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Meta-Analysis
. 2021 Jan;51(1):1-10.
doi: 10.1017/S0033291720004729. Epub 2020 Dec 3.

Transcranial magnetic stimulation neurophysiology of patients with major depressive disorder: a systematic review and meta-analysis

Megumi Kinjo  1 , Masataka Wada  1 , Shinichiro Nakajima  1 , Sakiko Tsugawa  1 , Tomomi Nakahara  1 , Daniel M Blumberger  2 , Masaru Mimura  1 , Yoshihiro Noda  1
Affiliations
Meta-Analysis

Transcranial magnetic stimulation neurophysiology of patients with major depressive disorder: a systematic review and meta-analysis

Megumi Kinjo et al. Psychol Med. 2021 Jan.

Abstract

Major depressive disorder (MDD) is a mental illness with high socio-economic burden, but its pathophysiology has not been fully elucidated. Recently, the cortical excitatory and inhibitory imbalance hypothesis and neuroplasticity hypothesis have been proposed for MDD. Although several studies have examined the neurophysiological profiles in MDD using transcranial magnetic stimulation (TMS), a meta-analysis of TMS neurophysiology has not been performed. The objective of this study was to compare TMS-electromyogram (TMS-EMG) findings between patients with MDD and healthy controls (HCs). To this end, we examined whether patients with MDD have lower short-interval cortical inhibition (SICI) which reflects gamma-aminobutyric acid (GABA)A receptor-mediated activity, lower cortical silent period (CSP) which represents GABAB receptor-mediated activity, higher intracortical facilitation (ICF) which reflects glutamate N-methyl-D-aspartate receptor-mediated activity, and the lower result of paired associative stimulation (PAS) paradigm which shows the level of neuroplasticity in comparison with HC. Further, we explored the effect of clinical and demographic factors that may influence TMS neurophysiological indices. We first searched and identified research articles that conducted single- or paired-pulse TMS-EMG on patients with MDD and HC. Subsequently, we extracted the data from the included studies and meta-analyzed the data with the comprehensive meta-analysis software. Patients with MDD were associated with lower SICI, lower CSP, potentially higher ICF, and lower PAS compared with HC. Our results confirmed the proposed hypotheses, suggesting the usefulness of TMS neurophysiology as potential diagnostic markers of MDD.

Keywords: TMS neurophysiology; cortical excitability; cortical inhibition; excitatory and inhibitory imbalance hypothesis; major depressive disorder; neuroplasticity hypothesis.

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Conflict of interest statement

None.

Figures

Fig. 1.
Fig. 1.
The results of meta-analyses for the SICI, LICI, CSP, ICF, and PAS paradigms comparing patients with MDD and HCs. Favors A (left side): HC. Favors B (right side): MDD.
Fig. 2.
Fig. 2.
The results of meta-analyses for the SICI, CSP, and ICF paradigms, when VD was included in MDD. Favors A (left side): HC. Favors B (right side): MDD.
See this image and copyright information in PMC

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