title: Efficacy of theta burst stimulation (TBS) for major depression: An exploratory meta-analysis of randomized and sham-controlled trials.
abstract: Theta burst stimulation (TBS) has been proposed as a novel treatment for major depression (MD). However, randomized and sham-controlled trials (RCTs) published to date have yielded heterogeneous clinical results and we have thus carried out the present systematic review and exploratory meta-analysis of RCTs to evaluate this issue. We searched the literature for RCTs on TBS for MD from January 2001 through September 2016 using MEDLINE, EMBASE, PsycINFO, and CENTRAL. We then performed a random-effects meta-analysis with the main outcome measures including pre-post score changes in the Hamilton Depression Rating Scale (HAM-D) as well as rates of response, remission and dropout. Data were obtained from 5 RCTs, totalling 221 subjects with MD. The pooled Hedges' g for pre-post change in HAM-D scores was 1.0 (p = 0.003), indicating a significant and large-sized difference in outcome favouring active TBS. Furthermore, active TBS was associated with significantly higher response rates when compared to sham TBS (35.6% vs. 17.5%, respectively; p = 0.005), although the groups did not differ in terms of rates of remission (18.6% vs. 10.7%, respectively; p = 0.1) and dropout (4.2% vs. 7.8%, respectively; p = 0.5). Finally, subgroup analyses indicated that bilateral TBS and unilateral intermittent TBS seem to be the most promising protocols. In conclusion, although TBS is a promising novel therapeutic intervention for MD, future studies should identify more clinically-relevant stimulation parameters as well as neurobiological predictors of treatment outcome, and include larger sample sizes, active comparators and longer follow-up periods.
authors.affiliation: Neuromodulation Research Clinic, Douglas Institute and McGill University, Montréal, Québec, Canada; Depressive Disorders Program, Douglas Institute and McGill University, Montréal, Québec, Canada. Electronic address: nrc.douglas@me.com.
authors.forename: Marcelo T
authors.initials: MT
authors.lastname: Berlim
authors.affiliation: Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Alexander
authors.initials: A
authors.lastname: McGirr
authors.affiliation: Neuromodulation Research Clinic, Douglas Institute and McGill University, Montréal, Québec, Canada.
authors.forename: Nicole
authors.initials: N
authors.lastname: Rodrigues Dos Santos
authors.affiliation: Neuromodulation Research Clinic, Douglas Institute and McGill University, Montréal, Québec, Canada; Institute of Neurology, University College London, London, United Kingdom.
authors.forename: Sara
authors.initials: S
authors.lastname: Tremblay
authors.affiliation: Neuromodulation Research Clinic, Douglas Institute and McGill University, Montréal, Québec, Canada.
authors.forename: Ruben
authors.initials: R
authors.lastname: Martins
mesh_terms: D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D003865:Major Depressive Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D015201:Meta-Analysis as Topic; D016032:Randomized Controlled Trials as Topic; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome
keywords: Acceptability; Efficacy; Major depression; Meta-analysis; Repetitive transcranial magnetic stimulation; TBS; Theta burst stimulation; rTMS