Evidence and expert consensus based German guidelines for the use of repetitive transcranial magnetic stimulation in depression

Hebel, Tobias; Grözinger, M.; Landgrebe, Michael; Padberg, Frank; Schecklmann, Martin; Schlaepfer, T.E.; Schönfeldt‐Lecuona, Carlos; Ullrich, Hermann; Zwanzger, Peter; Langguth, Berthold; Bajbouj, Malek; Bewernick, Bettina H.; Brinkmann, Kerstin; Cordes, Joachim; Pauli, Jan Di; Eichhammer, Peter; Freundlieb, Nils; Hajak, Göran; Höppner-Buchmann, Jacqueline; Hurlemann, René; Kamp, Daniel; Kayser, Sarah; Kis, Bernhard; Kreuzer, Peter; Kuhn, Jens; Lammers, Marc J. W.; Lugmayer, B; Mielacher, Clemens; Nickl‐Jockschat, Thomas; Nunhofer, C; Palm, Ulrich; Poeppl, Timm B.; Polak, Thomas; Sakreida, Katrin; Sartorius, Alexander; Silberbauer, C; Zilles-Wegner, David

doi:10.1080/15622975.2021.1995810

Cited by 5 publications

(4 citation statements)

References 119 publications

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“…However, a major strength is the large patient number and the realistic sample of seriously ill-and outpatients at a tertiary hospital with numerous pharmaceutical agents as co-therapy. As rTMS is currently very rarely used as a first-line treatment [7,11] these patients represent a very realistic sample of those who would receive rTMS as a treatment.…”

Section: Discussionmentioning

confidence: 99%

“…However, due to the rarer nature of the condition there is a lack of data on rTMS treatment for bipolar depression in the literature when compared with the number of published studies on unipolar depression and superiority over sham seems less clear than for unipolar depression, weakening the evidence base for its application in these patients [4,[11][12][13][14]. Nguyen et al presented a meta-analysis of 14 studies concluding that active rTMS is associated with a higher response rate than sham, however the authors stressed low participant number (the largest studies including only 59 patients and half of included studies including less than 10 patients) and heterogeneity of protocols as limitations [14].…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of Repetitive Transcranial Magnetic Stimulation in the Treatment of Bipolar Disorder in Comparison to the Treatment of Unipolar Depression in a Naturalistic Setting

et al. 2022

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Repetitive transcranial magnetic stimulation (rTMS) is effective in the treatment of depression. However, for the subset of patients with bipolar disorder, less data is available and overall strength of evidence is weaker than for its use in unipolar depression. A cohort of 505 patients (of which 46 had a diagnosis of bipolar disorder) with depression who were treated with rTMS were analyzed retrospectively with regards to their response to several weeks of treatment. Hamilton Depression Rating Scale (HDRS) was assessed as main outcome. Unipolar and bipolar patients with depression did not differ significantly in baseline demographic variables or severity of depression. Both groups did not differ significantly in their response to treatment as indicated by absolute and relative changes in the HDRS and response and remission rates. On HDRS subitem-analysis, bipolar patients showed superior amelioration of the symptom “paranoid symptoms” in a statistically significant manner. In conclusion, depressed patients with a diagnosis of bipolar disorder benefit from rTMS in a similar fashion as patients with unipolar depression in a naturalistic setting. rTMS might be more effective in reducing paranoia in bipolar than in unipolar patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effectiveness of Repetitive Transcranial Magnetic Stimulation in the Treatment of Bipolar Disorder in Comparison to the Treatment of Unipolar Depression in a Naturalistic Setting

et al. 2022

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“…Study results have been most convincing for the treatment of depression [13]. rTMS as a treatment for depression is usually applied over the dorsolateral prefrontal cortex (DLPFC) and induces a magnetic field that results in the depolarization of underlying neurons and the modulation of the neural circuitry involved in emotion regulation and depressive symptoms [14,15].…”

Section: Introductionmentioning

confidence: 99%

“…While rTMS is recognized as overall safe with a low incidence of adverse events in elderly patients [16], the evidence base for its application is less valid than for younger patients due to smaller sample sizes and the heterogeneity of treatment protocols [15,17,18]. Early high-quality studies found rTMS to show more effectiveness when applied in the first year of the onset of a depressive episode and in patients below the age of 65 [10,19], leading to the assumption that rTMS is a less-than-optimal option for geriatric depression.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Repetitive Transcranial Magnetic Stimulation in the Treatment of Depression in the Elderly: A Retrospective Natural Analysis

Almheiri

Algın

Abdelnaim

et al. 2023

JCM

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Introduction: Depression in the elderly is an understudied condition. Psychopharmacological and psychotherapeutic approaches suffer from specific difficulties with this patient group. Brain stimulation techniques such as repetitive transcranial magnetic stimulation (rTMS) offer a therapeutic alternative. rTMS remains understudied in this age group when compared with younger patients. Methods: A cohort of 505 patients with depression was analyzed in retrospect concerning their response to rTMS treatment. A total of 15.5% were 60 years old or older, defined as the elderly group of depressed patients. The majority of these were treated with high-frequency protocols over the left dorsolateral prefrontal cortex (DLPFC). For group comparisons, we used Student t-tests or chi-square-tests, depending on the scales of measurement. As measures for effect size, we used Cohen’s d for the relative and absolute change in the HDRS total score. Results: Groups did not differ significantly with respect to baseline depression severity or treatment parameters. In the group of elderly patients, a higher number of females were present. Groups did not differ significantly with respect to treatment efficacy, as indicated by the absolute and relative changes in the HDRS-21 sum score. Elderly patients tended to take higher numbers of mood stabilizers. Elderly patients showed a significantly superior reduction for the item “appetite” and a superior reduction tending towards significance for the item “work and interests”. Conclusions: Antidepressant rTMS treatment showed comparable efficacy for patients above 60 years to that in younger patients. Differences between the age groups concerning amelioration of distinct HDRS single items deserve further investigation.

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Treatment expectations and clinical outcomes following repetitive transcranial magnetic stimulation for treatment-resistant depression

Mollica,

Ng,

Burke

et al. 2024

Brain Stimulation

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Evidence and expert consensus based German guidelines for the use of repetitive transcranial magnetic stimulation in depression

Cited by 5 publications

References 119 publications

Effectiveness of Repetitive Transcranial Magnetic Stimulation in the Treatment of Bipolar Disorder in Comparison to the Treatment of Unipolar Depression in a Naturalistic Setting

Effectiveness of Repetitive Transcranial Magnetic Stimulation in the Treatment of Bipolar Disorder in Comparison to the Treatment of Unipolar Depression in a Naturalistic Setting

Effectiveness of Repetitive Transcranial Magnetic Stimulation in the Treatment of Depression in the Elderly: A Retrospective Natural Analysis

Treatment expectations and clinical outcomes following repetitive transcranial magnetic stimulation for treatment-resistant depression

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