title: Deep transcranial magnetic stimulation (DTMS) in the treatment of major depression: An exploratory systematic review and meta-analysis.
abstract: BACKGROUND
  Deep transcranial magnetic stimulation (DTMS) is a relatively new, non-invasive method of stimulating larger and, presumably, deeper brain regions. The current study investigated if DTMS delivered with H-coils has acute antidepressant effects in major depression using a systematic literature review and a quantitative meta-analysis.
  
  
  METHODS
  Seventeen studies on 'DTMS or H-coil' and 'depression' were identified on Medline, PsycInfo, and Google Scholar (until November 2014). Data from nine open-label studies were meta-analysed using a random-effects model with inverse-variance weights. The outcome measures were the standardised paired mean difference (Cohen's d) in depression scores on Hamilton Depression Rating Scale (HDRS), response, remission, and dropout rates after acute DTMS treatment compared to baseline.
  
  
  RESULTS
  There was a large antidepressant effect after 20 acute, high-frequency DTMS sessions compared to baseline according to HDRS change scores (overall mean weighted d=2.04, 95% confidence interval: 1.53-2.55; nine studies; 150 patients). Overall weighted response, remission, and dropout rates were 60%, 29%, and 18% respectively. HDRS change scores and response rates tended to be higher in four studies with 68 patients on concurrent antidepressants compared to two studies with 26 patients who received DTMS as a monotherapy.
  
  
  CONCLUSIONS
  These results are based on data from a low number of open-label studies.
  
  
  CONCLUSIONS
  High-frequency DTMS appears to have acute antidepressant effects after 20 sessions in mostly unipolar and treatment-resistant patients. Concurrent treatment with antidepressants might enhance the efficacy of DTMS.
authors: Institute of Psychology and Transfer, University of Bremen, Grazer Straße 2c, 28359 Bremen, Germany. Electronic address: kkedzior@graduate.uwa.edu.au.
authors: Karina Karolina
authors: KK
authors: Kedzior
authors: School of Engineering and Science, Jacobs University Bremen, Bremen, Germany.
authors: Helena Marie
authors: HM
authors: Gellersen
authors: School of Engineering and Science, Jacobs University Bremen, Bremen, Germany.
authors: Anna Katharina
authors: AK
authors: Brachetti
authors: Department of Psychiatry, McGill University, and Neuromodulation Research Clinic, Douglas Institute, Montreal, Canada.
authors: Marcelo T
authors: MT
authors: Berlim
mesh_terms: D003865:Major Depressive Disorder / Q000628:therapy*; D006801:Humans; D012107:Research Design; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome
keywords: Deep transcranial magnetic stimulation (DTMS); Major depressive disorder (MDD); Meta-analysis; Systematic literature review