title: Repetitive transcranial magnetic stimulation for the treatment of post-stroke depression: A systematic review and meta-analysis of randomized controlled clinical trials.
abstract: Every year, more than fifteen million people worldwide experience a stroke, nearly 30% of stroke survivors are likely to experience post-stroke depression (PSD). Repetitive transcranial magnetic stimulation (rTMS) is one of the emerging techniques which assist in targeting rehabilitation after stroke. Although deterioration of PSD greatly affects the recovery and quality of life of stroke sufferers, the effect of rTMS therapy has not been systematically studied.
  
  
  
  A systematic review and meta-analysis was conducted to determine the effect of rTMS on PSD.
  
  
  
  We carried out a systematic review and meta-analysis of randomized controlled trials (RCTs) of rTMS for the treatment of PSD. Primary outcome was severity of depression measured by the Hamilton Depression Rating Scale (HAMD). Secondary outcomes were response rates, remission rates, stroke severity and ability to perform daily activities.
  
  
  
  22 RCTs studies (n=1764 patients) were included. The results demonstrated that rTMS was beneficial on PSD using three scales: HAMD (MD=-6.09, 95% CI: -7.74, -4.45, P<0.001); response rates (OR=3.46, 95% CI: 2.52, 4.76, P<0.00001); remission rates (OR 0.99, 95% CI: 0.56, 1.75, P<0.00001); National Institutes of Health Stroke Scale (NIHSS) (MD=-2.74, 95% CI: -3.33, -2.15, P<0.001); Activities of daily living (ADL) (SMD=-1.20, 95% CI: 0.68, 1.72, P<0.001); Montgomery-Asberg Depression Scale (MARDE) (MD=-6.21; 95% CI: -9.34, -3.08; P=0.0001); CONCLUSION: In present meta-analysis, the positive findings suggest rTMS has beneficial effects on PSD. However, those findings should be treated with caution because of heterogeneity and potential biases.
authors.affiliation: Department of Clinical Medicine, Chengdu Medical College, Chengdu 610500, China. Electronic address: a976443005@qq.com.
authors.forename: XinYi
authors.initials: X
authors.lastname: Shen
authors.affiliation: Department of Clinical Medicine, Chengdu Medical College, Chengdu 610500, China. Electronic address: 786699618@qq.com.
authors.forename: MingYi
authors.initials: M
authors.lastname: Liu
authors.affiliation: Department of Clinical Medicine, Chengdu Medical College, Chengdu 610500, China. Electronic address: 609623127@qq.com.
authors.forename: Yu
authors.initials: Y
authors.lastname: Cheng
authors.affiliation: Department of Pathology and Pathophysiology, Chengdu Medical College, Chengdu 610500, China. Electronic address: 183431605@qq.com.
authors.forename: Cui
authors.initials: C
authors.lastname: Jia
authors.affiliation: Department of Clinical Medicine, Chengdu Medical College, Chengdu 610500, China. Electronic address: 353212334@qq.com.
authors.forename: XinYue
authors.initials: X
authors.lastname: Pan
authors.affiliation: Department of Clinical Medicine, Chengdu Medical College, Chengdu 610500, China. Electronic address: gqy2298462@126.com.
authors.forename: QingYun
authors.initials: Q
authors.lastname: Gou
authors.affiliation: Department of Pathology and Pathophysiology, Chengdu Medical College, Chengdu 610500, China. Electronic address: 504080342@qq.com.
authors.forename: XinLian
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Pathology and Pathophysiology, Chengdu Medical College, Chengdu 610500, China. Electronic address: xinxiang1987106@163.com.
authors.forename: Hui
authors.initials: H
authors.lastname: Cao
authors.affiliation: Department of Pathology and Pathophysiology, Chengdu Medical College, Chengdu 610500, China; Development and Regeneration Key Laboratory of Sichuan Province, Department of Neurobiology, Chengdu Medical College, Chengdu 610500, China. Electronic address: zhangls2012@163.com.
authors.forename: LuShun
authors.initials: L
authors.lastname: Zhang
mesh_terms: D000203:Activities of Daily Living; D003863:Depression / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction; D020521:Stroke / Q000150:complications / Q000628:therapy*; D017741:Survivors / Q000523:psychology; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome
keywords: Meta-analysis; Post-stroke depression; Transcranial magnetic stimulation