PMID: 18447962
TITLE: Antidepressant efficacy of high-frequency transcranial magnetic stimulation over the left dorsolateral prefrontal cortex in double-blind sham-controlled designs: a meta-analysis.
AUTHORS: D J L G Schutter
AFFILIATION: Experimental Psychology, Utrecht University, Utrecht, The Netherlands. d.schutter@uu.nl
REFERENCE: Psychol Med 2009 Jan 39(1):65-75
BACKGROUND: For more than a decade high-frequency repetitive
transcranial magnetic stimulation (rTMS) has been applied to the left
dorsolateral prefrontal cortex (DLPFC) in search of an alternative
treatment for depression. The aim of this study was to provide an update
on its clinical efficacy by performing a meta-analysis involving double
-blind sham-controlled studies. METHOD: A literature search was
conducted in the databases PubMed and Web of Science in the period
between January 1980 and November 2007 with the search terms 'depression
' and 'transcranial magnetic stimulation'. Thirty double-blind sham-
controlled parallel studies with 1164 patients comparing the percentage
change in depression scores from baseline to endpoint of active versus
sham treatment were included. A random effects meta-analysis was
performed to investigate the clinical efficacy of fast-frequency rTMS
over the left DLPFC in depression. RESULTS: The test for heterogeneity
was not significant (QT=30.46, p=0.39). A significant overall weighted
mean effect size, d=0.39 [95% confidence interval (CI) 0.25-0.54], for
active treatment was observed (z=6.52, p<0.0001). Medication
resistance and intensity of rTMS did not play a role in the effect size
CONCLUSIONS: These findings show that high-frequency rTMS over the
left DLPFC is superior to sham in the treatment of depression. The
effect size is robust and comparable to at least a subset of
commercially available antidepressant drug agents. Current limitations
and future prospects are discussed.
