BACKGROUND: Many trials of transcranial magnetic stimulation (TMS) have used small samples and, therefore, lack power. Here we present an up-to-date meta-analysis of TMS in the treatment of depression. METHODS: We searched Medline and Embase from 1996 until 2008 for randomized sham-controlled trials, with patients and investigators blinded to treatment, and outcome measured using a version of the Hamilton Depression Rating Scale (or similar). We identified 1,789 studies. Thirty-one were suitable for inclusion, with a cumulative sample of 815 active and 716 sham TMS courses. RESULTS: We found a moderately sized effect in favour of TMS [Random Effects Model Hedges' g = 0.64, 95% confidence interval (95% CI) = 0.50-0.79]. The corresponding Pooled Peto Odds Ratio for treatment response (≤50% reduction in depression scores) was 4.1 (95% CI = 2.9-5.9). There was significant variability between study effect sizes. Meta-regressions with relevant study variables did not reveal any predictors of treatment efficacy. Nine studies included follow-up data with an average follow-up time of 4.3 weeks; there was no mean change in depression severity between the end of treatment and follow-up (Hedges' g = -0.02, 95% CI = -0.22 to +0.18) and no heterogeneity in outcome. DISCUSSION: TMS appears to be an effective treatment; however, at 4 weeks' follow-up after TMS, there had been no further change in depression severity. Problems with finding a suitably blind and ineffective placebo condition may have confounded the published effect sizes. If the TMS effect is specific, only further large double-blind randomized controlled designs with systematic exploration of treatment and patient parameters will help to define optimum treatment indications and regimen.
BACKGROUND: Many trials of transcranial magnetic stimulation (TMS) have used small samples and, therefore, lack power. Here we present an up-to-date meta-analysis of TMS in the treatment of depression. METHODS: We searched Medline and Embase from 1996 until 2008 for randomized sham-controlled trials, with patients and investigators blinded to treatment, and outcome measured using a version of the Hamilton Depression Rating Scale (or similar). We identified 1,789 studies. Thirty-one were suitable for inclusion, with a cumulative sample of 815 active and 716 sham TMS courses. RESULTS: We found a moderately sized effect in favour of TMS [Random Effects Model Hedges' g = 0.64, 95% confidence interval (95% CI) = 0.50-0.79]. The corresponding Pooled Peto Odds Ratio for treatment response (≤50% reduction in depression scores) was 4.1 (95% CI = 2.9-5.9). There was significant variability between study effect sizes. Meta-regressions with relevant study variables did not reveal any predictors of treatment efficacy. Nine studies included follow-up data with an average follow-up time of 4.3 weeks; there was no mean change in depression severity between the end of treatment and follow-up (Hedges' g = -0.02, 95% CI = -0.22 to +0.18) and no heterogeneity in outcome. DISCUSSION: TMS appears to be an effective treatment; however, at 4 weeks' follow-up after TMS, there had been no further change in depression severity. Problems with finding a suitably blind and ineffective placebo condition may have confounded the published effect sizes. If the TMS effect is specific, only further large double-blind randomized controlled designs with systematic exploration of treatment and patient parameters will help to define optimum treatment indications and regimen.
Authors: David H Avery; Paul Zarkowski; Daniel Krashin; Wang-Ku Rho; Chandra Wajdik; Jutta M Joesch; David R Haynor; Dedra Buchwald; Peter Roy-Byrne Journal: J ECT Date: 2015-03 Impact factor: 3.635
Authors: Stephan F Taylor; Mahendra T Bhati; Marc J Dubin; John M Hawkins; Sarah H Lisanby; Oscar Morales; Irving M Reti; Shirlene Sampson; E Baron Short; Catherine Spino; Kuanwong Watcharotone; Jesse Wright Journal: J Affect Disord Date: 2016-10-14 Impact factor: 4.839
Authors: Tarique Perera; Mark S George; Geoffrey Grammer; Philip G Janicak; Alvaro Pascual-Leone; Theodore S Wirecki Journal: Brain Stimul Date: 2016-03-16 Impact factor: 8.955
Authors: Travis J A Craddock; Jack A Tuszynski; Deepak Chopra; Noel Casey; Lee E Goldstein; Stuart R Hameroff; Rudolph E Tanzi Journal: PLoS One Date: 2012-03-23 Impact factor: 3.240
Authors: Howard R Weeks; Scott C Tadler; Kelly W Smith; Eli Iacob; Mikala Saccoman; Andrea T White; Joshua D Landvatter; Gordon J Chelune; Yana Suchy; Elaine Clark; Michael K Cahalan; Lowry Bushnell; Derek Sakata; Alan R Light; Kathleen C Light Journal: PLoS One Date: 2013-07-26 Impact factor: 3.240