title: Meta-Review of Metanalytic Studies with Repetitive Transcranial Magnetic Stimulation (rTMS) for the Treatment of Major Depression.
abstract: BACKGROUND
  Major Depression (MD) and treatment-resistant depression (TRD) are worldwide leading causes of disability and therapeutic strategies for these impairing and prevalent conditions include pharmacological augmentation strategies and brain stimulation techniques. In this perspective, repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique with a favorable profile of tolerability which, despite being recently approved by the Food and Drug Administration (FDA) for the treatment of patients with medication-refractory unipolar depression, still raises some doubts about most effective parameters of stimulation.
  
  
  METHODS
  A literature search was performed using PubMed for the years 2001 through February 2011 in order to review meta-analytic studies assessing efficacy and safety issues for rTMS in depressive disorders. Fifteen meta-analyses were identified and critically discussed in order to provide an updated and comprehensive overview of the topic with specific emphasis on potentially optimal parameters of stimulation.
  
  
  RESULTS
  First meta-analyses on the efficacy of rTMS for the treatment of MD and TRD have shown mixed results. On the other hand, more recent meta-analytic studies seem to support the antidepressant efficacy of the technique to a greater extent, also in light of longer periods of stimulation (e.g. > 2 weeks).
  
  
  CONCLUSIONS
  rTMS seems to be an effective and safe brain stimulation technique for the treatment of medication refractory depression. Nevertheless, further studies are needed to better define specific stimulation-related issues, such as duration of treatment as well as durability of effects and predictors of response.
authors.affiliation: Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Dell'osso
authors.forename: Giulia
authors.initials: G
authors.lastname: Camuri
authors.forename: Filippo
authors.initials: F
authors.lastname: Castellano
authors.forename: Vittoria
authors.initials: V
authors.lastname: Vecchi
authors.forename: Matteo
authors.initials: M
authors.lastname: Benedetti
authors.forename: Sara
authors.initials: S
authors.lastname: Bortolussi
authors.forename: A Carlo
authors.initials: AC
authors.lastname: Altamura