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BMC Psychiatry
Published in: BMC Psychiatry 1/2019

Open Access 01-12-2019 | Antidepressant Drugs | Research article

Antidepressant outcomes of high-frequency repetitive transcranial magnetic stimulation (rTMS) with F8-coil and deep transcranial magnetic stimulation (DTMS) with H1-coil in major depression: a systematic review and meta-analysis

Authors: Helena M. Gellersen, Karina Karolina Kedzior

Published in: BMC Psychiatry | Issue 1/2019

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Abstract

Background

The current study aims to systematically assess and compare the antidepressant outcomes of repetitive transcranial magnetic stimulation (rTMS) with the figure-of-eight (F8)-coil and deep transcranial magnetic stimulation (DTMS) with the H1-coil in studies matched on stimulation frequency in unipolar major depressive disorder (MDD).

Methods

Electronic search of Medline and PsycInfo identified 19 studies with stimulation frequency of 18–20 Hz using F8-coil (k = 8 randomised sham-controlled trials, RCTs, k = 3 open-label; n = 168 patients) or H1-coil (k = 1 RCT, k = 7 open-label; n = 200). Depression severity (the primary outcome) and response/remission rates (the secondary outcomes) were assessed at session 10.

Results

Effects pooled with random-effects meta-analysis showed a large reduction in depression severity, 29% response, and 15% remission rates after 10 sessions of active stimulation with either coil relative to baseline. Reduction in depression severity was greater in studies with younger patients using either coil. The comparison between coils showed a larger reduction in depression severity in H1-coil vs. F8-coil studies (independent of the study design or the concurrent pharmacotherapy) and a trend towards higher remission rates in F8-coil vs. H1-coils studies. These effects are based on a low volume of studies, are not controlled for placebo, and may not be clinically-relevant. The stimulation protocols differed systematically because stimulation was more focal but less intense (80–110% of the resting motor threshold, MT) in the F8-coil studies and less focal but more intense (120% MT) in the H1-coil studies. Two seizures occurred in the H1-coil studies relative to none in the F8-coil studies.

Conclusion

When matched on frequency, the higher-intensity and less focal stimulation with the H1-coil reduces depression more than the lower-intensity and more focal stimulation with the F8-coil. Head-to-head trials should compare the antidepressant outcomes of F8-coil and H1-coil to identify the most optimal stimulation protocols for acute and longer-lasting efficacy.
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Literature
1.
Berlim MT, van den Eynde F, Tovar-Perdomo S, Daskalakis ZJ. Response, remission and drop-out rates following high-frequency repetitive transcranial magnetic stimulation (rTMS) for treating major depression: a systematic review and meta-analysis of randomized, double-blind and sham-controlled trials. Psychol Med. 2014;44:225–39.CrossRef
2.
George MS, Lisanby SH, Avery D, McDonald WM, Durkalski V, Pavlicova M, Anderson B, Nahas Z, Bulow P, Zarkowski P, Holtzheimer PE III, Schwartz T, Sackeim HA. Daily left prefrontal transcranial magnetic stimulation therapy for major depressive disorder: a sham-controlled randomized trial. Arch Gen Psychiatry. 2010;67:507–16.CrossRef
3.
Kedzior KK, Azorina V, Reitz SK. More female patients and fewer stimuli per session are associated with the short-term antidepressant properties of repetitive transcranial magnetic stimulation (rTMS): a meta-analysis of 54 sham-controlled studies published between 1997-2013. Neuropsychiatr Dis Treat. 2014;10:727–56.CrossRef
4.
O’Reardon J, Solvason H, Janicak P, Sampson S, Isenberg K, Nahas Z, McDonald W, Avery D, Fitzgerald P, Loo C, Demitrack M, George M, Sackeim H. Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial. Biol Psychiatry. 2007;62:1208–16.CrossRef
5.
Roth Y, Zangen A, Hallett M. A coil design for transcranial magnetic stimulation of deep brain regions. J Clin Neurophysiol. 2002;19:361–70.CrossRef
6.
Roth Y, Amir A, Levkovitz Y, Zangen A. Three-dimensional distribution of the electric field induced in the brain by transcranial magnetic stimulation using figure-8 and deep H-coils. J Clin Neurophysiol. 2007;24:31–8.CrossRef
7.
Kedzior KK, Gerkensmeier I, Schuchinsky M. Can deep transcranial magnetic stimulation (DTMS) be used to treat substance use disorders (SUD)? A systematic review. BMC Psychiatry. 2018;137:1–11.
8.
Kedzior KK, Gellersen H, Brachetti A, Berlim MT. Deep transcranial magnetic stimulation (DTMS) in the treatment of major depression: an exploratory systematic review and meta-analysis. J Affect Disord. 2015;187:73–83.CrossRef
9.
Levkovitz Y, Isserles M, Padberg F, Lisanby SH, Bystritsky A, Xia G, Tendler A, Daskalakis ZJ, Winston JL, Dannon P, Hafez HM, Reti IM, Morales OG, Schlaepfer TE, Hollander E, Berman JA, Husain MM, Sofer U, Stein A, Adler S, Deutsch L, Deutsch F, Roth Y, George MS, Zangen A. Efficacy and safety of deep transcranial magnetic stimulation for major depression: a prospective multicenter randomized controlled trial. World Psychiatry. 2015;14:64–73.CrossRef
10.
Brunoni AR, Chaimani A, Moffa AH, et al. Repetitive transcranial magnetic stimulation for the acute treatment of major depressive episodes: a systematic review with network meta-analysis. JAMA Psychiatry. 2016;74:143–52.CrossRef
11.
Padberg F, Brem AK, Palm U, Pogarell O, Hasan A, Brunelin J, Baeken C, Poulet E, Langguth B, Keeser D. Discovering the individual brain: brain stimulation in psychiatry. Eur Arch Psychiatry Clin Neurosci. 2017;267:109–12.CrossRef
12.
Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56–62.CrossRef
13.
Kedzior KK, Reitz SK. Short-term efficacy of repetitive transcranial magnetic stimulation (rTMS) in depression- reanalysis of data from meta-analyses up to 2010. BMC Psychology. 2014;2:39–58.CrossRef
14.
Moher D, Liberati A, Tetzlaff J, Altman D. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.CrossRef
15.
Levkovitz Y, Harel EV, Roth Y, Braw Y, Most D, Katz LN, Sheer A, Gersner R, Zangen A. Deep transcranial magnetic stimulation over the prefrontal cortex: evaluation of antidepressant and cognitive effects in depressive patients. Brain Stimul. 2009;2:188–200.CrossRef
16.
Rosenberg O, Shoenfeld N, Zangen A, Kotler M, Dannon PN. Deep TMS in a resistant major depressive disorder: a brief report. Depress Anxiety. 2010;27:465–9.CrossRef
17.
Rosenberg O, Zangen A, Stryjer R, Kotler M, Dannon PN. Response to deep TMS in depressive patients with previous electroconvulsive treatment. Brain Stimul. 2010;3:211–7.CrossRef
18.
Isserles M, Rosenberg O, Dannon P, Levkovitz Y, Kotler M, Deutsch F, Lerer B, Zangen A. Cognitive-emotional reactivation during deep transcranial magnetic stimulation over the prefrontal cortex of depressive patients affects antidepressant outcome. J Affect Disord. 2011;128:235–42.CrossRef
19.
Harel EV, Rabany L, Deutsch L, Bloch Y, Zangen A, Levkovitz Y. H-coil repetitive transcranial magnetic stimulation for treatment resistant major depressive disorder: an 18-week continuation safety and feasibility study. World J Biol Psychiatry. 2014;15:298–306.CrossRef
20.
Rapinesi C, Bersani F, Kotzalidis G, Imperatori C, Del Casale A, Di Pietro S, Ferri V, Serata D, Raccah R, Zangen A, Angeletti G, Girardi P. Maintenance deep transcranial magnetic stimulation sessions is associated with reduced depressive relapses in patients with unipolar or bipolar depression. Front Neurol. 2015;6:16.CrossRef
21.
Rapinesi C, Curto M, Kotzalidis GD, Del Casale A, Serata D, Ferri VR, Di Pietro S, Scatena P, Bersani FS, Raccah RN, Digiacomantonio V, Ferracuti S, Bersani G, Zangen A, Angeletti G, Girardi P. Antidepressant effectiveness of deep transcranial magnetic stimulation (dTMS) in patients with major depressive disorder (MDD) with or without alcohol use disorders (AUDs): a 6-month, open label, follow-up study. J Affect Disord. 2015;174:57–63.CrossRef
22.
George M, Wassermann EM, Williams WE, Kimbrell TA, Little JT, Hallett M, Post RM. Mood improvement following daily left prefrontal repetitive transcranial magnetic stimulation in patients with depression: a placebo-controlled crossover trial. Am J Psychiatry. 1997;154:1752–6.CrossRef
23.
Berman RM, Narasimhan M, Sanacora G, Miano AP, Hoffman RE, Hu XS, Charney DS, Boutros NN. A randomized clinical trial of repetitive transcranial magnetic stimulation in the treatment of major depression. Biol Psychiatry. 2000;47:332–7.CrossRef
24.
Catafau AM, Perez V, Gironell A, Martin JC, Kulisevsky J, Estorch M, Carrió I, Alvarez E. SPECT mapping of cerebral activity changes induced by repetitive transcranial magnetic stimulation in depressed patients: a pilot study. Psychiatry Res Neuroimaging. 2001;106:151–60.CrossRef
25.
Garcia-Toro M, Mayol A, Arnillas H, Capllonch I, Ibarra O, Crespí M, Micó J, Lafau O, Lafuente L. Modest adjunctive benefit with transcranial magnetic stimulation in medication-resistant depression. J Affect Disord. 2001;64:271–5.CrossRef
26.
García-Toro M, Pascual-Leone A, Romera M, González A, Micó J, Ibarra O, Arnillas H, Capllonch I, Mayol A, Tormos JM. Prefrontal repetitive transcranial magnetic stimulation as add on treatment for depression. J Neurol Neurosurg Psychiatry. 2001;71:546–8.CrossRef
27.
Boutros NN, Gueorguieva R, Hoffman RE, Oren DA, Feingold A, Berman RM. Lack of a therapeutic effect of a 2-week sub-threshold transcranial magnetic stimulation course for treatment-resistant depression. Psychiatry Res. 2002;113:245–54.CrossRef
28.
Bajbouj M, Brakemeier E-L, Schubert F, Lang UE, Neu P, Schindowski C, Danker-Hopfe H. Repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex and cortical excitability in patients with major depressive disorder. Exp Neurol. 2005;196:332–8.CrossRef
29.
Yukimasa T, Yoshimura R, Tamagawa A, Uozumi T, Shinkai K, Ueda N, Tsuji S, Nakamura J. High-frequency repetitive transcranial magnetic stimulation improves refractory depression by influencing catecholamine and brain-derived neurotrophic factors. Pharmacopsychiatry. 2006;39:52–9.CrossRef
30.
Luborzewski A, Schubert F, Seifert F, Danker-Hopfe H, Brakemeier E-L, Schlattmann P, Anghelescu I, Colla M, Bajbouj M. Metabolic alterations in the dorsolateral prefrontal cortex after treatment with high-frequency repetitive transcranial magnetic stimulation in patients with unipolar major depression. J Psychiatr Res. 2007;41:606–15.CrossRef
31.
Bakim B, Uzun UE, Karamustafalioglu O, Ozcelik B, Alpak G, Tankaya O, Cengiz Y, Yavuz BG. The combination of antidepressant drug therapy and high-frequency repetitive transcranial magnetic stimulation in medication-resistant depression. Klin Psikofarmakol B. 2012;22:244–53.CrossRef
32.
Chen S-J, Chang C-H, Tsai H-C, Chen S-T, Lin CC. Superior antidepressant effect occurring 1 month after rTMS: add-on rTMS for subjects with medication-resistant depression. Neuropsychiatr Dis Treat. 2013;9:397–401.CrossRef
33.
Borenstein M, Hedges L, Higgins J, Rothstein H. Introduction to meta-analysis. UK: Wiley; 2009.CrossRef
34.
Ziemann U. Thirty years of transcranial magnetic stimulation: where do we stand? Exp Brain Res. 2017;235:973–84.CrossRef
35.
Teng S, Guo Z, Peng H, Xing G, Chen H, He B, McClure MA, Mu Q. High-frequency repetitive transcranial magnetic stimulation over the left DLPFC for major depression: session-dependent efficacy: a meta-analysis. Eur Psychiatry. 2017;41:75–84.CrossRef
36.
Kedzior KK, Gellersen HM. Two vs. four weeks of high-frequency deep repetitive transcranial magnetic stimulation (HF-DTMS) for major depression: a systematic review and meta-analysis (Magstim 2015 Neuroscience Conference). UK: Magstim; 2015.
37.
Lisanby SH, Husain MM, Rosenquist PB, Maixner D, Gutierrez R, Krystal A, Gilmer W, Marangell LB, Aaronson S, Daskalakis ZJ, Canterbury R, Richelson E, Sackeim HA, George MS. Daily left prefrontal repetitive transcranial magnetic stimulation in the acute treatment of major depression: clinical predictors of outcome in a multisite, randomized controlled clinical trial. Neuropsychopharmacology. 2009;34:522–34.CrossRef
38.
Yip AG, George MS, Tendler A, Roth Y, Zangen A, Carpenter LL. 61% of unmedicated treatment resistant depression patients who did not respond to acute TMS treatment responded after four weeks of twice weekly deep TMS in the Brainsway pivotal trial. Brain Stimul. 2017;10:847–9.CrossRef
39.
Baeken C, Marinazzo D, Wu G-R, Van Schuerbeek P, De Mey J, Marchetti I, Vanderhasselt M-A, Remue J, Luypaert R, De Raedt R. Accelerated HF-rTMS in treatment-resistant unipolar depression: insights from subgenual anterior cingulate functional connectivity. World J Biol Psychiatry. 2014;15:286–97.CrossRef
40.
Conelea CA, Philip NS, Yip AG, Barnes JL, Niedzwiecki MJ, Greenberg BD, Tyrka AR, Carpenter LL. Transcranial magnetic stimulation for treatment-resistant depression: naturalistic treatment outcomes for younger versus older patients. J Affect Disord. 2017;217:42–7.CrossRef
41.
Sabesan P, Lankappa S, Khalifa N, Krishnan V, Gandhi R, Palaniyappan L. Transcranial magnetic stimulation for geriatric depression: promises and pitfalls. World J Psychiatry. 2015;5:170–81.CrossRef
42.
Kedzior K, Rajput V, Price G, Lee J, Martin-Iverson M. Cognitive correlates of repetitive transcranial magnetic stimulation (rTMS) in treatment-resistant depression- a pilot study. BMC Psychiatry. 2012;12:163–72.CrossRef
43.
Berlim MT, Van den Eynde F, Daskalakis ZJ. High-frequency repetitive transcranial magnetic stimulation accelerates and enhances the clinical response to antidepressants in major depression: a meta-analysis of randomized, double-blind, and sham-controlled trials. J Clin Psychiatr. 2013;74:e122–9.CrossRef
44.
Johnson KA, Baig M, Ramsey D, Lisanby SH, Avery D, McDonald WM, Li X, Bernhardt ER, Haynor DR, Holtzheimer PE 3rd, Sackeim HA, George MS, Nahas Z. Prefrontal rTMS for treating depression: location and intensity results from the OPT-TMS multi-site clinical trial. Brain Stimul. 2013;6:108–17.CrossRef
45.
Parazzini M, Fiocchi S, Chiaramello E, Roth Y, Zangen A, Ravazzani P. Electric field estimation of deep transcranial magnetic stimulation clinically used for the treatment of neuropsychiatric disorders in anatomical head models. Med Eng Phys. 2017;43:30–8.CrossRef
46.
Roth Y, Pell GS, Chistyakov AV, Sinai A, Zangen A, Zaaroor M. Motor cortex activation by H-coil and figure-8 coil at different depths. Combined motor threshold and electric field distribution study. Clin Neurophysiol. 2014;125:336–43.CrossRef
47.
Fadini T, Matthaus L, Rothkegel H, Sommer M, Tergau F, Schweikard A, Paulus W, Nitsche MA. H-coil: induced electric field properties and input/output curves on healthy volunteers, comparison with a standard figure-of-eight coil. Clin Neurophysiol. 2009;120:1174–82.CrossRef
48.
Deng Z-D, Lisanby SH, Peterchev AV. Coil design considerations for deep transcranial magnetic stimulation. Clin Neurophysiol. 2014;125:1202–12.CrossRef
49.
Fregni F, Marcolin MA, Myczkowski M, Amiaz R, Hasey G, Rumi DO, Rosa M, Rigonatti SP, Camprodon J, Walpoth M, Heaslip J, Grunhaus L, Hausmann A, Pascual-Leone A. Predictors of antidepressant response in clinical trials of transcranial magnetic stimulation. Int J Neuropsychopharmacol. 2006;9:641–54.CrossRef
50.
Rosenberg O, Dinur Klein L, Gersner R, Kotler M, Zangen A, Dannon P. Long-term follow-up of mdd patients who respond to deep rtms: a brief report. Isr J Psychiatry Relat Sci. 2015;52:17–23.PubMed
51.
Kedzior KK, Reitz SK, Azorina V, Loo C. Durability of the antidepressant effect of the high-frequency repetitive transcranial magnetic stimulation (rTMS) in the absence of maintenance treatment in major depression. A systematic review and meta-analysis of 16 double-blind, randomised, sham-controlled trials. Depress Anxiety. 2015;32:193–203.CrossRef
52.
Aleman A, Slotema CW, Sommer IE. rTMS deserves a fair chance as a novel treatment for depression. Acta Psychiatr Scand. 2014;130:324–5.CrossRef
53.
Gellersen HM, Kedzior KK. Durability of the antidepressant effect of high-frequency deep repetitive transcranial magnetic stimulation (HF-DTMS) in major depression: a systematic review (Magstim 2015 Neuroscience Conference). UK: Magstim; 2015.
54.
Herrmann CS, Murray MM, Ionta S, Hutt A, Lefebvre J. Shaping intrinsic neural oscillations with periodic stimulation. J Neurosci. 2016;36:5328–37.CrossRef
55.
Kobayashi B, Cook IA, Hunter AM, Minzenberg MJ, Krantz DE, Leuchter AF. Can neurophysiologic measures serve as biomarkers for the efficacy of repetitive transcranial magnetic stimulation treatment of major depressive disorder? Int Rev Psychiatry. 2017;29:98–114.CrossRef
56.
Huang YZ, Edwards MJ, Rounis E, Bhatia KP, Rothwell JC. Theta burst stimulation of the human motor cortex. Neuron. 2005;45:201–6.CrossRef
57.
Gharabaghi A, Kraus D, Leão MT, Spüler M, Walter A, Bogdan M, Rosenstiel W, Naros G, Ziemann U. Coupling brain-machine interfaces with cortical stimulation for brain-state dependent stimulation: enhancing motor cortex excitability for neurorehabilitation. Front Hum Neurosci. 2014;8:122.PubMedPubMedCentral
58.
Leuchter AF, Cook IA, Feifel D, Goethe JW, Husain M, Carpenter LL, Thase ME, Krystal AD, Philip NS, Bhati MT, Burke WJ, Howland RH, Sheline YI, Aaronson ST, Iosifescu DV, O'Reardon JP, Gilmer WS, Jain R, Burgoyne KS, Phillips B, Manberg PJ, Massaro J, Hunter AM, Lisanby SH, George MS. Efficacy and safety of low-field synchronized transcranial magnetic stimulation (stms) for treatment of major depression. Brain Stimul. 2015;8:787–94.CrossRef
59.
Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savović J, Schulz KF, Weeks L, Sterne JAC. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.CrossRef
60.
Guse B, Falkai P, Wobrock T. Cognitive effects of high-frequency repetitive transcranial magnetic stimulation: a systematic review. J Neural Transm. 2010;117:105–22.CrossRef
61.
Kedzior KK, Gierke L, Gellersen HM, Berlim MT. Cognitive functioning and deep transcranial magnetic stimulation (DTMS) in major psychiatric disorders: a systematic review. J Psychiatr Res. 2016;75:107–15.CrossRef
62.
Rossi S, Hallett M, Rossini PM, Pascual-Leone A. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol. 2009;120:2008–39.CrossRef
Metadata
Title
Antidepressant outcomes of high-frequency repetitive transcranial magnetic stimulation (rTMS) with F8-coil and deep transcranial magnetic stimulation (DTMS) with H1-coil in major depression: a systematic review and meta-analysis
Authors
Helena M. Gellersen
Karina Karolina Kedzior
Publication date
01-12-2019

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