Preliminary assessment of the therapeutic efficacy of continuous theta-burst magnetic stimulation (cTBS) in major depression: A double-blind sham-controlled study

Chistyakov, Andrei V.; Kreinin, B.; Marmor, Sara; Kaplan, Boris; Khatib, Adel; Darawsheh, Nawaf; Koren, Danny; Zaaroor, Menashe; Klein, Ehud

doi:10.1016/j.jad.2014.08.035

Cited by 63 publications

(45 citation statements)

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“…However, response and remission rates were not reported for each trial, and some missing data could not be obtained. Studies have also suggested that the antidepressant efficacy of active stimulation may separate from sham only after multiple weeks of treatment, for both rTMSO’Reardon, et al 9 , Chistyakov, et al 49 and cTBS 49 . We only looked at the acute antidepressant effects at primary study endpoint, and we cannot estimate the long-term effects.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and acceptability of non-invasive brain stimulation for the treatment of adult unipolar and bipolar depression: A systematic review and meta-analysis of randomised sham-controlled trials

Mutz

Edgcumbe

Brunoni

et al. 2018

Preprint

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26We examined the efficacy and acceptability of non-invasive brain stimulation in adult 27 unipolar and bipolar depression. Randomised sham-controlled trials of transcranial direct 28 current stimulation (tDCS), transcranial magnetic stimulation (TMS) and theta-burst 29 stimulation (TBS), without co-initiation of another treatment, were included. We analysed 30 response, remission and all-cause discontinuation rates, and depression severity scores. Fifty-31 four studies were included (N = 2,959, mean age = 44.94 years, 61.98% female). Response 32 rates demonstrated efficacy of high-frequency rTMS over the left DLPFC (OR = 3.94, 95% 33 CI [2.52; 6.15]), right-sided low-frequency rTMS (OR = 7.44, 95% CI [2.06; 26.83]) bilateral 34 rTMS (OR = 3.68, 95% CI [1.66; 8.13]), deep TMS (OR = 1.69, 95% CI [1.003; 2.85]), 35 intermittent TBS (OR = 4.70, 95% CI [1.14; 19.38]) and tDCS (OR = 4.32, 95% CI [2.02; 36 9.29]); but not for continuous TBS, bilateral TBS or synchronised TMS. There were no 37 differences in all-cause discontinuation rates. The strongest evidence was for high-frequency 38 rTMS over the left DLPFC. Intermittent TBS provides an advance in terms of reduced 39 treatment duration. tDCS is a potential treatment for non-resistant depression. 40 41 Keywords: transcranial magnetic stimulation, theta burst stimulation, transcranial direct 42 current stimulation, major depression, meta-analysis 43 BRAIN STIMULATION DEPRESSION META-ANALYSIS (≤ 1 Hz) stimulation inhibits neural firingRosa and Lisanby 7 . 62 63The rationale for using rTMS to treat depressive illness comes from clinical symptomatology 64 and neuroanatomy as well as neuroimaging studies indicating functional impairments in 65 prefrontal cortical and limbic regions 8 . In 2008, the US Food and Drug Administration (FDA) 66 approved the first rTMS device for the treatment major depressive disorder (MDD) in which 67 there was poor response to at least one pharmacological agent in the current episode 9 , and its 68 clinical utilisation has increased since 10 . 69 BRAIN STIMULATION DEPRESSION META-ANALYSIS 70As stimulation at high frequencies can be uncomfortable during the initial stimulation period, 71 low-frequency rTMS may minimise the occurrence of undesired side effects, namely 72 headaches and scalp discomfort, and may be associated with fewer adverse events, for 73 instance by lowering the risk for seizures 11 . 74 75 Bilateral applications of rTMS have also been developed: simultaneous stimulation over the 76 left and right DLPFC (rDLPFC) or stimulation over one side followed by stimulation of the 77 other side. These applications were hypothesised to be potentially additive or synergistic to 78 reinstate any imbalance in prefrontal neural activity 12 . Moreover, there may be a selective 79 unilateral response and the likelihood for a clinical response may increase by providing both 80 types of stimulation 13 . 81 82 Technical and methodological efforts to improve the antidepressant efficacy of TMS have led 83 to several alternative treatment pro...

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Section: Discussionmentioning

confidence: 99%

Efficacy and acceptability of non-invasive brain stimulation for the treatment of adult unipolar and bipolar depression: A systematic review and meta-analysis of randomised sham-controlled trials

Mutz

Edgcumbe

Brunoni

et al. 2018

Preprint

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“…Pilot clinical studies in humans for the treatment of depression have generated initial positive results. 50 , 51 Although there are no direct comparison studies yet, TBS may provide the same clinical benefits as TMS but with shorter treatment sessions and lower magnetic intensities. 52 …”

Section: Future Directionsmentioning

confidence: 99%

Transcranial magnetic stimulation for the treatment of major depression

Janicak

Dokucu

2015

NDT

100

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Major depression is often difficult to diagnose accurately. Even when the diagnosis is properly made, standard treatment approaches (eg, psychotherapy, medications, or their combination) are often inadequate to control acute symptoms or maintain initial benefit. Additional obstacles involve safety and tolerability problems, which frequently preclude an adequate course of treatment. This leaves an important gap in our ability to properly manage major depression in a substantial proportion of patients, leaving them vulnerable to ensuing complications (eg, employment-related disability, increased risk of suicide, comorbid medical disorders, and substance abuse). Thus, there is a need for more effective and better tolerated approaches. Transcranial magnetic stimulation is a neuromodulation technique increasingly used to partly fill this therapeutic void. In the context of treating depression, we critically review the development of transcranial magnetic stimulation, focusing on the results of controlled and pragmatic trials for depression, which consider its efficacy, safety, and tolerability.

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“…In total, we retained 19 RCTs in our meta-analysis [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] , totaling 181 patients with bipolar disorder (type I, N540; type II, N520; unspecified, N5121). The RCTs employed different stimulation targets: the left dorsolateral prefrontal cortex (DLPFC) [1][2][3][4][5][6][9][10][11]13,16,17 , the right DLPFC 8,14,15,18 , or bilateral DLPFC 7,12,17,19 .…”

mentioning

confidence: 99%

“…The RCTs employed different stimulation targets: the left dorsolateral prefrontal cortex (DLPFC) [1][2][3][4][5][6][9][10][11]13,16,17 , the right DLPFC 8,14,15,18 , or bilateral DLPFC 7,12,17,19 . The majority of studies delivered high-frequency stimulation (HFS) 1,3-6,9-13,16,18 , while some delivered low-frequency stimulation (LFS) 3 The issue of treatment-emergent affective switches in managing bipolar depression is important and controversial, and extends to neuromodulatory treatments.…”

mentioning

confidence: 99%

Clinical efficacy and safety of repetitive transcranial magnetic stimulation in acute bipolar depression

et al. 2016

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Preliminary assessment of the therapeutic efficacy of continuous theta-burst magnetic stimulation (cTBS) in major depression: A double-blind sham-controlled study

Cited by 63 publications

References 14 publications

Efficacy and acceptability of non-invasive brain stimulation for the treatment of adult unipolar and bipolar depression: A systematic review and meta-analysis of randomised sham-controlled trials

Efficacy and acceptability of non-invasive brain stimulation for the treatment of adult unipolar and bipolar depression: A systematic review and meta-analysis of randomised sham-controlled trials

Transcranial magnetic stimulation for the treatment of major depression

Clinical efficacy and safety of repetitive transcranial magnetic stimulation in acute bipolar depression

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