Evidence map›Paper›PMID 30621636›Full record

SynthesisBMC psychiatry2019

A systematic literature review of the clinical efficacy of repetitive transcranial magnetic stimulation (rTMS) in non-treatment resistant patients with major depressive disorder.

Jeffrey Voigt, Linda Carpenter, Andrew Leuchter

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC psychiatry, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
28citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

28 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Trial
  4. Trial
  5. Trial
  6. Advances in the Clinical Application of Neurostimulation in Major Depression.Advances in experimental medicine and biology · 2026
    Review
  7. Article
  8. Open letter to the Medical Services Advisory Committee regarding TMS Item Number regulations.Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists · 2025
    Article
  9. Article
  10. Review
  11. Article
  12. Review
  13. Psychiatric Considerations of Infertility.Psychiatry investigation · 2024
    Article
  14. Review
  15. Article
  16. Article
  17. Article
  18. Article
  19. Review
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors.

Jeffrey VoigtMedical Device Consultants of Ridgewood, LLC, 99 Glenwood Rd, Ridgewood, NJ, 07450, USA. meddevconsultant@aol.com.
Linda CarpenterDepartment of Psychiatry and Human Behavior, Brown Institute for Brain Science, Brown University, 700 Butler Dr, Providence, RI, 02906, USA.
Andrew LeuchterUniversity of California Los Angeles (UCLA), Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, UCLA, 760 Westwood Plaza, Room 37-452, Los Angeles, CA, 90095, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe clinical efficacy of repetitive transcranial magnetic stimulation (rTMS) in treatment resistant patients (at least 4 medication trials) appears to be well accepted and forms the coverage policies and rTMS's use in many of the largest US payers. However, less is known about rTMS's use in patients who have undergone ≤1 failed medication trial. The purpose of this analysis was to determine the clinical efficacy of rTMS in patients after ≤1 medication trials.

methodsA systematic review of the literature was undertaken to identify all articles which addressed the use of rTMS in ≤1 medication trial. All types of study designs were included and assessed for quality and strength of evidence using: GRADE and CEBM. Searches of peer reviewed articles were undertaken for the year 2000 to the present. All languages were considered. Electronic databases were searched and included: PubMed and EBSCO. Evidence assessment websites were also searched and included: Cochrane, NICE, AHRQ, and ICER. Additionally, the clinical guidelines for specialty societies which use rTMS was searched. Hand searches of the reference sections of identified articles was also undertaken.

resultsElectronic and other sources identified 165 after duplicates were removed. Twenty two articles were assessed for eligibility and ultimately 10 articles were included in the systematic review and graded. Six articles were graded high quality (CEBM/GRADE: 1c/B) demonstrating that the use of rTMS was clinically efficacious in patients after ≤1 medication trial. Four additional trials demonstrated a positive effect of rTMS in patients after ≤1 medication trial but were of a lower quality.

conclusionThe use of rTMS in patients after ≤1 medication trial should be considered. US payers should consider revising their coverage policies to include the use of rTMS in these patients.

Indexed as

Antidepressive AgentsHumansMajor Depressive DisorderRandomized Controlled Trials as TopicTranscranial Magnetic StimulationTreatment OutcomeAntidepressive AgentsClinical efficacyMedication resistanceRepetitive transcranial magnetic stimulation

Identifiers

PMID30621636
PMCPMC6325728

What OpenQuestion holds

Textmetadata
LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.