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More rTMS pulses or more sessions? The impact on treatment outcome for treatment resistant depression.

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Title: More rTMS pulses or more sessions? The impact on treatment outcome for treatment resistant depression.
Authors: Oostra, E. (AUTHOR), Jazdzyk, P. (AUTHOR), Vis, V. (AUTHOR), Dalhuisen, I. (AUTHOR), Hoogendoorn, A. W. (AUTHOR), Planting, C. H. M. (AUTHOR), van Eijndhoven, P. F. (AUTHOR), van der Werf, Y. D. (AUTHOR), van den Heuvel, O. A. (AUTHOR), van Exel, E. (AUTHOR)
Source: Acta Psychiatrica Scandinavica. Apr2025, Vol. 151 Issue 4, p485-505. 21p.
Subjects: Transcranial magnetic stimulation, Treatment effectiveness, Clinical trials, Database searching, Subgroup analysis (Experimental design)
Abstract: Background: Repetitive transcranial magnetic stimulation (rTMS) is effective for treatment‐resistant depression (TRD). Optimal rTMS parameters remain unclear, especially whether number of sessions or amount of pulses contribute more to treatment outcome. We hypothesize that treatment outcome depends on the number of sessions rather than on the amount of pulses. Methods: We searched databases for randomized clinical trials (RCTs) on high‐frequent (HF) or low‐frequent (LF)‐rTMS targeting the left or right DLPFC for TRD. Treatment efficacy was measured using standardized mean difference (SMD), calculated from pre‐ and post‐treatment depression scores. Meta‐regressions were used to explore linear associations between SMD and rTMS pulses, pulses/session and sessions for HF and LF‐rTMS, separately for active and sham‐rTMS. If these variables showed no linear association with SMD, we divided the data into quartiles and explored subgroup SMDs. Results: Eighty‐seven RCTs were included: 67 studied HF‐rTMS, eleven studied LF‐rTMS, and nine studied both. No linear association was found between SMD and amount of pulses or pulses/session for HF and LF‐rTMS. Subgroup analyses showed the largest SMDs for 1200–1500 HF‐pulses/session and 360–450 LF‐pulses/session. The number of sessions was significantly associated with SMD for active HF (β = 0.09, p < 0.05) and LF‐rTMS (β = 0.06, p < 0.01). Thirty was the maximal number of sessions, in the included RCTs. Conclusion: More rTMS sessions, but not more pulses, were associated with improved treatment outcome, in both HF and LF‐rTMS. Our findings suggest that 1200–1500 HF‐pulses/session and 360–450 LF‐pulses/session are already sufficient, and that a treatment course should consist of least 30 sessions for higher chance of response. [ABSTRACT FROM AUTHOR]
Copyright of Acta Psychiatrica Scandinavica is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: More rTMS pulses or more sessions? The impact on treatment outcome for treatment resistant depression.
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  Data: &lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Oostra%2C+E%2E%22&quot;&gt;Oostra, E.&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Jazdzyk%2C+P%2E%22&quot;&gt;Jazdzyk, P.&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Vis%2C+V%2E%22&quot;&gt;Vis, V.&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Dalhuisen%2C+I%2E%22&quot;&gt;Dalhuisen, I.&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Hoogendoorn%2C+A%2E+W%2E%22&quot;&gt;Hoogendoorn, A. W.&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Planting%2C+C%2E+H%2E+M%2E%22&quot;&gt;Planting, C. H. M.&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22van+Eijndhoven%2C+P%2E+F%2E%22&quot;&gt;van Eijndhoven, P. F.&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22van+der+Werf%2C+Y%2E+D%2E%22&quot;&gt;van der Werf, Y. D.&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22van+den+Heuvel%2C+O%2E+A%2E%22&quot;&gt;van den Heuvel, O. A.&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22van+Exel%2C+E%2E%22&quot;&gt;van Exel, E.&lt;/searchLink&gt; (AUTHOR)
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  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%22Acta+Psychiatrica+Scandinavica%22&quot;&gt;Acta Psychiatrica Scandinavica&lt;/searchLink&gt;. Apr2025, Vol. 151 Issue 4, p485-505. 21p.
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– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: Repetitive transcranial magnetic stimulation (rTMS) is effective for treatment‐resistant depression (TRD). Optimal rTMS parameters remain unclear, especially whether number of sessions or amount of pulses contribute more to treatment outcome. We hypothesize that treatment outcome depends on the number of sessions rather than on the amount of pulses. Methods: We searched databases for randomized clinical trials (RCTs) on high‐frequent (HF) or low‐frequent (LF)‐rTMS targeting the left or right DLPFC for TRD. Treatment efficacy was measured using standardized mean difference (SMD), calculated from pre‐ and post‐treatment depression scores. Meta‐regressions were used to explore linear associations between SMD and rTMS pulses, pulses/session and sessions for HF and LF‐rTMS, separately for active and sham‐rTMS. If these variables showed no linear association with SMD, we divided the data into quartiles and explored subgroup SMDs. Results: Eighty‐seven RCTs were included: 67 studied HF‐rTMS, eleven studied LF‐rTMS, and nine studied both. No linear association was found between SMD and amount of pulses or pulses/session for HF and LF‐rTMS. Subgroup analyses showed the largest SMDs for 1200–1500 HF‐pulses/session and 360–450 LF‐pulses/session. The number of sessions was significantly associated with SMD for active HF (β = 0.09, p &lt; 0.05) and LF‐rTMS (β = 0.06, p &lt; 0.01). Thirty was the maximal number of sessions, in the included RCTs. Conclusion: More rTMS sessions, but not more pulses, were associated with improved treatment outcome, in both HF and LF‐rTMS. Our findings suggest that 1200–1500 HF‐pulses/session and 360–450 LF‐pulses/session are already sufficient, and that a treatment course should consist of least 30 sessions for higher chance of response. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
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  Data: &lt;i&gt;Copyright of Acta Psychiatrica Scandinavica is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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        Value: 10.1111/acps.13768
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        Text: English
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              Text: Apr2025
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