Antidepressant class and concurrent rTMS outcomes in major depressive disorder: a systematic review and meta-analysis

• Published in: EClinicalMedicine 2024-09, Vol.75, p.102760, Article 102760
• Main Authors: Zaidi, Alina, Shami, Rafeya, Sewell, Isabella J., Cao, Xingshan, Giacobbe, Peter, Rabin, Jennifer S., Goubran, Maged, Hamani, Clement, Swardfager, Walter, Davidson, Benjamin, Lipsman, Nir, Nestor, Sean M.
• Format: Article
• Language: English
• Subjects: Antidepressant; Major depressive disorder; Selective serotonin reuptake inhibitors; Serotonin norepinephrine reuptake inhibitors; Transcranial magnetic stimulation
• ISSN: 2589-5370; 2589-5370
• DOI: 10.1016/j.eclinm.2024.102760

Repetitive transcranial magnetic stimulation (rTMS) is frequently used as an adjunctive treatment with antidepressants for depression. We aimed to evaluate the clinical efficacy and safety of antidepressant classes when administered concurrently with rTMS for the management of major depressive disorder (MDD). In this systematic review and meta-analysis, MEDLINE, Embase, PsycINFO, and the Cochrane Library were searched from inception to April 12th 2024 for terms relating to medication, depression, and rTMS and appraised by 2 independent screeners. All randomized clinical trials that prospectively evaluated a specific antidepressant adjunctively with sham rTMS as a control in MDD were included. The study was registered with PROSPERO (CRD42023418435). The primary outcome measure assessed symptomatic improvement measured by formal depression scales. We used a random-effects model with pooled Standardized Mean Differences (SMDs) and log odds ratios (OR). All studies were assessed for their methodological quality and bias using the Cochrane Collaboration Risk of Bias tool version 2 (RoB2). 14 articles from 5376 identified studies were included in the systematic review and meta-analysis. There was only sufficient trial data to evaluate the effects of rTMS and combination therapy with selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs). Across studies, 848 participants (mean [SD] age:41.1 [18.7] years for SSRIs, 51.8 [3.8] years for SNRIs) prospectively examined the efficacy of antidepressant medication with rTMS. Combining rTMS with SSRIs led to significantly lower depression scores, (SMD [CI] of −0.65 [−0.98, −0.31], p = 0.0002, I2 = 66.1%), higher response (OR = 0.97 [0.50, 1.44], p