Transcranial magnetic stimulation in the management of mood disorders.
BACKGROUND: Many trials of transcranial magnetic stimulation (TMS) have used small samples and, therefore, lack power. Here we present an up-to-date meta-analysis of TMS in the treatment of depression. METHODS: We searched Medline and Embase from 1996 until 2008 for randomized sham-controlled trials...
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| Format: | Journal article |
| Language: | English |
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2011
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| _version_ | 1797083224173707264 |
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| author | Allan, C Herrmann, L Ebmeier, K |
| author_facet | Allan, C Herrmann, L Ebmeier, K |
| author_sort | Allan, C |
| collection | OXFORD |
| description | BACKGROUND: Many trials of transcranial magnetic stimulation (TMS) have used small samples and, therefore, lack power. Here we present an up-to-date meta-analysis of TMS in the treatment of depression. METHODS: We searched Medline and Embase from 1996 until 2008 for randomized sham-controlled trials, with patients and investigators blinded to treatment, and outcome measured using a version of the Hamilton Depression Rating Scale (or similar). We identified 1,789 studies. Thirty-one were suitable for inclusion, with a cumulative sample of 815 active and 716 sham TMS courses. RESULTS: We found a moderately sized effect in favour of TMS [Random Effects Model Hedges' g = 0.64, 95% confidence interval (95% CI) = 0.50-0.79]. The corresponding Pooled Peto Odds Ratio for treatment response (≤50% reduction in depression scores) was 4.1 (95% CI = 2.9-5.9). There was significant variability between study effect sizes. Meta-regressions with relevant study variables did not reveal any predictors of treatment efficacy. Nine studies included follow-up data with an average follow-up time of 4.3 weeks; there was no mean change in depression severity between the end of treatment and follow-up (Hedges' g = -0.02, 95% CI = -0.22 to +0.18) and no heterogeneity in outcome. DISCUSSION: TMS appears to be an effective treatment; however, at 4 weeks' follow-up after TMS, there had been no further change in depression severity. Problems with finding a suitably blind and ineffective placebo condition may have confounded the published effect sizes. If the TMS effect is specific, only further large double-blind randomized controlled designs with systematic exploration of treatment and patient parameters will help to define optimum treatment indications and regimen. |
| first_indexed | 2024-03-07T01:38:41Z |
| format | Journal article |
| id | oxford-uuid:9616ad70-b79d-442b-bc36-366f68dfacf0 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T01:38:41Z |
| publishDate | 2011 |
| record_format | dspace |
| spelling | oxford-uuid:9616ad70-b79d-442b-bc36-366f68dfacf02022-03-26T23:50:41ZTranscranial magnetic stimulation in the management of mood disorders.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:9616ad70-b79d-442b-bc36-366f68dfacf0EnglishSymplectic Elements at Oxford2011Allan, CHerrmann, LEbmeier, KBACKGROUND: Many trials of transcranial magnetic stimulation (TMS) have used small samples and, therefore, lack power. Here we present an up-to-date meta-analysis of TMS in the treatment of depression. METHODS: We searched Medline and Embase from 1996 until 2008 for randomized sham-controlled trials, with patients and investigators blinded to treatment, and outcome measured using a version of the Hamilton Depression Rating Scale (or similar). We identified 1,789 studies. Thirty-one were suitable for inclusion, with a cumulative sample of 815 active and 716 sham TMS courses. RESULTS: We found a moderately sized effect in favour of TMS [Random Effects Model Hedges' g = 0.64, 95% confidence interval (95% CI) = 0.50-0.79]. The corresponding Pooled Peto Odds Ratio for treatment response (≤50% reduction in depression scores) was 4.1 (95% CI = 2.9-5.9). There was significant variability between study effect sizes. Meta-regressions with relevant study variables did not reveal any predictors of treatment efficacy. Nine studies included follow-up data with an average follow-up time of 4.3 weeks; there was no mean change in depression severity between the end of treatment and follow-up (Hedges' g = -0.02, 95% CI = -0.22 to +0.18) and no heterogeneity in outcome. DISCUSSION: TMS appears to be an effective treatment; however, at 4 weeks' follow-up after TMS, there had been no further change in depression severity. Problems with finding a suitably blind and ineffective placebo condition may have confounded the published effect sizes. If the TMS effect is specific, only further large double-blind randomized controlled designs with systematic exploration of treatment and patient parameters will help to define optimum treatment indications and regimen. |
| spellingShingle | Allan, C Herrmann, L Ebmeier, K Transcranial magnetic stimulation in the management of mood disorders. |
| title | Transcranial magnetic stimulation in the management of mood disorders. |
| title_full | Transcranial magnetic stimulation in the management of mood disorders. |
| title_fullStr | Transcranial magnetic stimulation in the management of mood disorders. |
| title_full_unstemmed | Transcranial magnetic stimulation in the management of mood disorders. |
| title_short | Transcranial magnetic stimulation in the management of mood disorders. |
| title_sort | transcranial magnetic stimulation in the management of mood disorders |
| work_keys_str_mv | AT allanc transcranialmagneticstimulationinthemanagementofmooddisorders AT herrmannl transcranialmagneticstimulationinthemanagementofmooddisorders AT ebmeierk transcranialmagneticstimulationinthemanagementofmooddisorders |