Evidence map›Paper›PMID 30720259›Full record

SynthesisJournal of psychiatry & neuroscience : JPN2019

Unilateral and bilateral repetitive transcranial magnetic stimulation for treatment-resistant depression: a meta-analysis of randomized controlled trials over 2 decades

Shayan Sehatzadeh, Zafiris J. Daskalakis, Belinda Yap, Hong-Anh Tu, Stefan Palimaka, James M. Bowen, Daria J. O’Reilly

Abstract readMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Journal of psychiatry & neuroscience : JPN, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
38citing papers in PubMed, 8 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

38 citing papers in PubMed, 8 syntheses or guidelines pooled it.

  1. Pooled it
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  16. Advances in the Clinical Application of Neurostimulation in Major Depression.Advances in experimental medicine and biology · 2026
    Review
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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

7 authors.

Shayan SehatzadehFrom Health Quality Ontario, Toronto, Ont., Canada (Sehatzadeh, Tu, Palimaka); the Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ont., Canada (Daskalakis); the Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe’s Hamilton, Hamilton, Ont., Canada (Yap, Bowen, O’Reilly); and the Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ont., Canada (Bowen, O’Reilly).
Zafiris J. DaskalakisFrom Health Quality Ontario, Toronto, Ont., Canada (Sehatzadeh, Tu, Palimaka); the Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ont., Canada (Daskalakis); the Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe’s Hamilton, Hamilton, Ont., Canada (Yap, Bowen, O’Reilly); and the Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ont., Canada (Bowen, O’Reilly).
Belinda YapFrom Health Quality Ontario, Toronto, Ont., Canada (Sehatzadeh, Tu, Palimaka); the Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ont., Canada (Daskalakis); the Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe’s Hamilton, Hamilton, Ont., Canada (Yap, Bowen, O’Reilly); and the Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ont., Canada (Bowen, O’Reilly).
Hong-Anh TuFrom Health Quality Ontario, Toronto, Ont., Canada (Sehatzadeh, Tu, Palimaka); the Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ont., Canada (Daskalakis); the Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe’s Hamilton, Hamilton, Ont., Canada (Yap, Bowen, O’Reilly); and the Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ont., Canada (Bowen, O’Reilly).
Stefan PalimakaFrom Health Quality Ontario, Toronto, Ont., Canada (Sehatzadeh, Tu, Palimaka); the Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ont., Canada (Daskalakis); the Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe’s Hamilton, Hamilton, Ont., Canada (Yap, Bowen, O’Reilly); and the Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ont., Canada (Bowen, O’Reilly).
James M. BowenFrom Health Quality Ontario, Toronto, Ont., Canada (Sehatzadeh, Tu, Palimaka); the Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ont., Canada (Daskalakis); the Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe’s Hamilton, Hamilton, Ont., Canada (Yap, Bowen, O’Reilly); and the Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ont., Canada (Bowen, O’Reilly).
Daria J. O’ReillyFrom Health Quality Ontario, Toronto, Ont., Canada (Sehatzadeh, Tu, Palimaka); the Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ont., Canada (Daskalakis); the Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe’s Hamilton, Hamilton, Ont., Canada (Yap, Bowen, O’Reilly); and the Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ont., Canada (Bowen, O’Reilly).

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Approximately 35% of people with depression do not respond to 2 courses of antidepressant medications of adequate dosage, and treatment-resistant depression (TRD) is still a major clinical concern with a great impact on patients, their families, society and the health system. The present meta-analysis evaluates antidepressant efficacy of unilateral and bilateral repetitive transcranial magnetic stimulation (rTMS) in patients with unipolar TRD. Methods: We searched for randomized controlled trials that compared rTMS with sham treatment and were published by Apr. 3, 2017. The primary outcome was improvement in depression scores measured using the Hamilton Rating Scale for Depression. The secondary outcomes were remission and response rates. Two independent review authors screened the studies and extracted the data. Results: Twenty-three studies met the inclusion criteria. Meta-analysis of the depression scores showed a weighted mean difference (WMD) of 3.36 (95% confidence interval [CI] 1.85–4.88) between unilateral rTMS and sham treatment. Stratified data showed that the effect was relatively higher when rTMS was used as an add-on to antidepressant medications (WMD 3.64, 95% CI 1.52–5.76) than when it was used as a stand-alone treatment (WMD 2.47, 95% CI 0.90–4.05). The WMD between bilateral rTMS and sham was 2.67 (95% CI 0.83–4.51), and all studies that contributed to this outcome used rTMS while participants were taking antidepressant medications. The pooled remission and response rates for unilateral rTMS versus sham treatment were 16.0% and 25.1% for rTMS and 5.7% and 11.0% for sham treatment, respectively. The pooled remission and response rates for bilateral rTMS versus sham treatment were 16.6% and 25.4% for rTMS and 2.0% and 6.8% for sham treatment, respectively. Conclusion: This study suggests that rTMS has moderate antidepressant effects and appears to be promising in the short-term treatment of patients with unipolar TRD.

Indexed as

Outcome and Process Assessment, Health CareRandomized Controlled Trials as TopicAdultDepressive Disorder, Treatment-ResistantFemaleHumansMaleMiddle AgedTranscranial Magnetic Stimulation

Identifiers

PMID30720259
PMCPMC6488490

What OpenQuestion holds

Textmetadata
Read underepoch 390

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.