REVIEW OF: Filipcic I et al, J Psychiatr Res 2019;114:113–119

TYPE OF STUDY: Randomized single-blind controlled trial

Seven transcranial magnetic stimulation (TMS) devices are FDA approved for depression, but only one—the Brainsway—is distinctly different from the others. Brainsway uses a patented H1 coil that penetrates deeper into the cortex than the standard figure-8 coil. Brainsway’s marketing materials suggest that deeper is better, but the two versions of TMS have never been compared head to head—until now.

In this non-industry-sponsored study, 228 patients with moderate major depression were randomized to 1 of 3 arms over 4 weeks: TMS with the H1 coil, TMS with the figure-8 coil, or 2 visits of standard psychopharmacology. All patients were taking an antidepressant and stayed on that medication during the trial. The evaluators were blinded, but the patients knew which treatment they were getting. The primary outcome was remission on the 17-item Hamilton Rating Scale for Depression (HAMD-17). The study was funded by a public psychiatric hospital in Croatia, which is where the treatments were conducted.

The H1 coil and figure-8 coil were not statistically different on the primary outcome of remission, although both were superior to the standard psychopharmacology group. On secondary measures, the H1 coil had a greater response rate on the HAMD-17 than the figure-8 coil, but there were no differences in the total change on the HAMD-17 on quality-of-life measures. Likewise, safety and tolerability were equal for both devices.

These mixed results are similar to a recent meta-analysis that looked at outcomes in 19 studies of the 2 coils. The H1 coil led to greater reductions in depression severity, but the figure-8 coil had a slight advantage in remission rates (Gellersen HM and Kedzoir KK, BMC Psych 2019;19(1):139).

TCPR’s TAKE
Both types of TMS work, and deeper stimulation with the H1 coil does not work any better than earlier figure-8 coils.