Effects of Hesel-coil deep transcranial magnetic stimulation for depression - a systematic review.
BACKGROUND
One third of the depressed patients are not improved by antidepressant drugs and psychological treatments, and there is a need for additional treatments. Repetitive transcranial magnetic stimulation (rTMS) is being developed towards an alternative in treatment-resistant depression. Deep transcranial stimulation (dTMS) with the Hesel-coil (H-coil) is a further development of rTMS aiming to enhance the effect by getting the magnetic pulses to penetrate deeper into the brain.


OBJECTIVE
This report aims to assess the evidence-base for dTMS for depression. The report also includes an assessment of the ethical and economic aspects involved.


METHODS
A systematic review of the effects of H-coil dTMS on depression was conducted and the scientific support was evaluated using GRADE (Grading of Recommendations Assessment, Development and Evaluation).


RESULTS
Only one controlled study was identified. In the sham-controlled randomized study, 212 participants with major depression that had not responded to antidepressant medication were enrolled. A two-point superiority in Hamilton Depression Rating Scale was observed in the dTMS arm vs the sham-arm at 4 weeks, but the difference was not statistically significant. No serious adverse events were reported apart from rare cases of epileptic seizures.


CONCLUSIONS
The existing scientific support for H-coil dTMS therapy for depression is insufficient. The clinical implication is that the use of dTMS in depression should be restricted to the framework of clinical trials pending further studies. Fortunately, additional studies are underway and the evidence base should presumably improve over the next several years.
a Department of Psychiatry, Faculty of Medicine and Health , Örebro University , Örebro , Sweden ;
Axel
A
Nordenskjöld
b Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden ;
Björn
B
Mårtensson
c Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) and Department of Learning, Informatics, Management and Ethics , Karolinska Institutet , Stockholm , Sweden ;
Agneta
A
Pettersson
d Health Economist, Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) and Department of Learning, Informatics, Management and Ethics , Karolinska Institutet , Stockholm , Sweden ;
Emelie
E
Heintz
e Institute of Neuroscience and Physiology, the Sahlgrenska Academy at Gothenburg University , Gothenburg, Sweden and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet , Stockholm , Sweden.
Mikael
M
Landén
D003866:Depressive Disorder / Q000628:therapy*; D006801:Humans; D017063:Outcome Assessment, Health Care; D050781:Transcranial Magnetic Stimulation / Q000295:instrumentation / Q000379:methods*
Deep transcranial magnetic stimulation (dTMS); electroconvulsive therapy (ECT); major depression; repetitive transcranial magnetic stimulation (rTMS); systematic review