The efficacy of repetitive transcranial magnetic stimulation (rTMS) for bipolar depression: A systematic review and meta-analysis

Nguyen, Tuan Dang; Hieronymus, Fredrik; Lorentzen, Rasmus; McGirr, Alexander; Østergaard, Søren Dinesen

doi:10.1016/j.jad.2020.10.013

Cited by 63 publications

(42 citation statements)

References 35 publications

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“…The underlying biological assumption is that, at least at the circuit level, the 2 conditions may present with similar pathophysiological signatures that can be effectively engaged by the same therapeutic intervention. A number of previous positive trials and metaanalyses of TMS in bipolar depression, predominantly using high-frequency or low-frequency TMS over the DLPFC, may have suggested this was, in fact, true,5 but the current findings from McGirr…”

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confidence: 56%

Therapeutic Neuromodulation for Bipolar Disorder—The Case for Biomarker-Driven Treatment Development

Camprodon

2021

JAMA Netw Open

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Transcranial magnetic stimulation (TMS) is a noninvasive neuromodulation technique with both diagnostic and therapeutic clinical applications. Its capacity to facilitate lasting neuroplastic changes has led to a growing number of treatment indications cleared by the US Food and Drug Administration (FDA), including major depressive disorder (MDD), migraine headaches, obsessive compulsive disorder, and smoking cessation. In 2020, the FDA granted breakthrough device designation to TMS for treating bipolar depression. This is not a formal approval, but it indicates interest, is generally supported by evidence, and provides an expedited path for FDA review.Broadly speaking, TMS is not a therapy but rather a tool. However, when it is applied over a specific brain target using specific parameters that facilitate specific neurophysiological changes, then TMS has the potential to become a treatment. Choosing a different target or changing other

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confidence: 56%

Therapeutic Neuromodulation for Bipolar Disorder—The Case for Biomarker-Driven Treatment Development

Camprodon

2021

JAMA Netw Open

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“…There are limitations to this study, which should be acknowledged by the readers. First, as there are phenomenological overlaps between negative and depressive symptoms and since depression responds well to TMS [105, 106], the relief of depressive symptoms during treatment could potentially confound the estimation of the effect on negative symptoms. However, our analysis of data from studies measuring depressive symptoms in the context of schizophrenia found no statistically significant efficacy regarding depressive symptoms, suggesting that the effect on negative symptoms is not confounded in this respect.…”

Section: Discussionmentioning

confidence: 99%

The efficacy of transcranial magnetic stimulation (TMS) for negative symptoms in schizophrenia: A systematic review and meta-analysis

Lorentzen

Nguyen

McGirr

et al. 2021

Preprint

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Several trials have shown preliminary evidence for the efficacy of Transcranial Magnetic Stimulation (TMS) as a treatment for negative symptoms in schizophrenia. Here, we synthesize this literature in a systematic review and quantitative meta-analysis of double-blind randomized controlled trials of TMS in patients with schizophrenia. Specifically, MEDLINE, EMBASE, Web of Science, and PsycINFO were searched for sham-controlled, randomized trials of TMS among patients with schizophrenia. The standardized mean difference (SMD, Cohen’s d) with 95% confidence intervals (CI) was calculated for each study (TMS vs. sham) and pooled across studies using an inverse variance random effects model. We identified 56 studies with a total of 2550 participants that were included in the meta-analysis. The pooled analysis showed statistically significant superiority of TMS (SMD=0.37, 95%CI: 0.23; 0.52, p-value <0.00001), corresponding to a number needed to treat of 5. Furthermore, stratified analyses suggested that TMS targeting the left dorsolateral prefrontal cortex, using a stimulation frequency >1 Hz, and a stimulation intensity at or above the motor threshold, was most efficacious. There was, however, substantial heterogeneity and high risk of bias among the included studies. In conclusion, TMS appears to be an efficacious treatment option for patients with schizophrenia suffering from negative symptoms, but the optimal TMS parameters have yet to be resolved.

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“…Non-invasive neurostimulation techniques, such as transcranial magnetic stimulation (TMS), are efficacious in the treatment of Major Depressive Disorder (MDD). Accordingly, they are often considered in acute bipolar depression, however the literature in BD is small ( 4 , 5 ). Newer TMS protocols, such as intermittent theta-burst stimulation (iTBS), are efficacious in MDD ( 6 , 7 ) but have not demonstrated efficacy in BD to date ( 8 , 9 ).…”

Section: Introductionmentioning

confidence: 99%

Intermittent Theta-Burst Stimulation Transcranial Magnetic Stimulation Increases GABA in the Medial Prefrontal Cortex: A Preliminary Sham-Controlled Magnetic Resonance Spectroscopy Study in Acute Bipolar Depression

et al. 2021

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Background: Magnetic resonance spectroscopy (MRS) has been used to identify gamma-aminobutyric acid (GABA) alterations in mood disorders, particularly in the medial prefrontal cortex (mPFC) where decreased concentrations have been associated with anhedonia. In major depressive disorder (MDD), prior work suggests that repetitive transcranial magnetic stimulation (rTMS) increases mPFC GABA concentrations proportional to antidepressant response. To our knowledge, this has not been examined in acute bipolar depression.Methods: As part of a multicentre 4-week randomized, double-blind, sham-controlled trial using intermittent theta-burst stimulation (iTBS) of the left dorsolateral prefrontal cortex (DLPFC) in individuals with acute bipolar depression, we quantified mPFC GABA and Glx (glutamate+glutamine) concentrations using a 3T MRS scan at baseline and after the intervention. Depressive symptoms were measured using the Montgomery-Asberg Depression Rating Scale (MADRS) and the Hamilton Depression Rating Scale-17 (HRDS-17), and anhedonia was measured using the Snaith-Hamilton Pleasure Scale (SHAPS).Results: The trial was terminated for futility and magnetic resonance spectroscopy data was acquired for 18 participants. At baseline, there were no associations between GABA or Glx concentrations and anhedonia, however GABA was negative correlated with depressive symptom severity on the HRDS-17. Compared to the sham-iTBS group, participants receiving active-iTBS had a significant increase in mPFC GABA concentrations. This was unrelated to antidepressant outcomes or improvements in anhedonia.Conclusion: Our data suggests that iTBS targeting the DLPFC is associated with physiological changes in the mPFC. In acute bipolar depression, our preliminary data suggests that mPFC GABA is dissociated from antidepressant iTBS treatment outcomes and anhedonia.

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The efficacy of repetitive transcranial magnetic stimulation (rTMS) for bipolar depression: A systematic review and meta-analysis

Cited by 63 publications

References 35 publications

Therapeutic Neuromodulation for Bipolar Disorder—The Case for Biomarker-Driven Treatment Development

Therapeutic Neuromodulation for Bipolar Disorder—The Case for Biomarker-Driven Treatment Development

The efficacy of transcranial magnetic stimulation (TMS) for negative symptoms in schizophrenia: A systematic review and meta-analysis

Intermittent Theta-Burst Stimulation Transcranial Magnetic Stimulation Increases GABA in the Medial Prefrontal Cortex: A Preliminary Sham-Controlled Magnetic Resonance Spectroscopy Study in Acute Bipolar Depression

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