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What is the clinical efficacy of high frequency repetitive transcranial magnetic stimulation in people with major depression?
Depressive symptoms measured using the Hamilton Depression Rating Scale (HAMD) or the Montgomery–Asberg Depression Rating Scale (MADRS).
Systematic review with meta-analysis.
PubMed and Web of Science were searched from January 1980 to November 2007 for randomised controlled trials (RCTs). Reference lists of six previous meta-analyses and six reviews were hand searched.
Study selection and analysis:
English language studies from peer reviewed journals were appraised, and RCTs in adults with major depressive episodes without psychotic features (DSM-IV) that met the following criteria were selected: random allocation, double blind, sham controlled, parallel design, intention to treat analysis, minimum of five treatment sessions of high frequency (>5 Hz) repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex with an intensity >80% motor threshold (MT) and treatment sessions completed up to 6 weeks after the first session. Comparator treatments included a sham coil or treatments at 45° and 90° from the scalp. Treatments had to be completed within 6 weeks of the first session for the study to be included. The difference in absolute and percentage changes in HAMD or MADRS scores from baseline to the final session were used to calculate effect sizes, with authors being contacted to obtain missing data. Hedges’ g was used to calculate effect size estimates. To correct for bias in effect size due to small group samples, Hedges’ d …
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