Repetitive Transcranial Magnetic Stimulation for Major Depressive Disorder in Older Adults: Systematic Review and Meta-analysis

被引:36
作者
Valiengo, Leandro [1 ,2 ]
Maia, Ana [3 ,4 ]
Cotovio, Goncalo [3 ,4 ]
Gordon, Pedro C. [2 ,5 ]
Brunoni, Andre R. [1 ,2 ]
Forlenza, Orestes, V [1 ]
Oliveira-Maia, Albino J. [3 ,6 ]
机构
[1] Univ Sao Paulo, Hosp Clin HCFMUSP, Fac Med, Dept & Inst Psiquiatria,Lab Neurociencias LIM 27, Sao Paulo, Brazil
[2] Univ Sao Paulo, Serv Interdisciplinar Neuromodulacao SIN, Dept & Inst Psiquiatria, Hosp Clin HCFMUSP,Fac Med, Sao Paulo, Brazil
[3] Champalimaud Ctr Unknown, Champalimaud Res & Clin Ctr, Av Brasilia, P-1400038 Lisbon, Portugal
[4] Ctr Hosp Lisboa Ocidental, Dept Psychiat & Mental Hlth, Lisbon, Portugal
[5] Univ Tubingen, Hertie Inst Clin Brain Res, Dept Neurol & Stroke, Tubingen, Germany
[6] Univ Nova Lisboa, NMS, NOVA Med Sch, Lisbon, Portugal
来源
JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES | 2022年 / 77卷 / 04期
基金
巴西圣保罗研究基金会;
关键词
Brain stimulation; Depression; Meta-analysis; Meta-regression; TREATMENT-RESISTANT DEPRESSION; CEREBRAL BLOOD-FLOW; VASCULAR DEPRESSION; PREFRONTAL CORTEX; META-REGRESSION; DOUBLE-BLIND; OPEN-LABEL; HF-RTMS; EFFICACY; LIFE;
D O I
10.1093/gerona/glab235
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
Background Major depressive disorder (MDD) in older adults is a serious public health concern. Repetitive transcranial magnetic stimulation (rTMS) is a nonpharmacological intervention approved for MDD treatment in adults, but its value in older adults remains unknown. This study aims to systematically review and meta-analyze evidence of rTMS efficacy in MDD treatment among older adults. Methods We systematically reviewed the literature for randomized controlled trials (RCTs) and open-label studies assessing rTMS for the treatment of MDD in patients older than 50 years, published until June 2020. Random-effects meta-analyses using standardized mean differences (SMDs) were conducted to assess change in depression severity score (primary outcome), while odds ratios (ORs) were used to assess secondary categorical outcomes (response and remission). Additionally, univariate meta-regression analyses were performed to identify potential predictors of change in depression severity scores. Results Fourteen RCTs were included in meta-analyses and 26 studies (10 RCTs and 16 open-label studies) in meta-regression. Active rTMS was significantly superior to sham treatment for reduction of severity (SMD = 0.36; 95% CI = 0.13-0.60), as well as response (OR = 3.26; 95% CI = 2.11-5.04) and remission (OR = 4.63; 95% CI = 2.24-9.55). Studies were of moderate to high quality, with funnel plots and Egger's regression test not suggestive of publication bias. In meta-regressions, higher mean age and number of sessions were significantly associated with greater improvement. Conclusions Our results support that rTMS is an effective, safe, and well-tolerated treatment for MDD in older adults and that it should be considered in the treatment of this vulnerable population.
引用
收藏
页码:851 / 860
页数:10
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