Repetitive transcranial magnetic stimulation for the treatment of depression. Systematic review and meta-analysis.

BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) may be useful in the treatment of depression but results from trials have been inconclusive to date. AIMS To assess the efficacy of rTMS in treating depression. METHOD We conducted a systematic review of randomised controlled trials that compared rTMS with sham in patients with depression. We assessed the quality of design of all studies and conducted a meta-analysis of data from trials with similar rTMS delivery. RESULTS We included a total of 14 trials. The quality of the included studies was low. Pooled analysis using the Hamilton Rating Scale for Depression showed an effect in favour of rTMS compared with sham after 2 weeks of treatment (standardised mean difference=-0.35; 95% CI -0.66 to -0.04), but this was not significant at the 2-week follow-up (standardised mean difference=-0.33; 95% CI -0.84 to 0.17). CONCLUSIONS Current trials are of low quality and provide insufficient evidence to support the use of rTMS in the treatment of depression.

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