BACKGROUND: There are no head-to-head studies comparing the antidepressant effect of transcranial direct current stimulation (tDCS) with repetitive transcranial magnetic stimulation (rTMS). This pooled analysis compared indirectly the antidepressant efficacy and acceptability of rTMS, tDCS, and the antidepressant venlafaxine (VNF) extended-release. METHODS: The analysis (n=117, both patients with treatment-resistant depression (TRD) and non-TRD were included) examined pooled data from two 4-week, single-centered, two-armed, double-blind, randomized studies (EUDRACT n. 2005-000826-22 and EUDRACT n. 2015-001639-19). The antidepressant efficacy of right-sided low-frequency rTMS (n=29) vs VNF (n=31) and left-sided anodal tDCS (n=29) vs VNF (n=28) was evaluated. The primary outcome was a change in the Montgomery-Åsberg Depression Rating Scale (MADRS) score from baseline to the treatment endpoint at week 4. The response was defined as a ≥50% reduction in the MADRS score and remission as the MADRS score ≤10 points, both were calculated for the primary treatment endpoint at week 4. RESULTS: Mean change in total MADRS scores from baseline to week 4 was 7.0 (95% CI, 4.8-9.1) points in the rTMS group, 7.6 (95% CI, 5.5-9.8) in the tDCS group, and 8.9 (95% CI, 7.4-10.4) among patients in the VNF group, a non-significant difference (F(2111)=0.62, p=0.54). Similarly, neither the response rates nor remission rates for rTMS (response 31%; remission 17%), tDCS (24%, 17%), or VNF (41%; 27%) significantly differed among treatment groups (χ 2=2.59, p=0.28; χ 2=1.66, p=0.44). Twenty patients (17%) dropped out of the studies in a similar proportion across groups (rTMS 3/29, tDCS 6/29, VNF 11/59, χ 2=1.41, p=0.52). CONCLUSION: Our current analysis found a comparable efficacy and acceptability in all three treatment modalities (rTMS, tDCS, and VNF) and clinical relevance for the acute treatment of major depressive disorder.

Department of Psychiatry and Medical Psychology 3rd Medical Faculty Charles University Prague Czech Republic

NIMH Clinical Center National Institute of Mental Health Czech Republic Klecany Czech Republic

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Murray CJL, Barber RM, Foreman KJ, et al. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: quantifying the epidemiological transition. PubMed PMC

Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. PubMed DOI PMC

Gibbons RD, Hur K, Brown CH, Davis JM, Mann JJ. Benefits from antidepressants synthesis of 6-week patient-level outcomes from double-blind placebo-controlled randomized trials of fluoxetine and venlafaxine. PubMed DOI PMC

Arroll B, Chin WY, Martis W, et al. Antidepressants for treatment of depression in primary care: a systematic review and meta-analysis. PubMed DOI

Rush AJ, Trivedi MH, Wisniewski SR, et al. Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression. PubMed DOI

Kikuchi T, Suzuki T, Uchida H, Watanabe K, Mimura M. Association between antidepressant side effects and functional impairment in patients with major depressive disorders. PubMed DOI

McClintock SM, Reti IM, Carpenter LL, et al. Consensus recommendations for the clinical application of repetitive transcranial magnetic stimulation (rTMS) in the treatment of depression. PubMed DOI PMC

Gaynes BN, Lloyd SW, Lux L, et al. Repetitive transcranial magnetic stimulation for treatment-resistant depression: a systematic review and meta-analysis. PubMed DOI

Berlim MT, van den Eynde F, Tovar-Perdomo S, Daskalakis ZJ. Response, remission and drop-out rates following high-frequency repetitive transcranial magnetic stimulation (rTMS) for treating major depression: a systematic review and meta-analysis of randomized, double-blind and sham-controlled trials. PubMed DOI

Cao X, Deng CS, Su XL, Guo Y. Response and remission rates following high-frequency vs. low-frequency repetitive transcranial magnetic stimulation (rTMS) over right DLPFC for treating major depressive disorder (MDD): a meta-analysis of randomized, double-blind trials. PubMed DOI PMC

Chen JJ, Zhou CJ, Wu B, et al. Left versus right repetitive transcranial magnetic stimulation in treating major depression: a meta-analysis of randomised controlled trials. PubMed DOI

Berlim MT, Van den Eynde F, Daskalakis ZJ. Clinically meaningful efficacy and acceptability of low-frequency repetitive transcranial magnetic stimulation (rTMS) for treating primary major depression: a meta-analysis of randomized, double-blind and sham-controlled trials. PubMed DOI PMC

Milev RV, Giacobbe P, Kennedy SH, et al. Canadian network for mood and anxiety treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 4. neurostimulation treatments. PubMed DOI PMC

Berlim MT, Van den Eynde F, Daskalakis ZJ. Clinical utility of transcranial direct current stimulation (tDCS) for treating major depression: a systematic review and meta-analysis of randomized, double-blind and sham-controlled trials. PubMed DOI

Shiozawa P, Fregni F, Bensenor IM, et al. Transcranial direct current stimulation for major depression: an updated systematic review and meta-analysis (vol 17, pg 1443, 2014). PubMed DOI

Meron D, Hedger N, Garner M, Baldwin DS. Transcranial direct current stimulation (tDCS) in the treatment of depression: systematic review and meta-analysis of efficacy and tolerability. PubMed DOI

Brunoni AR, Moffa AH, Fregni F, et al. Transcranial direct current stimulation for acute major depressive episodes: meta-analysis of individual patient data. PubMed DOI PMC

Mutz J, Edgcumbe DR, Brunoni AR, Fu CHY. Efficacy and acceptability of non-invasive brain stimulation for the treatment of adult unipolar and bipolar depression: a systematic review and meta-analysis of randomised sham-controlled trials. PubMed DOI

Moffa AH, Martin D, Alonzo A, et al. Efficacy and acceptability of transcranial direct current stimulation (tDCS) for major depressive disorder: an individual patient data meta-analysis. PubMed

Bares M, Kopecek M, Novak T, et al. Low frequency (1-Hz), right prefrontal repetitive transcranial magnetic stimulation (rTMS) compared with venlafaxine ER in the treatment of resistant depression: a double-blind, single-centre, randomized study. PubMed DOI

Bares M, Brunovsky M, Stopkova P, Hejzlar M, Novak T. Transcranial direct-current stimulation (tDCS) versus venlafaxine ER in the treatment of depression: a randomized, double-blind, single-center study with open-label, follow-up. PubMed DOI PMC

American Psychiatric Association.

Sheehan DV, Lecrubier Y, Sheehan KH, et al. The mini-international neuropsychiatric interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. PubMed

Montgomery SA, Asberg M. New depression scale designed to be sensitive to change. PubMed DOI

Guy W. Clinical global impression.

Beck AT, Rial WY, Rickels K. Short form of depression inventory - cross-validation. PubMed DOI

Baeken C, Brem AK, Arns M, et al. Repetitive transcranial magnetic stimulation treatment for depressive disorders: current knowledge and future directions. PubMed DOI PMC

Loo CK, Husain MM, McDonald WM, et al. International randomized-controlled trial of transcranial direct current stimulation in depression. PubMed DOI

Mutz J, Vipulananthan V, Carter B, Hurlemann R, Fu CHY, Young AH. Comparative efficacy and acceptability of non-surgical brain stimulation for the acute treatment of major depressive episodes in adults: systematic review and network meta-analysis. PubMed PMC

Razza LB, Palumbo P, Moffa AH, et al. A systematic review and meta-analysis on the effects of transcranial direct current stimulation in depressive episodes. PubMed DOI

Brunelin J, Jalenques I, Trojak B, et al. The efficacy and safety of low frequency repetitive transcranial magnetic stimulation for treatment-resistant depression: the results from a large multicenter French RCT. PubMed DOI

Rigonatti SP, Boggio PS, Myczkowski ML, et al. Transcranial direct stimulation and fluoxetine for the treatment of depression. PubMed DOI

Brunoni AR, Valiengo L, Baccaro A, et al. The sertraline vs electrical current therapy for treating depression clinical study results from a factorial, randomized, controlled trial. PubMed DOI

Brunoni AR, Moffa AH, Sampaio B, et al. Trial of electrical direct-current therapy versus escitalopram for depression. PubMed DOI

Goerigk SA, Padberg F, Buhner M, et al. Distinct trajectories of response to prefrontal tDCS in major depression: results from a 3-arm randomized controlled trial. PubMed DOI PMC

Alonzo A, Fong J, Ball N, Martin D, Chand N, Loo C. Pilot trial of home-administered transcranial direct current stimulation for the treatment of depression. PubMed DOI

Lefaucheur JP, Aleman A, Baeken C, et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): an update (2014–2018). PubMed

Dedoncker J, Brunoni AR, Baeken C, Vanderhasselt MA. A systematic review and meta-analysis of the effects of transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex in healthy and neuropsychiatric samples: influence of stimulation parameters. PubMed DOI

Kiebs M, Hurlemann R, Mutz J. Repetitive transcranial magnetic stimulation in non-treatment-resistant depression. PubMed DOI

Furukawa TA, Cipriani A, Atkinson LZ, et al. Placebo response rates in antidepressant trials: a systematic review of published and unpublished double-blind randomised controlled studies. PubMed DOI

Razza LB, Moffa AH, Moreno ML, et al. A systematic review and meta-analysis on placebo response to repetitive transcranial magnetic stimulation for depression trials. PubMed DOI

Sinyor M, Levitt AJ, Cheung AH, et al. Does inclusion of a placebo arm influence response to active antidepressant treatment in randomized controlled trials? Results from pooled and meta-analyses. PubMed DOI

Kennedy SH, Lam RW, McIntyre RS, et al. Canadian network for mood and anxiety treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 3. pharmacological treatments. PubMed DOI PMC

Henssler J, Kurschus M, Franklin J, Bschor T, Baethge C. Trajectories of acute antidepressant efficacy: how long to wait for response? A systematic review and meta-analysis of long-term, placebo-controlled acute treatment trials. PubMed

Perera T, George MS, Grammer G, Janicak PG, Pascual-Leone A, Wirecki TS. The clinical TMS society consensus review and treatment recommendations for TMS therapy for major depressive disorder. PubMed DOI PMC