Randomized controlled trials that were excluded from the meta-analysis (n = 13)
| Study | Participants | Methods | Outcome measures | Conclusions | Reason for exclusion |
|---|---|---|---|---|---|
| Berman et al (34) | 20 Adults: major depression Failed to benefit from 1 trial of antidepressants | Parallel study Intent-to-treat analysis Left DLPFC 80% intensity 20 Hz for 10 weekdays 20 trains for 2-s duration with a 28-s intertrain interval Sham at 30°–45° | 25-item HAM-D HAM-A BDI | Statistically significant, but clinically modest, reductions of depressive symptoms | Outcome measure not the 21-item HAM-D |
| Boutros et al (30) | 22 Adults: major depression Failed to benefit from 2 trials of antidepressants | Parallel study Left DLPFC 80% intensity 20 Hz for 10 weekdays 20 trains for 2-s duration with 58-s intertrain interval Sham at 90° | 25-item HAM-D | No significant differences between sham and treatment | Outcome measure not the 21-item HAM-D No intent-to-treat analysis |
| Garcia-Toro et al (27) | 40 Adults: major depression Failed to benefit from 2 trials of antidepressants | Parallel study Left DLPFC 90% intensity 20 Hz for 10 weekdays 30 trains for 2-s duration with a 20–40-s intertrain interval Sham at 90° | 21-item HAM-D HAM-A CGI BDI | TMS associated with significant decrease on HAM-D | No intent-to-treat analysis |
| Garcia-Toro et al (28) | 28 Adults: major depression | Parallel study Left DLPFC 90% intensity 20 Hz for 10 weekdays Sham at 90° | 21-item HAM-D | TMS does not add efficacy over the use of standard antidepressant medication | No intent-to-treat analysis Concurrent treatment with sertraline |
| Herwig et al (38) | 25 Adults: major depression | Parallel study Intent-to-treat analysis Left DLPFC 110% intensity 15 Hz for 10 weekdays 30 trains for 2-s duration with a 4-s intertrain interval Sham at parieto-occipital transition | 21-item HAM-D MADRS BDI | Moderate antidepressant effect | Neuronavigation with PET used to localize DLPFC (different method from other studies) Sham conditions not the same as in the other studies |
| Hoppner et al (32) | 30 Adults: major depression | Parallel study Left DLPFC compared with right DLPFC and sham 90% intensity 20 Hz for 10 weekdays 20 trains for 2-s duration with a 60-s intertrain interval Sham at 90° | 21-item HAM-D BDI | No significant differences between sham and treatment | No intent-to-treat analysis |
| Klein et al (29) | 70 Adults: major depression | Parallel study Right DLPFC 1 Hz for 10 weekdays Sham at 90° | 17-item HAM-D MADRS CGI | Significantly greater improvement on depression scales with rTMS | Right DLPFC 1-Hz frequency No intent-to-treat analysis |
| Loo et al (37) | 19 Adults: major depression Medication resistant | Parallel study Intent-to-treat analysis Bilateral PFC 90% intensity 15 Hz for 3 weeks 24 trains for 5-s duration with a 25-s intertrain interval | HAM-D MADRS | No significant differences between sham and treatment | Bilateral prefrontal stimulation |
| Loo et al (33) | 18 Adults: 15 major depression 3 bipolar depression (1 with psychotic features) | Parallel study Intent-to-treat analysis Left DLPFC 110% intensity 10 Hz for 10 weekdays 30 trains of 5-s duration with 30-s intertrain intervals Sham at 45° | 17-item HAM-D MADRS BDI | No significant differences between sham and treatment | Outcome measure not the 21-item HAM-D |
| Manes et al (26) | 20 Elderly subjects: major depression Treatment refractory | Parallel study Left DLPFC 80% intensity 20 Hz for 5 days 20 trains of 2-s duration | HAM-D | No significant differences | Elderly subjects |
| Padberg et al (31) | 31 Adults: major depression | Parallel study Left DLPFC 100% and 90% intensity 10 Hz for 10 weekdays 15 trains of 10-s duration with 30-s intertrain interval | 21-item HAM-D MADRS CGI | Significant reduction in depression scores with treatment | No intent-to-treat analysis Data reported as means (and SEM) instead of means (and SD) |
| Pascual-Leone et al (36) | 17 Adults: major depression with psychotic features | Multiple crossover study Intent-to-treat analysis Left DLPFC 90% intensity 10 Hz for 5 days 20 trains of 10-s duration with 1-min intertrain intervals Sham at 45° Patients also treated with nimodipine | 21-item HAM-D | Significant decrease in depression scores | Psychotic subtype of depression Concurrent treatment with nimodipine |
| Szuba et al (35) | 16 Adults: major depression | Parallel study Intent-to-treat analysis Left DLPFC 100% intensity 10 Hz for 2 weeks 20 trains of 5-s duration over 10 minutes Outcomes measured before and after each session of TMS Sham at 90° | HAM-6 YMR-6 POMS | Significantly greater improvement on the POMS in the TMS group | Outcome measure not the 21-item HAM-D Outcomes were measured before and after each treatment (not at the end of 2 weeks as in the other studies) |
Note: BDI = Beck Depression Inventory; CGI = Clinical Global Impressions scale; DLPFC = dorsolateral prefrontal cortex; HAM-6 = 6-Item Hamilton Rating Scale for Depression; HAM-A = Hamilton Rating Scale for Anxiety; HAM-D = Hamilton Rating Scale for Depression; MADRS = Montgomery–Asberg Depression Rating Scale; PET = positron emission tomography; POMS = Profile of Mood States; rTMS = repetitive transcranial magnetic stimulation; SD = standard deviation; SEM = standard error of the mean; TMS = transcranial magnetic stimulation; YMR-6 = 6-item Young Mania Rating Scale.