The dose-effect relationship of six stimulation parameters with rTMS over left DLPFC on treatment-resistant depression: A systematic review and meta-analysis

Tien-Wei Hsu; Ta-Chuan Yeh; Yu-Chen Kao; Trevor Thompson; Andre R Brunoni; Andre F Carvalho; Chih-Wei Hsu; Yu-Kang Tu; Chih-Sung Liang

doi:10.1016/j.neubiorev.2024.105704

The dose-effect relationship of six stimulation parameters with rTMS over left DLPFC on treatment-resistant depression: A systematic review and meta-analysis

Neurosci Biobehav Rev. 2024 May 7:162:105704. doi: 10.1016/j.neubiorev.2024.105704. Online ahead of print.

Authors

Tien-Wei Hsu¹, Ta-Chuan Yeh², Yu-Chen Kao³, Trevor Thompson⁴, Andre R Brunoni⁵, Andre F Carvalho⁶, Chih-Wei Hsu⁷, Yu-Kang Tu⁸, Chih-Sung Liang⁹

Affiliations

¹ Department of Psychiatry, E-DA Dachang Hospital, I-Shou University, Kaohsiung, Taiwan; Department of Psychaitry, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
² Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Centre, Taipei, Taiwan; Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, Taipei, Taiwan.
³ Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Centre, Taipei, Taiwan; Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, Taipei, Taiwan.
⁴ Centre for Chronic Illness and Ageing, University of Greenwich, London, UK.
⁵ Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil; Service of Electroconvulsive Therapy, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil.
⁶ IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia.
⁷ Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
⁸ Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan; Institute of Health Data Analytics & Statistics, College of Public Health, National Taiwan University, Taiwan.
⁹ Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Centre, Taipei, Taiwan; Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, Taipei, Taiwan. Electronic address: lcsyfw@gmail.com.

PMID: 38723735
DOI: 10.1016/j.neubiorev.2024.105704

Abstract

This study aimed to evaluate the association of the six parameters, namely stimulation intensity, stimulation frequency, pulses per session, treatment duration, number of sessions, and total number of pulses with the efficacy of conventional transcranial magnetic stimulation (rTMS) over left dorsolateral prefrontal cortex for patients with treatment-resistant depression (TRD). A random-effects dose-response meta-analysis of blinded randomized controlled trials (RCTs) involving 2391 participants were conducted to examine the dose-effect relationship of six stimulation parameters. Any of the six parameters significantly individually predicted proportion of variance in efficacy: pulses per session (R²=52.7%), treatment duration (R²=51.2%), total sessions (R²=50.9%), frequency (R²=49.6%), total pulses (R²=49.5%), and intensity (R²= 40.4%). Besides, we identified frequency as a potential parameter interacting with the other five parameters, resulting in a significant increase in variance(ΔR²) ranging from 5.0% to 16.7%. Finally, we found that RCTs using frequency > 10 Hz compared to those of 10 Hz showed better dose-effect relationships. We conclude that the six stimulation parameters significantly predict the dose-effect relationship of conventional rTMS on TRD. Besides, higher stimulation frequency, higher stimulation intensity, and adequate number of pulses were associated with treatment efficacy.

Keywords: Dose-response meta-analysis; Major depressive disorder; RTMS parameters; Repetitive transcranial magnetic stimulation; Treatment-resistant.

Publication types

Review