DURABILITY OF THE ANTIDEPRESSANT EFFECT OF THE HIGH-FREQUENCY REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (rTMS) IN THE ABSENCE OF MAINTENANCE TREATMENT IN MAJOR DEPRESSION: A SYSTEMATIC REVIEW AND META-ANALYSIS OF 16 DOUBLE-BLIND, RANDOMIZED, SHAM-CONTROLLED TRIALS

作者：Kedzior Karina Karolina^*; Reitz Sarah Kim; Azorina Valeriya; Loo Colleen

来源：Depression and Anxiety, 2015, 32(3): 193-203.

DOI：10.1002/da.22339

• major depressive disorder (MDD)
• randomized-controlled trial (RCT)
• long-term effect
• dorsolateral prefrontal cortex (DLPFC)

BackgroundThe aim of the current meta-analysis was to investigate predictors of the durability of the antidepressant effect of high-frequency (>1 Hz) repetitive transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex in the absence of active maintenance treatment.
MethodsFollowing a systematic literature search of Medline and PsycInfo, N = 16 double-blind, parallel-design, randomized-controlled trials (RCTs) with high-frequency rTMS and inactive sham were included in the current meta-analysis. The effect size (Cohen's d) was the standardized mean difference in depression scores between sham and rTMS groups (baseline -follow-up). Meta-analysis was conducted according to a random-effects model with inverse-variance weights.
ResultsMost RCTs reported only short follow-up phases of 2 weeks (range of 1-16 weeks). The antidepressant effect was observed during follow-up (in the absence of maintenance treatment) compared to baseline (overall mean weighted d = -.48, 95% confidence interval: -.70, -.25, P < .001, N = 16 RCTs with 495 patients). Such an antidepressant effect during follow-up was higher in RCTs with patients who were less severely ill, unipolar, nonpsychotic, treatment-resistant, and on antidepressants (either started with rTMS or continued at stable doses during acute treatment phases). The effect sizes were lower in RCTs with longer (8-16 weeks) compared to shorter (1-4 weeks) follow-up periods. The risk of publication bias was low.
ConclusionsHigh-frequency rTMS has only a small antidepressant effect during follow-up after short acute treatment (5-15 sessions) in the absence of active maintenance treatment. This effect depends on illness severity, decreases over time, and appears to be enhanced by antidepressants.

• 出版日期2015-3