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

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.

Neuronavigation‐Guided rTMS for the Treatment of Depressive Patients With Suicidal Ideation: A Double‐Blind, Randomized, Sham‐Controlled Trial

“…31 The conclusion was also supported by a recent me taanalysis. 32 However, another newly published study showed that there was no difference in response or remission rates for depressive symptoms between standard and highdose treatment conditions in patients with treatmentresistant depression. The higher dose inter vention produced a greater response rate when controlling for illness duration.…”

Evaluation of a novel 5 day accelerated 1 Hz repetitive transcranial magnetic stimulation protocol in major depression

“…This suggests a delayed effect, akin to what was reported in some arTMS trials. 7,25,26 Thus, accumulating evidence points toward the idea that it is possible to shorten rTMS treatment and eventually reach similar improvement rates as standard once-daily rTMS, however without being able to "accelerate" the effect per se in all eventual responders.…”

“…Medication stability up until the 4-weeks follow-up point would therefore need to be part of a future RCT protocol in order to allow separate outcome analyses of patients who changed their medication before the end of the study. Furthermore, given the reports of improvement beyond the 4-week mark 25 , additional follow-ups should be planned in future studies. We also used a limited number of pulses (600 per session), which is 50% lower than what was viewed as maximally efficacious for 1 Hz stimulation in a metaanalysis.…”

Efficacy of Intensive Cerebellar Intermittent Theta Burst Stimulation (iCiTBS) in Treatment-Resistant Schizophrenia: a Randomized Placebo-Controlled Study

“…This intensive iTBS protocol was pragmatically implemented in order to shorten the total treatment duration. Similar intensive and accelerated protocols have been successfully investigated in other refractory psychiatric disorders [ 45 ]. However, our study failed to show significant placebo-controlled improvement with this protocol.…”