The Combination of Antidepressant Drug Therapy and High-Frequency Repetitive Transcranial Magnetic Stimulation in Medication-Resistant Depression

Bakım, Bahadır; Uzun, U.; Karamustafalıoğlu, Oğuz; Özçelik, Başak; Alpak, Gökay; Tankaya, Onur; Cengiz, Y.; Yavuz, Betül

doi:10.5455/bcp.20120807092434

Cited by 21 publications

(35 citation statements)

References 47 publications

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“…For this article on rTMS interventions versus sham control, we included 35 published articles reporting on 27 trials involving all 3 tiers. For tier 1, we identified 18 trials of either good or fair quality: 13 MDD-only [22][23][24][25][26][27][28][29][30][31][32][33][34] and 5 MDD/bipolar mix studies. [35][36][37][38][39] Table 1 lists their characteristics, sorted first by diagnostic population involved (MDD-only or MDD/bipolar mix) and then by treatment strategy (whether rTMS is used as part of an augmentation strategy, a switch strategy, or a mixture of the 2).…”

Section: Resultsmentioning

confidence: 99%

Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression

Gaynes¹,

Lloyd²,

Lux³

et al. 2014

J. Clin. Psychiatry

284

174

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Section: Resultsmentioning

confidence: 99%

Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression

Gaynes¹,

Lloyd²,

Lux³

et al. 2014

J. Clin. Psychiatry

284

174

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“…22,[24][25][26]28 Fourteen of the studies (74%) did not include participants with bipolar disorder. 16,18,[22][23][24][25][27][28][29][30][31][32][33][34] In studies that did include individuals with bipolar disorder, the proportion of those individuals ranged from 1.7% to 16.7%. The proportion of participants with bipolar disorder in the total sample was very small (0.9%).…”

Section: Unilateral Rtms Versus Sham Treatmentmentioning

confidence: 99%

“…Seven studies used a stimulation intensity of more than 100% of MT. [22][23][24][25]28,29,32 The number of trains per session ranged from 20 to 75, and the train duration ranged from 2 to 8 s. The intertrain interval varied across the studies, ranging from 22 to 60 s. Two studies did not report the intertrain interval. 31,32 The number of sessions varied from 10 to 30, and the number of pulses per session ranged from 800 to 3000.…”

Section: Characteristics Of Interventionsmentioning

confidence: 99%

“…Sixteen studies reported that the rTMS coil shape was a figure-eight. [16][17][18]22,23,[26][27][28][29][30][31][32][33][34]36,37 The sham condition in most of these studies was created using the same active coil held on the scalp with an angle and not tangentially. Nine studies held the coil at 90°, 16,18,22,23,30,31,33,36,37 and 5 studies held it at 45°.…”

Section: Characteristics Of Interventionsmentioning

confidence: 99%

“…Nine studies held the coil at 90°, 16,18,22,23,30,31,33,36,37 and 5 studies held it at 45°. 26,28,29,32,38 This method was used to blind the participants to the type of intervention they were receiving, as the sham coil sounded like a real condition, but with no ensuing stimulation of the cortical structures. Three studies used an embedded magnetic shield to prevent the magnetic energy from reaching the cortex, 24,25,34 and 2 studies used either a placebo coil or a coil that had no electric connection.…”

Section: Characteristics Of Interventionsmentioning

confidence: 99%

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Unilateral and bilateral repetitive transcranial magnetic stimulation for treatment-resistant depression: a meta-analysis of randomized controlled trials over 2 decades

Sehatzadeh

Daskalakis

Yap

et al. 2019

jpn

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Background: Approximately 35% of people with depression do not respond to 2 courses of antidepressant medications of adequate dosage, and treatment-resistant depression (TRD) is still a major clinical concern with a great impact on patients, their families, society and the health system. The present meta-analysis evaluates antidepressant efficacy of unilateral and bilateral repetitive transcranial magnetic stimulation (rTMS) in patients with unipolar TRD. Methods: We searched for randomized controlled trials that compared rTMS with sham treatment and were published by Apr. 3, 2017. The primary outcome was improvement in depression scores measured using the Hamilton Rating Scale for Depression. The secondary outcomes were remission and response rates. Two independent review authors screened the studies and extracted the data. Results: Twenty-three studies met the inclusion criteria. Meta-analysis of the depression scores showed a weighted mean difference (WMD) of 3.36 (95% confidence interval [CI] 1.85-4.88) between unilateral rTMS and sham treatment. Stratified data showed that the effect was relatively higher when rTMS was used as an add-on to antidepressant medications (WMD 3.64, 95% CI 1.52-5.76) than when it was used as a stand-alone treatment (WMD 2.47, 95% CI 0.90-4.05). The WMD between bilateral rTMS and sham was 2.67 (95% CI 0.83-4.51), and all studies that contributed to this outcome used rTMS while participants were taking antidepressant medications. The pooled remission and response rates for unilateral rTMS versus sham treatment were 16.0% and 25.1% for rTMS and 5.7% and 11.0% for sham treatment, respectively. The pooled remission and response rates for bilateral rTMS versus sham treatment were 16.6% and 25.4% for rTMS and 2.0% and 6.8% for sham treatment, respectively. Conclusion: This study suggests that rTMS has moderate antidepressant effects and appears to be promising in the short-term treatment of patients with unipolar TRD.

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Magnitude of the Placebo Response Across Treatment Modalities Used for Treatment-Resistant Depression in Adults

et al. 2021

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IMPORTANCEThe placebo effect in depression clinical trials is a substantial factor associated with failure to establish efficacy of novel and repurposed treatments. However, the magnitude of the placebo effect and whether it differs across treatment modalities in treatment-resistant depression (TRD) is unclear.OBJECTIVE To examine the magnitude of the placebo effect in patients with TRD across different treatment modalities and its possible moderators. DATA SOURCESSearches were conducted on MEDLINE, Web of Science, and PsychInfo from inception to June 21, 2021. STUDY SELECTION Randomized clinical trials (RCTs) were included if they recruited patients with TRD and randomized them to a placebo or sham arm and a pharmacotherapy, brain stimulation, or psychotherapy arm. DATA EXTRACTION AND SYNTHESIS Independent reviewers used standard forms for data extraction and quality assessment. Random-effects analyses and standard pairwise meta-analyses were performed. MAIN OUTCOMES AND MEASURES The primary outcome was the Hedges g value for the reported depression scales. Secondary outcomes included moderators assessed via meta-regression and response and remission rates. Heterogeneity was assessed with the I 2 test, and publication bias was evaluated using the Egger test and a funnel plot. Cochrane Risk of Bias Tool was used to estimate risks. RESULTS Fifty RCTs were included involving various types of placebo or sham interventions with a total of 3228 participants (mean [SD] age, 45.8 [6.0] years; 1769 [54.8%] female). The pooledplacebo effect size for all modalities was large (g = 1.05; 95% CI, 0.91-1.1); the placebo effect size in RCTs of specific treatment modalities did not significantly differ. Similarly, response and remission rates associated with placebo were comparable across modalities. Heterogeneity was large. Three variables were associated with a larger placebo effect size: open-label prospective treatment before double-blind placebo randomization (β = 0.35; 95% CI, 0.11 to 0.59; P = .004), later year of publication (β = 0.03; 95% CI, 0.003 to 0.05; P = .03), and industry-sponsored trials (β = 0.34; 95% CI, 0.09 to 0.58; P = .007). The number of failed interventions was associated with the probability a smaller placebo effect size (β = −0.12; 95% CI, −0.23 to −0.01, P = .03). The Egger test result was not significant for small studies' effects. (continued) Key Points Question What is the placebo effect magnitude in different treatment modalities used for management of patients with treatment-resistant depression? Findings In this systematic review and meta-analysis of 3228 patients with treatment-resistant depression in 50 randomized clinical trials, the placebo effect size was large and consistent across treatment modalities. Response and remission rates associated with placebo effect were comparable across modalities.Meaning The findings of this study suggest a placebo effect size benchmark may be used to interpret the findings of past and future clinical trials.

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The Combination of Antidepressant Drug Therapy and High-Frequency Repetitive Transcranial Magnetic Stimulation in Medication-Resistant Depression

Cited by 21 publications

References 47 publications

Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression

Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression

Unilateral and bilateral repetitive transcranial magnetic stimulation for treatment-resistant depression: a meta-analysis of randomized controlled trials over 2 decades

Magnitude of the Placebo Response Across Treatment Modalities Used for Treatment-Resistant Depression in Adults

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