Efficacy of Repetitive Transcranial Magnetic Stimulation on Comorbid Anxiety and Depression Symptoms in Obsessive-Compulsive Disorder: A Meta-Analysis of Randomized Sham-Controlled Trials

Abstract

Objective To systematically evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in reducing comorbid anxiety and depressive symptoms in patients with obsessive-compulsive disorder (OCD). Methods Three electronic databases were searched for randomized, sham-controlled clinical trials evaluating rTMS for the treatment of OCD. Hedge's g was calculated as the effect size for anxiety/depression symptom severity (primary outcome) and OCD severity (secondary outcome). Subgroup analyses and meta-regression analyses were carried out to evaluate the most promising target and whether a reduction in OCD severity moderates the change in anxiety or depression scores. Results Twenty studies ( n = 688) were included in the meta-analysis. rTMS had small-medium effect size on OCD (Hedge's g = 0.43; 95% confidence interval [CI]: [0.20, 0.65]; P < 0.001), anxiety (Hedge's g = 0.3; 95% CI: [0.11, 0.48]; P = 0.001) and depression (Hedge's g = 0.24; 95% CI: [0.07, 0.40]; P = 0.003) symptoms. Subgroup analysis showed that protocols targeting dorsolateral prefrontal cortex (DLPFC) were effective for 3 outcome measures. The change in anxiety, but not depression severity, was moderated by a change in OCD symptom scores. However, the findings are uncertain as a majority of the studies had some concerns or a high risk of bias. Conclusions Active rTMS protocol targeting DLPFC is effective in reducing the comorbid anxiety/depression symptoms along with OCD severity. The antidepressant effect is not moderated by the anti-obsessive effect of rTMS. Abrégé

The Efficacy of Transcranial Magnetic Stimulation in the Treatment of Obsessive-Compulsive Disorder: An Umbrella Review of Meta-Analyses

“…Similarly, Hyde et al, reported that BL-DLPFC produces maximum therapeutic efficacy in the management of OCD 25 . The most recent meta-analysis by Thatikonda et al, emphasizes the superiority of DLPFC targets than non-DLPFC targets 27 . Suhas et al, in their network meta-analysis found the superiority of deep TMS than conventional TMS treatments in the management of OCD 26 …”

“…In terms of study heterogeneity, nine studies reported high heterogeneity, 16 , 17 , 19 - 21 , 24 - 27 , two studies found moderate heterogeneity, 22 , 23 and only one reported low heterogeneity 18 . Several factors may contribute to the significant differences in the RCT outcomes: (1) the intrinsic heterogeneous nature of the disorder: OCD has four subtypes––symmetry (26.7%), taboo thoughts (21.0%), contamination (15.9%), and hoarding (15.4%) 7 .…”

“…Twelve eligible meta-analyses were included in this review. [16][17][18][19][20][21][22][23][24][25][26][27] The different rTMS stimulation procedures were organized according to two main categories: (1) the prefrontal area stimulated: DLPFC, SMA, OFC, and mPFC/ACC; including their respective laterality (right, left, or bilateral); and (2) the type of paradigm of stimulation: Low-frequency rTMS (= < 1 Hz); High-frequency rTMS (> = 5 Hz); Theta-burst Stimulation (TBS)-either continuous-TBS (cTBS) or intermittent-TBS (iTBS); Deep TMS (it is a form of high-frequency rTMS, it just uses a different coil to target the mPFC/ACC).…”

“…25 The most recent meta-analysis by Thatikonda et al, emphasizes the superiority of DLPFC targets than non-DLPFC targets. 27 Suhas et al, in their network meta-analysis found the superiority of deep TMS than conventional TMS treatments in the management of OCD. 26 ("obsessive compulsive disorder" OR "OCD" OR "obsessions" OR "compulsions") AND ("transcranial magnetic stimulation" OR "TMS" OR "magnetic stimulation" OR "rTMS.…”