@article {Couturier83, author = {Jennifer L. Couturier}, title = {Efficacy of rapid-rate repetitive transcranial magnetic stimulation in the treatment of depression: a systematic review and meta-analysis}, volume = {30}, number = {2}, pages = {83--90}, year = {2005}, publisher = {Journal of Psychiatry and Neuroscience}, abstract = {Objective: To systematically review the literature pertaining to rapid-rate repetitive transcranial magnetic stimulation (rTMS) compared with sham therapy for the treatment of a major depressive episode in order to arrive at qualitative and quantitative conclusions about the efficacy of rapid-rate rTMS.Methods: MEDLINE, the Cochrane Library, the metaRegister of Controlled Trials and abstracts from scientific meetings were searched for the years 1966 until July 2003. The search terms {\textquotedblleft}transcranial magnetic stimulation{\textquotedblright} and {\textquotedblleft}transcranial magnetic stimulation AND depression{\textquotedblright} were used. Eighty-seven randomized controlled trials investigating the efficacy of rTMS were referenced on MEDLINE. Nineteen of these involved treatment of a major depressive episode, and these were reviewed. Six met more specific inclusion criteria including the use of rapid-rate stimulation, application to the left dorsolateral prefrontal cortex, evaluation with the 21-item Hamilton Rating Scale for Depression (HAM-D) and use of an intent-to-treat analysis. Scores on the 21-item HAM-D after treatment and standard deviations were extracted from each article for treatment and control subjects. A random-effects model was chosen for the meta-analysis, and the weighted mean difference was used as a summary measure.Results: Six studies that met the inclusion criteria were identified and included in the meta-analysis. Two of these reported a significantly greater improvement in mood symptoms in the treatment versus the sham group. When combined in the meta-analysis, the overall weighted mean difference was -1.1 (95\% confidence interval -4.5 to 2.3), and the results of a test for heterogeneity were not significant (χ25 = 5.81, p = 0.33).Conclusions: This meta-analysis suggests that rapid-rate rTMS is no different from sham treatment in major depression; however, the power within these studies to detect a difference was generally low. Randomized controlled trials with sufficient power to detect a clinically meaningful difference are required.}, issn = {1180-4882}, URL = {https://www.jpn.ca/content/30/2/83}, eprint = {https://www.jpn.ca/content/30/2/83.full.pdf}, journal = {Journal of Psychiatry and Neuroscience} }