title: Has repetitive transcranial magnetic stimulation (rTMS) treatment for depression improved? A systematic review and meta-analysis comparing the recent vs. the earlier rTMS studies.
abstract: OBJECTIVE
  To investigate whether the recent repetitive transcranial magnetic stimulation (rTMS) studies on depression using new parameters of stimulation have shown improved clinical results.
  
  
  METHODS
  We performed a systematic review and a meta-analysis of the rTMS studies on depression published in the past 12 months comparing these results with an earlier meta-analysis that analyzed the results of the initial rTMS studies on depression.
  
  
  RESULTS
  Using our inclusion criteria, we selected the meta-analysis of Martin [Br J Psychiatry (2003) Vol. 182, 480-491] that included 13 studies (324 patients) and five studies for the recent meta-analysis (274 patients). The pooled effect size (standardized mean difference between pretreatment vs. post-treatment) from the random effects model was -0.76 (95% confidence interval, CI, -1.01 to -0.51). This result was significantly larger than that of the earlier meta-analysis (-0.35, 95% CI -0.66 to -0.04).
  
  
  CONCLUSIONS
  Our findings suggest that recent rTMS clinical trials have shown larger antidepressant effects when compared with the earlier studies.
authors.affiliation: Department of Psychiatry, University of São Paulo, São Paulo, Brazil.
authors.forename: M
authors.initials: M
authors.lastname: Gross
authors.forename: L
authors.initials: L
authors.lastname: Nakamura
authors.forename: A
authors.initials: A
authors.lastname: Pascual-Leone
authors.forename: F
authors.initials: F
authors.lastname: Fregni
mesh_terms: D003866:Depressive Disorder / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D004292:Dominance, Cerebral / Q000502:physiology; D006801:Humans; D017397:Prefrontal Cortex / Q000503:physiopathology; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome