt to increase the efficiency of standard TMS. This systematic review and meta-analysis aimed to examine accelerated TMS studies for depressive disorders in accordance with PRISMA guidelines. Inclusion criteria consisted of studies with full text publications available in English describing more than one session of TMS (repetitive or theta burst stimulation) per day. Studies describing accelerated TMS protocols for conditions other than depression or alternative neuromodulation methods, preclinical studies, and neurophysiology studies regarding transcranial stimulation were excluded. Eighteen articles describing eleven distinct studies (seven publications described overlapping samples) met eligibility criteria. A Hedges' g effect size and confidence intervals were calculated. The summary analysis of three suitable randomized control trials revealed a cumulative effect size of 0.39 (95% CI 0.005-0.779). A separate analysis including open-label trials and active arms of suitable RCTs revealed a g of 1.27 (95% CI 0.902-1.637). Overall, the meta-analysis suggested that aTMS improves depressive symptom severity. In general, study methodologies were acceptable, but future efforts could enhance sham techniques and blinding.

Keywords: Accelerated TMS; Depression; MDD; Major depressive disorder; TMS; TRD; Treatment resistant depression.

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Figures

Fig. 1.
Fig. 1.. PRISMA flow diagram.
Note: TMS= transcranial magnetic stimulation; aTMS = accelerated transcranial magnetic stimulation; tDCS = transcranial direct current stimulation; T-PEMF = transcranial pulsating electromagnetic fields.
Fig. 2.
Fig. 2.
Forest plot of RCT-only meta-analysis
Fig. 3.
Fig. 3.
Forest plot of all study meta-analysis
Fig. 4.
Fig. 4.
Forest plot of RCT response rates
See this image and copyright information in PMC

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