Response trajectory to left dorsolateral prefrontal rTMS in major depressive disorder: A systematic review and meta-analysis: Trajectory of rTMS.
Journal
Psychiatry research
Journal Volume
338
Start Page
115979
ISSN
1872-7123
Date Issued
2024-08
Author(s)
Hsu, Tien-Wei
Yeh, Ta-Chuan
Kao, Yu-Chen
Thompson, Trevor
Brunoni, Andre R
Carvalho, Andre F
Tseng, Ping-Tao
Yu, Chia-Ling
Cheng, Shu-Li
Liang, Chih-Sung
Abstract
The depression response trajectory after a course of repetitive transcranial magnetic stimulation(rTMS) remains understudied. We searched for blinded randomized controlled trials(RCTs) that examined conventional rTMS over left dorsolateral prefrontal cortex(DLPFC) for major depressive episodes(MDE). The effect size was calculated as the difference in depression improvement, between active and sham rTMS. We conducted a random-effects dose-response meta-analysis to model the response trajectory from the beginning of rTMS to the post-treatment follow-up phase. The area under curve (AUC) of the first 8-week response trajectory was calculated to compare antidepressant efficacy between different rTMS protocols. We included 40 RCTs(n = 2012). The best-fitting trajectory model exhibited a logarithmic curve(X=17.7, P < 0.001), showing a gradual ascent with tapering off around the 3-4th week mark and maintaining until week 16. The maximum effect size was 6.1(95 %CI: 1.25-10.96) at week 16. The subgroup analyses showed distinct trajectories across different rTMS protocols. Besides, the comparisons of AUC showed that conventional rTMS protocols with more pulse/session group or more total pulses were associated with greater efficacy than those with fewer pulse/session or fewer total pulses, respectively. A course of conventional left DLPFC rTMS could lead to both acute antidepressant effects and sustained after-effects, which were modeled by different rTMS protocols in MDE.
Subjects
Dose-response meta-analysis
Major depression
Sustained after-effect
TMS
Trajectory
Publisher
Elsevier B.V.
Type
journal article