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The British Journal of Psychiatry (2003) 182: 480-491
© 2003 The Royal College of Psychiatrists

REVIEW ARTICLE

Repetitive transcranial magnetic stimulation for the treatment of depression

Systematic review and meta-analysis

JOSÉ LUIS R. MARTIN, MPsychSc

Iberoamerican Cochrane Centre, Hospital de la Santa Crue i Sant Pau, Barcelona, Spain

MANUEL J. BARBANOJ, MD

Department of Pharmacology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

THOMAS E. SCHLAEPFER, MD

University Hospital Bern, Switzerland and The Johns Hopkins University, Baltimore, Maryland, USA

ELINOR THOMPSON, MB

Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

VÍCTOR PÉREZ, MD

Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

JAIME KULISEVSKY, MD

Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

Correspondence: José Luis Rodríguez Martin, Centro Cochrane Iberoamericano, Servei d'Epidemiologia Clínica i Salut Pública, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona UAB, Casa de Convalescència, C/171 Sant Antoni M^a Claret, Barcelona 08041, Spain. E-mail: jrodriguezma{at}hsp.santpau.es

Declaration of interest The study was funded by the Ministerio de Sanidad y Consumo,Instituto de Salud Carlos III, Spain (grant no. 00/10099). T.E.S. is involved in one of the studies included in this review and is also Secretary–Treasurer of the International Society for Transcranial Stimulation.

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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