title: Bilateral vs. unilateral repetitive transcranial magnetic stimulation in treating major depression: a meta-analysis of randomized controlled trials.
abstract: Previous studies have demonstrated inconsistent findings regarding the efficacy of bilateral vs. unilateral repetitive transcranial magnetic stimulation (rTMS) in treating major depressive disorder (MDD). Therefore, this meta-analysis was conducted to compare the efficacy of these two rTMS modalities. Data were obtained from seven randomized controlled trials (RCTs) consisting of 509 subjects. Bilateral and unilateral rTMS displayed comparable efficacy in treating MDD with a pooled odds ratios of 1.06 (95% confidence interval (CI)=0.58-1.91) for response rates and 1.05 (95% CI=0.52-2.11) for remission rates. Subgroup analysis found that bilateral rTMS was equally effective in comparison with both left and right unilateral rTMS. No significant differences in drop-out rates were found. No publication bias was detected. In conclusion, the pooled examination demonstrated that bilateral rTMS displays comparable anti-depressant efficacy and acceptability to unilateral rTMS in treating MDD. These findings suggest that simultaneous rTMS of the right and left dorsolateral prefrontal cortices in MDD patients does not provide marginal benefits in terms of efficacy or acceptability. As the number of RCTs included here was limited, further large-scale multi-center RCTs are required to validate our conclusions.
authors.affiliation: Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, 1 Yixue Road, Yuzhong District, Chongqing 400016, China; Chongqing Key Laboratory of Neurobiology, Chongqing 400016, China; Institute of Neuroscience, Chongqing Medical University, Chongqing 400016, China.
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: Chen
authors.affiliation: Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, 1 Yixue Road, Yuzhong District, Chongqing 400016, China; Chongqing Key Laboratory of Neurobiology, Chongqing 400016, China; Institute of Neuroscience, Chongqing Medical University, Chongqing 400016, China.
authors.forename: Zhao
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, 1 Yixue Road, Yuzhong District, Chongqing 400016, China; Chongqing Key Laboratory of Neurobiology, Chongqing 400016, China; Institute of Neuroscience, Chongqing Medical University, Chongqing 400016, China.
authors.forename: Dan
authors.initials: D
authors.lastname: Zhu
authors.affiliation: Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, 1 Yixue Road, Yuzhong District, Chongqing 400016, China; Chongqing Key Laboratory of Neurobiology, Chongqing 400016, China; Institute of Neuroscience, Chongqing Medical University, Chongqing 400016, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Li
authors.affiliation: Chongqing Key Laboratory of Neurobiology, Chongqing 400016, China; Institute of Neuroscience, Chongqing Medical University, Chongqing 400016, China.
authors.forename: Hongzhi
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Chongqing Key Laboratory of Neurobiology, Chongqing 400016, China; Institute of Neuroscience, Chongqing Medical University, Chongqing 400016, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Huang
authors.affiliation: Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, 1 Yixue Road, Yuzhong District, Chongqing 400016, China; Chongqing Key Laboratory of Neurobiology, Chongqing 400016, China; Institute of Neuroscience, Chongqing Medical University, Chongqing 400016, China.
authors.forename: Youdong
authors.initials: Y
authors.lastname: Wei
authors.affiliation: Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, 1 Yixue Road, Yuzhong District, Chongqing 400016, China; Chongqing Key Laboratory of Neurobiology, Chongqing 400016, China; Institute of Neuroscience, Chongqing Medical University, Chongqing 400016, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Mu
authors.affiliation: Chongqing Key Laboratory of Neurobiology, Chongqing 400016, China; Institute of Neuroscience, Chongqing Medical University, Chongqing 400016, China.
authors.forename: Deyu
authors.initials: D
authors.lastname: Yang
authors.affiliation: Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, 1 Yixue Road, Yuzhong District, Chongqing 400016, China; Chongqing Key Laboratory of Neurobiology, Chongqing 400016, China; Institute of Neuroscience, Chongqing Medical University, Chongqing 400016, China. Electronic address: xiepeng@cqmu.edu.cn.
authors.forename: Peng
authors.initials: P
authors.lastname: Xie
mesh_terms: D003865:Major Depressive Disorder / Q000628:therapy*; D006801:Humans; D008297:Male; D016032:Randomized Controlled Trials as Topic; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome
keywords: Depression; MDD; Meta-analysis; Repetitive transcranial magnetic stimulation; rTMS