TMS Plus Antidepressants Shows Greater Efficacy in MDD Than Antidepressants Alone
Combining transcranial magnetic stimulation (TMS) with antidepressants to treat patients with major depressive disorder (MDD) was found to be more effective than the same antidepressants and sham TMS, according to a recent systematic review and meta-analysis published in the Journal of Affective Disorders.
Researchers reviewed randomized controlled trials (RCTs) and open-label trials from PubMed/Medline and EMBASE; all studies were published between 2000 and 2023. Case reports, case series, and clinical studies that augmented TMS with antidepressants and vice versa were all excluded from analysis.
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In total, 10 RCTs were included with a total of 654 participants. Meta-analysis showed active TMS combined with pre-specified antidepressants were more effective for MDD treatment than sham TMS combined with the same antidepressants (Hedge's g = 1; 95 % CI [0.27, 1.73]). Researchers noted that there was greater short-term efficacy in this combination from the get-go in MDD treatment.
‘Given the increasing role of accelerated TMS protocols in expediting remission in MDD and the results of our meta-analysis, we advocate for RCTs examining the short-term and long-term effects of various antidepressant classes on these TMS protocols in MDD,” noted lead author Gopalkumar Rakesh, MD, department of psychiatry, College of Medicine, University of Kentucky, Lexington, Kentucky, and coauthors. “This can also optimize and individualize maintenance TMS protocols to prevent relapse in MDD.”