Efficacy of repetitive transcranial magnetic stimulation for post-stroke depression: a systematic review and meta-analysis of randomized clinical trials

Шао, Ди; Zhao, Zhiyong; Zhang, Y.Q.; Zhao, Libo; Dong, Meng; Xiang, Yajie; Luo, Haiyan

doi:10.1590/1414-431x202010010

Cited by 22 publications

(15 citation statements)

References 31 publications

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“…Regarding the effect of rTMS on PSD, a recent meta-analysis showed that rTMS was considerably more effective than the control condition, with a SMD of −1.15 (95% CI: −1.62 to −0.69) 19. The result was corresponding to our result.…”

Section: Discussionsupporting

confidence: 88%

Repetitive Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation as Treatment of Poststroke Depression

et al. 2022

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Background: Previous studies showed that the application of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) during stroke rehabilitation improve the depression symptoms in poststroke depression (PSD). However, some studies showed inconsistent results. The study was designed to make a meta-analysis to evaluate the effect of noninvasive brain stimulation (tDCS and rTMS) on PSD. Methods: Articles published before July 2021 were searched in databases: PubMed, Web of Science, and Google Scholar. STATA 12.0 software was utilized to make meta-analysis. We extracted or calculated mean values and SD of reduction or increase rate of depression-related scales. Standardized mean difference (SMD) and 95% confidence intervals (CIs) were calculated as effect size. Results: The study showed increased immediate and long-term improvement in depression in rTMS group compared with sham rTMS group after treatment with random-effects models (immediate: SMD=4.92, 95% CI=2.69-7.15, I 2=95.2%, P-value for Q test <0.001; long term: SMD=7.21, 95% CI=3.50-10.92, I 2=93.9%, P-value for Q test <0.001). Meta-analysis showed increased substantially immediate improvement in depression in tDCS group compared with sham tDCS group with a random effect model (SMD=5.30, 95% CI=1.30-9.30, I 2=97.3%, P-value for Q test <0.001). Conclusions: rTMS and tDCS were demonstrated to be effective and safe treatment techniques for PSD. More large-scale studies were essential to explore the effect of rTMS with different frequencies and tDCS on PSD.

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Section: Discussionsupporting

confidence: 88%

Repetitive Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation as Treatment of Poststroke Depression

et al. 2022

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“…82 Other approaches such as repetitive transcranial magnetic stimulation, vagal nerve stimulation, magnetic seizure therapy, transcranial direct current stimulation, and deep brain stimulation have been explored, 83 but supportive evidence for their use remains scarce and inconclusive. 66 A separate review on repetitive transcranial magnetic stimulation 84 (7 RCTs, 351 participants) suggested that repetitive transcranial magnetic stimulation decreases the severity of PSD (SMD, −1.15 [95% CI, −1.02 to −0.32]) and increases the odds of remission of symptoms (odds ratio, 3.46 [95% CI, 1.68–7.12]), but statistical and clinical heterogeneity was apparent. A small, sham-controlled RCT of transcranial direct current stimulation in 48 antidepressant-free patients with PSD showed benefit with active treatment (mean difference on Hamilton Depression Rating Scale, 4.7; SD, 9.21; P <0.001), 85 but these results were not replicated in a similar trial focusing on poststroke motor recovery.…”

Section: Methodsmentioning

confidence: 99%

Depression, Anxiety, and Suicide After Stroke: A Narrative Review of the Best Available Evidence

Chun

Ford

Kutlubaev

et al. 2022

Stroke

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Depression and anxiety each affect around 1 in 3 people during the first year after a stroke. Suicide causes the death of about 3 to 4/1000 stroke survivors during the first 5 years. This narrative review describes the best available evidence for the epidemiology of depression, anxiety, and suicide; their prevention; and the treatment of anxiety and depression. We conclude with directions for future research.

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“…The results showed that the combination of NIBS and antidepressants might have a better effect on PSD and could improve the depression scale score and quality of life compared with antidepressants alone. It is well known that guidelines recommend rTMS for the treatment of major depression, and many meta-analyses have shown that TMS intervention with PSD was positive ( Shen et al, 2017 ; Liu et al, 2019 ; Shao et al, 2021 ), but a growing number of studies have recommended multi-module combination therapy and population-specific personalized treatment ( Wang et al, 2019 ; Nestor and Blumberger, 2020 ), which warrants further research on the frequency and site of TMS intervention. The use of low-frequency TMS by Daniel R Schaffer significantly improved depression with cognitive impairment, suggesting that low-frequency TMS is more effective in specific populations ( Schaffer et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Effects of Noninvasive Brain Stimulation Combined With Antidepressants in Patients With Poststroke Depression: A Systematic Review and Meta-Analysis

Liang

Jiang

et al. 2022

Front. Pharmacol.

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Objective: To evaluated the efficacy and safety of noninvasive brain stimulation (NIBS) combined with antidepressants in patients with poststroke depression (PSD).Methods: Seven databases were searched to identify randomized controlled trials of NIBS combined with antidepressants in the treatment of PSD based on the international classification of diseases (ICD-10) criteria and exclusion criteria. The retrieval time was from the database establishment to 31 October 2021. Two researchers independently screened the identified studies through the search strategy, extracted their characteristics, and evaluated the quality of the included literature. Cochrane Collaboration’s tool was used to assess risk of bias. RevMan 5.3 software was applied for meta-analysis.Results: A total of 34 randomized controlled trials were included, involving 2,711 patients with PSD. Meta-analysis showed that the total effective rate was higher in the combined therapy than the antidepressant alone [odds ratio (OR): 4.33; 95% confidence interval (CI): 3.07 to 6.11; p < 0.00001]. The Hamilton depressive scale (HAMD) score was significantly lower in repeated transcranial magnetic stimulation (rTMS) (≤10 Hz) combined with antidepressant than in antidepressant alone [standard mean difference (SMD): −1.44; 95% CI: −1.86 to −1.03; p < 0.00001]. No significant difference was seen in rTMS (>10 Hz) combined with antidepressant versus antidepressant alone (SMD: −4.02; 95% CI: −10.43 to 2.39; p = 0.22). In addition, combination therapy more strongly improved the modified Barthel index (MBI) scale than antidepressants [mean difference (MD): 8.29; 95% CI: 5.23–11.35; p < 0.00001]. Adverse effects were not significantly different between two therapies (OR: 1.33; 95% CI: 0.87 to 2.04; p = 0.18).Conclusion: Low-frequency rTMS (≤10 Hz) combined with antidepressants tends to be more effective than antidepressants alone in patients with PSD, and there are no significant adverse effects. In addition, combined therapy may enhance quality of life after stroke. Combination therapy with high-frequency rTMS (>10 Hz) showed no advantage in treating PSD. The transcranial electrical stimulation (TES) combined with antidepressants might be more effective than antidepressants alone, which are needed to confirm by more clinical trials since the.

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Efficacy of repetitive transcranial magnetic stimulation for post-stroke depression: a systematic review and meta-analysis of randomized clinical trials

Cited by 22 publications

References 31 publications

Repetitive Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation as Treatment of Poststroke Depression

Repetitive Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation as Treatment of Poststroke Depression

Depression, Anxiety, and Suicide After Stroke: A Narrative Review of the Best Available Evidence

Effects of Noninvasive Brain Stimulation Combined With Antidepressants in Patients With Poststroke Depression: A Systematic Review and Meta-Analysis

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