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*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

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.

Original languageEnglish
Article number105704
Pages (from-to)105704
JournalNeuroscience and Biobehavioral Reviews
Volume162
DOIs
StatePublished - 07 2024

Bibliographical note

Copyright © 2024 Elsevier Ltd. All rights reserved.

Keywords

  • Dose-response meta-analysis
  • Major depressive disorder
  • Repetitive transcranial magnetic stimulation
  • RTMS parameters
  • Treatment-resistant
  • Dorsolateral Prefrontal Cortex/physiology
  • Humans
  • Transcranial Magnetic Stimulation/methods
  • Depressive Disorder, Treatment-Resistant/therapy

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