Effects of Hesel-coil deep transcranial magnetic stimulation for depression – a systematic review

<p><b>Background:</b> One third of the depressed patients are not improved by antidepressant drugs and psychological treatments, and there is a need for additional treatments. Repetitive transcranial magnetic stimulation (rTMS) is being developed towards an alternative in treatment-resistant depression. Deep transcranial stimulation (dTMS) with the Hesel-coil (H-coil) is a further development of rTMS aiming to enhance the effect by getting the magnetic pulses to penetrate deeper into the brain.</p> <p><b>Aims:</b> This report aims to assess the evidence-base for dTMS for depression. The report also includes an assessment of the ethical and economic aspects involved.</p> <p><b>Methods:</b> A systematic review of the effects of H-coil dTMS on depression was conducted and the scientific support was evaluated using GRADE (Grading of Recommendations Assessment, Development and Evaluation).</p> <p><b>Results:</b> Only one controlled study was identified. In the sham-controlled randomized study, 212 participants with major depression that had not responded to antidepressant medication were enrolled. A two-point superiority in Hamilton Depression Rating Scale was observed in the dTMS arm vs the sham-arm at 4 weeks, but the difference was not statistically significant. No serious adverse events were reported apart from rare cases of epileptic seizures.</p> <p><b>Conclusions:</b> The existing scientific support for H-coil dTMS therapy for depression is insufficient. The clinical implication is that the use of dTMS in depression should be restricted to the framework of clinical trials pending further studies. Fortunately, additional studies are underway and the evidence base should presumably improve over the next several years.</p

Evidence of Short-term Efficacy of Internet-Delivered Psychological Treatments for Mood and Anxiety Disorders.

<p>ABM =  Attention bias modification. ADIS =  Anxiety Disorders Interview Schedule. BAT =  Behavioral approach test. BDI =  Beck Depression Inventory (I or II). BSQ =  Body Sensations Questionnaire. CBT =  Cognitive behavior therapy. FQ =  Fear Questionnaire. GAD =  Generalized anxiety disorder. GAI =  Generalized Anxiety Inventory. LSAS =  Liebowitz Social Anxiety Scale. OCD =  Obsessive-compulsive disorder. PCL-C =  PTSD Checklist–Civilian version. PDSS =  Panic Disorder Severity Scale, Self-Report. PDT =  Psychodynamic therapy. PSWQ =  Penn State Worry Questionnaire. SIAS =  Social Interaction Anxiety Scale. PTSD =  Posttraumatic stress disorder. SPS =  Social Phobia Scale. Y-BOCS =  Yale-Brown Obsessive-Compulsive Scale.</p>a<p>Study limitations (risk of bias);</p>b<p>Imprecision (e.g., small samples, heterogeneous effect sizes);</p>c<p>Indirectness (e.g., single trial).</p

Randomized controlled trials assessed as having low or moderate risk of bias.

<p>ABM =  Attention bias modification. CBT =  Cognitive behavior therapy. GAD =  Generalized anxiety disorder. OCD =  Obsessive-compulsive disorder. PD =  Panic disorder. PDT =  Psychodynamic therapy. PTSD =  Posttraumatic stress disorder.</p>a<p>Includes full- and part-time employed and students. For a few studies that only reported number of participants on sick leave, we report the proportion not on sick leave.</p>b<p>Psychotropic medication, although this was not stated explicitly in each report.</p>c<p>Includes major depressive episode acute/in partial remission, major depressive disorder, dysthymia; mainly mild/moderate severity, low suicidality.</p>d<p>Mainly GAD, social anxiety disorder, panic disorder; also major depressive disorder (<i>k</i> = 2).</p

Short-term efficacy of therapist-guided internet-based cognitive behavioral therapy (I-CBT) vs. waiting list for depression in adults.

<p>For the meta-analysis, the outcome chosen from each study was the Beck Depression Inventory I or II.</p

Association between pulse width and health-related quality of life after electroconvulsive therapy in patients with unipolar or bipolar depression: an observational register-based study

To examine the association between pulse width and HRQoL measured within one week after electroconvulsive therapy (ECT) and at six-month follow-up in patients with unipolar or bipolar depression. This was an observational register study using data from the Swedish National Quality Registry for ECT (2011–2019). Inclusion criteria were: age ≥18 years; index treatment for unipolar/bipolar depression; unilateral electrode placement; information on pulse width; EQ-5D measurements before and after ECT. Multiple linear regressions were performed to investigate the association between pulse width (0.5 ms) and HRQoL (EQ-5D-3L index; EQ VAS) one week after ECT (primary outcome) and six months after ECT (secondary outcome). The sample included 5,046 patients with unipolar (82%) or bipolar (18%) depression. At first ECT session, 741 patients (14.7%) had pulse width 0.5 ms. There were no statistically significant associations between pulse width and HRQoL one week after ECT. In the subsample of patients with an EQ-5D index recorded six months after ECT (n = 730), patients receiving 0.5 ms had significantly lower HRQoL (−0.089) compared to p = .011). The corresponding analysis for EQ VAS did not show any statistically significant associations. No robust associations were observed between pulse width and HRQoL after ECT. On average, significant improvements in HRQoL were observed one week and six months after ECT for patients with unipolar or bipolar disease, independent of the pulse width received.</p

Short-term efficacy of internet-based attention bias modification (I-ABM) vs. sham treatment for social phobia in adults.

<p>For the meta-analysis, the outcome chosen from each study was the Social Interaction Anxiety Scale.</p

Short-term efficacy of therapist-guided internet-based cognitive behavioral therapy (I-CBT) vs. waiting list for social phobia in adults.

<p>For the meta-analysis, the outcome chosen from each study was the Social Interaction Anxiety Scale.</p

Short-term efficacy of internet-based cognitive behavioral therapy (I-CBT) vs. waiting list for generalized anxiety disorder in adults.

<p>For the meta-analysis, the outcome chosen from each study was the Penn State Worry Questionnaire.</p

Flowchart of included efficacy trials and additional reports of long-term follow-up assessments.

<p>Flowchart of included efficacy trials and additional reports of long-term follow-up assessments.</p