Effects of Hesel-coil deep transcranial magnetic stimulation for depression - a systematic review
Sammanfattning
Background: 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.
Aims: 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.
Methods: 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).
Results: 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.
Conclusions: 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.