Repetitive transcranial magnetic stimulation (TMS) is now widely available for the clinical treatment of depression, but the associated financial and time burdens are problematic for patients. Accelerated TMS (aTMS) protocols address these burdens and attempt to increase the efficiency of standard TMS. This systematic review and meta-analysis aimed to examine accelerated TMS studies for depressive disorders in accordance with PRISMA guidelines. Inclusion criteria consisted of studies with full text publications available in English describing more than one session of TMS (repetitive or theta burst stimulation) per day. Studies describing accelerated TMS protocols for conditions other than depression or alternative neuromodulation methods, preclinical studies, and neurophysiology studies regarding transcranial stimulation were excluded. Eighteen articles describing eleven distinct studies (seven publications described overlapping samples) met eligibility criteria. A Hedges’ g effect size and confidence intervals were calculated. The summary analysis of three suitable randomized control trials revealed a cumulative effect size of 0.39 (95% CI 0.005–0.779). A separate analysis including open-label trials and active arms of suitable RCTs revealed a g of 1.27 (95% CI 0.902–1.637). Overall, the meta-analysis suggested that aTMS improves depressive symptom severity. In general, study methodologies were acceptable, but future efforts could enhance sham techniques and blinding.
Bibliographical noteFunding Information:
DDC receives research grant support from the Mayo Foundation Departmental Small Grant Program. JLVV receives equipment in-kind support from Assurex Health, Inc. for an investigator-initiated study and is a site investigator for a multicenter study funded by Neuronetics, Inc. SK receives research support from the Mayo Clinic Department of Psychiatry and Psychology and equipment in-kind support from Assurex Health, Inc. and Neuronetics, Inc. He is a site investigator for a multicenter trial funded by NeoSync, Inc. and has received speaker support from Psychopharmacology Institute. CPL receives research grant support from the Mayo Foundation Departmental Small Grant Program and is a site investigator on multicenter studies funded by Neuronetics, Inc. and NeoSync, Inc. PEC has received research grant support from Pfizer , Inc., has received equipment support from Neuronetics, Inc., and receives supplies and genotyping services from Assurex Health, Inc. for an investigator-initiated study. He is the primary investigator for a multicenter study funded by Neuronetics, Inc. and a site primary investigator for a study funded by NeoSync, Inc. AIS and ALN have no financial conflicts of interest.
This research was supported by grants from the Brain and Behavior Research Foundation (Young Investigator Award 20883 ) and the National Institute of Mental Health ( R01MH113700 ). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
- Accelerated TMS
- Major depressive disorder
- Treatment resistant depression