Examining Treatment Modalities for Noninvasive Brain Stimulation for Adult Depression

Transcranial magnetic stimulation
Transcranial magnetic stimulation
These data could be useful to clinicians and patients alike in selecting the proper treatment method.

A meta-analysis published in Neuroscience and Biobehavioral Reviews examined the efficacy and safety of noninvasive brain stimulation in adult unipolar and bipolar depression. Results supported the efficacy of high-frequency repetitive transcranial magnetic stimulation (TMS), but there was not sufficient evidence to confirm the effectiveness and acceptability of theta-burst stimulation (TBS) or synchronized transcranial magnetic stimulation (tDCS).  

Researchers extracted data on treatment response, remission, all-cause discontinuation rates, and continuous depression severity measures from 56 placebo-controlled studies regarding TMS, TBS, and tDCS. The total study cohort included 3058 participants (61.73% women), mean age 44.96. 

Response rates across studies demonstrated the efficacy of high-frequency repetitive TMS over the left dorsolateral prefrontal cortex (odds ratio [OR] 3.75; 95% CI, 2.44-5.75), right-sided low-frequency rTMS (OR, 7.44; 95% CI, 2.06-26.83), bilateral repetitive TMS (OR, 3.68; 95% CI, 1.66-8.13), deep TMS (OR, 1.69; 95% CI, 1.003-2.85), intermittent TBS (OR, 4.70; 95% CI, 1.14-19.38), and tDCS (OR, 4.17; 95% CI, 2.25-7.74). However, the meta-analysis did not identify significant response rates for continuous TBS, bilateral TBS, or synchronized TMS. There were no significant differences in discontinuation rates across treatment modalities. The strongest response and remission rates were for high-frequency repetitive TMS, with intermittent TBS offering the advantage of reduced treatment duration. Researchers also highlighted tDCS as a treatment option for non-treatment resistance depression. 

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These data could be useful to clinicians and patients alike in selecting the proper treatment method. Additional studies on the relative efficacy and acceptability of different treatment modalities are necessary to further clarify the mechanisms and advantages of each. 


Mutz J, Edgcumbe DR, BrunoniMD AR, FuMD CHY. 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 [published online May 12, 2018]. Neurosci Biobehav Rev. doi:10.1016/j.neubiorev.2018.05.015