title: Should we expand the toolbox of psychiatric treatment methods to include Repetitive Transcranial Magnetic Stimulation (rTMS)? A meta-analysis of the efficacy of rTMS in psychiatric disorders.
abstract: OBJECTIVE
  Repetitive transcranial magnetic stimulation (rTMS) is a safe treatment method with few side effects. However, efficacy for various psychiatric disorders is currently not clear.
  
  
  METHODS
  A literature search was performed from 1966 through October 2008 using PubMed, Ovid Medline, Embase Psychiatry, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, and PsycINFO. The following search terms were used: transcranial magnetic stimulation, TMS, repetitive TMS, psychiatry, mental disorder, psychiatric disorder, anxiety disorder, attention-deficit hyperactivity disorder, bipolar disorder, catatonia, mania, depression, obsessive-compulsive disorder, psychosis, posttraumatic stress disorder, schizophrenia, Tourette's syndrome, bulimia nervosa, and addiction.
  
  
  METHODS
  Data were obtained from randomized, sham-controlled studies of rTMS treatment for depression (34 studies), auditory verbal hallucinations (AVH, 7 studies), negative symptoms in schizophrenia (7 studies), and obsessive-compulsive disorder (OCD, 3 studies). Studies of rTMS versus electroconvulsive treatment (ECT, 6 studies) for depression were meta-analyzed.
  
  
  METHODS
  Standardized mean effect sizes of rTMS versus sham were computed based on pretreatment-posttreatment comparisons.
  
  
  RESULTS
  The mean weighted effect size of rTMS versus sham for depression was 0.55 (P < .001). Monotherapy with rTMS was more effective than rTMS as adjunctive to antidepressant medication. ECT was superior to rTMS in the treatment of depression (mean weighted effect size -0.47, P = .004). In the treatment of AVH, rTMS was superior to sham treatment, with a mean weighted effect size of 0.54 (P < .001). The mean weighted effect size for rTMS versus sham in the treatment of negative symptoms in schizophrenia was 0.39 (P = .11) and for OCD, 0.15 (P = .52). Side effects were mild, yet more prevalent with high-frequency rTMS at frontal locations.
  
  
  CONCLUSIONS
  It is time to provide rTMS as a clinical treatment method for depression, for auditory verbal hallucinations, and possibly for negative symptoms. We do not recommend rTMS for the treatment of OCD.
authors.affiliation: Center for Personality Disorders, Lijnbaan 4, The Hague, the Netherlands. c.slotema@psyq.nl
authors.forename: Christina W
authors.initials: CW
authors.lastname: Slotema
authors.forename: Jan Dirk
authors.initials: JD
authors.lastname: Blom
authors.forename: Hans W
authors.initials: HW
authors.lastname: Hoek
authors.forename: Iris E C
authors.initials: IE
authors.lastname: Sommer
mesh_terms: D003131:Combined Modality Therapy; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D004565:Electroconvulsive Therapy; D006212:Hallucinations / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D011569:Psychiatric Status Rating Scales; D016032:Randomized Controlled Trials as Topic; D012559:Schizophrenia / Q000175:diagnosis / Q000628:therapy; D012565:Schizophrenic Psychology; D050781:Transcranial Magnetic Stimulation / Q000009:adverse effects; D016896:Treatment Outcome