Repetitive Transcranial Magnetic Stimulation (rTMS) was found to be more effective for treatment-resistant depression (TRD) than sham rTMS— any approach that tries to mimic the effects of active TMS without the actual brain stimulation—in a meta-analysis recently published in BMC Psychiatry. 

“Our results strengthened that rTMS is associated with clinically relevant antidepressant effect in TRD as well, and may be a beneficial tool in the add-on treatment of patients with TRD,” authors wrote. “Furthermore, rTMS adjunctive treatment to antidepressants was found to be specifically effective in achieving full remission.”

In March 2022, researchers reviewed articles published after 2000 on PubMed and Scopus and compared evidence of rTMS efficacy against standard pharmacotherapy in TRD. Included studies had session numbers between 10 and 30 and pulse numbers between 6000 and 120,000. Depression severity was measured with the Hamilton Depression Rating Scale (HAM-D/HDRS) or the Montgomery-Asberg Depression Rating Scale (MADRS). Random effects models were used to identify the effects of rTMS on response—the number of subjects that had a 50% or more reduction in post-treatment MADRS or HAM-D/HDRS scores—and remission rates.

A total of 19 randomized double-blinded sham-controlled studies were included for response (n = 854 patients) and 9 studies for remission (n = 551 patients). Active rTMS participants had a mean age of 47.7 years and were 52.5% women, and the sham rTMS participants had a mean age of 47.8 years and were 50.3% women. Response risk ratio (RR) for response was 2.25 and remission RR was 2.78 for patients who had experienced 2 treatment failures using rTMS as add-on treatment compared to standard pharmacotherapy. The overall response rates were 39.7% for the active rTMS group and 13.7% for the sham rTMS group while remission rates were 35.71% for the active group and 8.37% in the sham group.

“Further research is needed to identify the patient population that will benefit most from the rTMS treatment,” researchers concluded. “In addition, high quality meta-analyses can also support the conduct of health technology assessments, which can help to secure the reimbursement needed for their application in everyday clinical practice.”