Association Between Concurrent Psychotropic Medication Use and Clinical Outcomes of Transcranial Magnetic Stimulation for Unipolar or Bipolar Depression: A Systematic Review and Meta-analysis

• Grant number: 24/22023-7
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: February 01, 2025
• End date: January 31, 2026
• Field of knowledge: Health Sciences - Medicine - Psychiatry
• Principal Investigator: Leandro da Costa Lane Valiengo
• Grantee: Isabela Borja de Oliveira
• Host Institution: Instituto de Psiquiatria Doutor Antonio Carlos Pacheco e Silva (IPq). Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP). Secretaria da Saúde (São Paulo - Estado). São Paulo , SP, Brazil

Abstract

Major depressive disorder (MDD) and bipolar disorder (BD) are conditions of high prevalence and significant global impact, with associated costs exceeding $500 billion annually. Treatment-resistant forms of these disorders are associated with even greater economic costs and reductions in quality of life. Transcranial magnetic stimulation (TMS) emerges as an effective alternative for treating unipolar and bipolar depressive disorders; however, the interaction between TMS and psychotropic medications-often used to treat these disorders and their comorbidities-is not yet understood. Medications such as antidepressants, benzodiazepines, anticonvulsants, and antipsychotics may modify the response to TMS, and there is no consensus or prior systematic reviews on how different combinations of these medications influence TMS outcomes. This study aims to synthesize evidence regarding the association between the concomitant use of psychotropic medication and clinical outcomes of TMS in patients with MDD or BD. The systematic review will include: searching and selecting studies, screening, quality assessment, data extraction, and result analysis. Studies will be systematically searched in the MEDLINE, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) databases. Clinical trials and cohort studies that evaluate the association between the use of psychotropic medications and clinical outcomes of TMS will be included, with the primary outcome being changes in the severity of depressive symptoms and additional outcomes including changes in suicidal ideation, general psychiatric symptoms, anxiety, manic symptoms, and cognitive performance. The risk of bias in the included studies will be assessed using the Revised Cochrane Risk-of-Bias Tool for Randomized Trials (RoB 2) for randomized studies and the Risk of Bias in Non-Randomized Studies (ROBINS) for non-randomized studies. Statistical analysis will include random effects meta-analysis for continuous and categorical variables, calculating mean differences, standardized mean differences, or odds ratios. Heterogeneity will be evaluated using Cochran's Q test and the I² statistic. Sensitivity and subgroup analyses will be conducted, including for treatment-resistant patients, and meta-regression will be used to investigate sources of heterogeneity. Expected outcomes for this project include the submission and publication of a scientific article in a prominent journal, as well as oral or poster presentations at conferences related to psychiatry, neuromodulation, or TMS.