Theta burst stimulation for the acute treatment of major depressive disorder: A systematic review and meta-analysis
Abstract Patients with major depressive disorder (MDD) may be refractory to or have contraindications that preclude treatment with antidepressant pharmacotherapies. Alternative therapies such as repetitive transcranial magnetic stimulation (rTMS) continue to evolve, and include theta burst stimulati...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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Nature Publishing Group
2021-05-01
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| Series: | Translational Psychiatry |
| Online Access: | https://doi.org/10.1038/s41398-021-01441-4 |
| _version_ | 1818600921071878144 |
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| author | Jeffrey D. Voigt Andrew F. Leuchter Linda L. Carpenter |
| author_facet | Jeffrey D. Voigt Andrew F. Leuchter Linda L. Carpenter |
| author_sort | Jeffrey D. Voigt |
| collection | DOAJ |
| description | Abstract Patients with major depressive disorder (MDD) may be refractory to or have contraindications that preclude treatment with antidepressant pharmacotherapies. Alternative therapies such as repetitive transcranial magnetic stimulation (rTMS) continue to evolve, and include theta burst stimulation (TBS), which has advantages over conventional rTMS. The aim of this study was to identify and meta-analyze efficacy data from all randomized controlled trials (RCTs) investigating TBS as a treatment for MDD. Published reports of RCTs (January 1, 2010 to October 23, 2020) were identified via systematic searches in computerized databases, followed by review of individual reports for inclusion. Inclusion criteria included primary diagnosis of MDD ≥ 1 week duration of therapy with ≥10 sessions, and treatment with any form of TBS. The Cochrane GRADE methodology and PRISMA criteria were used for evaluation of individual trials. Data from ten RCTs were included, representing 667 patients. Of these, 8 RCTs compared TBS to sham treatment and one compared TBS to standard rTMS (i.e., high frequency stimulation over left dorsolateral prefrontal cortex [HFL]). Quality of evidence assessment yielded high confidence in the finding of TBS being superior to sham on response measured by the Hamilton Depression Rating Scale (HRSD) (RR = 2.4; 95% CI: 1.27 to 4.55; P = 0.007; I 2 = 40%). Comparison of HRSD response rates for TBS versus rTMS produced no statistically significant difference (RR = 1.02; 95% CI: 0.85 to 1.23; P = 0.80; I 2 = 0%). The incidence of adverse events between TBS and rTMS was not statistically different. The findings of a positive effect of TBS vs. sham, and noninferiority of TBS vs. standard HFL rTMS support the continued development of TBS to treat depression. |
| first_indexed | 2024-12-16T12:43:10Z |
| format | Article |
| id | doaj.art-3434794b0d7f4080bf7b93bb8dc1ecd7 |
| institution | Directory Open Access Journal |
| issn | 2158-3188 |
| language | English |
| last_indexed | 2024-12-16T12:43:10Z |
| publishDate | 2021-05-01 |
| publisher | Nature Publishing Group |
| record_format | Article |
| series | Translational Psychiatry |
| spelling | doaj.art-3434794b0d7f4080bf7b93bb8dc1ecd72022-12-21T22:31:22ZengNature Publishing GroupTranslational Psychiatry2158-31882021-05-0111111210.1038/s41398-021-01441-4Theta burst stimulation for the acute treatment of major depressive disorder: A systematic review and meta-analysisJeffrey D. Voigt0Andrew F. Leuchter1Linda L. Carpenter299 Glenwood RoadUniversity of California Los Angeles (UCLA), Neuromodulation Division, Semel Institute for Neuroscience and Human BehaviorBrown University Department of Psychiatry and Human Behavior, Butler Hospital TMS Clinic and Neuromodulation Research FacilityAbstract Patients with major depressive disorder (MDD) may be refractory to or have contraindications that preclude treatment with antidepressant pharmacotherapies. Alternative therapies such as repetitive transcranial magnetic stimulation (rTMS) continue to evolve, and include theta burst stimulation (TBS), which has advantages over conventional rTMS. The aim of this study was to identify and meta-analyze efficacy data from all randomized controlled trials (RCTs) investigating TBS as a treatment for MDD. Published reports of RCTs (January 1, 2010 to October 23, 2020) were identified via systematic searches in computerized databases, followed by review of individual reports for inclusion. Inclusion criteria included primary diagnosis of MDD ≥ 1 week duration of therapy with ≥10 sessions, and treatment with any form of TBS. The Cochrane GRADE methodology and PRISMA criteria were used for evaluation of individual trials. Data from ten RCTs were included, representing 667 patients. Of these, 8 RCTs compared TBS to sham treatment and one compared TBS to standard rTMS (i.e., high frequency stimulation over left dorsolateral prefrontal cortex [HFL]). Quality of evidence assessment yielded high confidence in the finding of TBS being superior to sham on response measured by the Hamilton Depression Rating Scale (HRSD) (RR = 2.4; 95% CI: 1.27 to 4.55; P = 0.007; I 2 = 40%). Comparison of HRSD response rates for TBS versus rTMS produced no statistically significant difference (RR = 1.02; 95% CI: 0.85 to 1.23; P = 0.80; I 2 = 0%). The incidence of adverse events between TBS and rTMS was not statistically different. The findings of a positive effect of TBS vs. sham, and noninferiority of TBS vs. standard HFL rTMS support the continued development of TBS to treat depression.https://doi.org/10.1038/s41398-021-01441-4 |
| spellingShingle | Jeffrey D. Voigt Andrew F. Leuchter Linda L. Carpenter Theta burst stimulation for the acute treatment of major depressive disorder: A systematic review and meta-analysis Translational Psychiatry |
| title | Theta burst stimulation for the acute treatment of major depressive disorder: A systematic review and meta-analysis |
| title_full | Theta burst stimulation for the acute treatment of major depressive disorder: A systematic review and meta-analysis |
| title_fullStr | Theta burst stimulation for the acute treatment of major depressive disorder: A systematic review and meta-analysis |
| title_full_unstemmed | Theta burst stimulation for the acute treatment of major depressive disorder: A systematic review and meta-analysis |
| title_short | Theta burst stimulation for the acute treatment of major depressive disorder: A systematic review and meta-analysis |
| title_sort | theta burst stimulation for the acute treatment of major depressive disorder a systematic review and meta analysis |
| url | https://doi.org/10.1038/s41398-021-01441-4 |
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