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Table 2 Patient characteristics at baseline and depression scores in the active rTMS and sham groups in N = 40 RCTs

From: Short-term efficacy of repetitive transcranial magnetic stimulation (rTMS) in depression- reanalysis of data from meta-analyses up to 2010

Study Mean age (all patients) Female (% all patients) Treatment-resistanceA Bipolar (%)B Psychotic (%)C MedicationD Data source ScaleE Mean ± SD(number of patients) depression severity score
Baseline Last sessionF Baseline – last session
Sham rTMS Sham rTMS Sham rTMS
George et al. ([1997]) 42 92% some + 8% N/A + Tab one HAMD21 26 ± 3 (5) 30 ± 4 (7) 30 ± 8 (5) 23 ± 9 (7) -4 ± 7 (5) 7 ± 8 (7)
Avery et al. ([1999]) 44 83% + + 17% - + Tab one HAMD21 20 ± 8 (2) 21 ± 7 (4) 15 ± 2 (2) 11 ± 4 (4) 5 ± 7 (2) 10 ± 6 (4)
BDI21 20 ± 7 (2) 28 ± 7 (4) 14 ± 11 (2) 20 ± 11 (4) 6 ± 10 (2) 8 ± 10 (4)
Kimbrell et al. ([1999]) 42 54% N/A + 31% N/A - All (Tab one) HAMD21 24 ± 7 (3) 30 ± 8 (10) 25 ± 10 (3) 27 ± 10 (10) -1 ± 9 (3) 3 ± 9 (10)
20Hz 24 ± 7 (3) 25 ± 7 (5) 25 ± 10 (3) 28 ± 8 (5) -1 ± 9 (3) -3 ± 8 (5)
1Hz 24 ± 7 (3) 34 ± 8 (5) 25 ± 10 (3) 27 ± 13 (5) -1 ± 9 (3) 7 ± 11 (5)
Klein et al. ([1999]) 59 76% - + 19% + 23% + Tab two HAMD17 25 ± 6 (32) 26 ± 6 (35) 20 ± 10 (32) 14 ± 9 (35) 5 ± 9 (32) 12 ± 8 (35)
MADRS 34 ± 8 (32) 34 ± 5 (35) 27 ± 12 (32) 20 ± 12 (35) 7 ± 11 (32) 14 ± 10 (35)
Loo et al. ([1999]) 48 50% some + 17% + 6% + Authors HAMD21 25 ± 6 (9) 21 ± 7 (9) 19 ± 7 (9) 17 ± 7 (9) 6 ± 7 (9) 4 ± 7 (9)
MADRS 38 ± 6 (9) 33 ± 9 (9) 29 ± 10 (9) 26 ± 9 (9) 9 ± 9 (9) 7 ± 9 (9)
Padberg et al. ([1999]) 51 61% + - N/A + All HAMD21 22 ± 9 (6) 28 ± 9 (12) 24 ± 10 (6) 25 ± 8 (12) -2 ± 10 (6) 3 ± 8 (12)
Text 10Hz 22 ± 9 (6) 30 ± 10 (6) 24 ± 10 (6) 28 ± 9 (6) -2 ± 10 (6) 2 ± 10 (6)
Fig one 0.3Hz 22 ± 9 (6) 27 ± 9 (6) 24 ± 10 (6) 22 ± 6 (6) -2 ± 10 (6) 5 ± 8 (6)
Berman et al. ([2000]) 42 30% some + 5% + 5% - Tab one HAMD25 37 ± 8 (10) 37 ± 10 (10) 36 ± 9 (10) 25 ± 9 (10) 1 ± 8 (10) 12 ± 10 (10)
Eschweiler et al. ([2000]) 57 67% N/A - + 8% + Tab one HAMD21 20 ± 4 (5) 27 ± 4 (7) 23 ± 6 (5) 22 ± 5 (7) -3 ± 5 (5) 5 ± 5 (7)
BDI21 28 ± 10 (5) 40 ± 6 (7) 32 ± 9 (5) 33 ± 11 (7) -4 ± 10 (5) 7 ± 10 (7)
George et al. ([2000]) 44 63% N/A + 30% - - All (Tab one) HAMD21 24 ± 4 (10) 28 ± 6 (20) 19 ± 6 (10) 18 ± 9 (20) 5 ± 5 (10) 10 ± 8 (20)
Garcia-Toro et al. ([2001a]) 51 43% + - N/A + Tab two HAMD21 26 ± 5 (18) 27 ± 7 (17) 24 ± 4 (18) 20 ± 6 (17) 2 ± 5 (18) 7 ± 7 (17)
BDI17 26 ± 6 (18) 27 ± 9 (17) 24 ± 5 (18) 22 ± 7 (17) 2 ± 6 (18) 5 ± 8 (17)
Garcia-Toro et al. ([2001b]) 44 55% - N/A N/A +D1 Tab one HAMD21 27 ± 6 (11) 26 ± 6 (11) 18 ± 9 (11) 16 ± 8 (11) 9 ± 8 (11) 10 ± 7 (11)
BDI17 23 ± 7 (11) 27 ± 8 (11) 21 ± 8 (11) 19 ± 7 (11) 2 ± 8 (11) 8 ± 8 (11)
Manes et al. ([2001]) 61 50% some N/A N/A - Tab two HAMD21 23 ± 7 (10) 23 ± 5 (10) 16 ± 8 (10) 14 ± 5 (10) 7 ± 8 (10) 9 ± 5 (10)
Boutros et al. ([2002]) 51 22% + - N/A + Tab two HAMD25 36 ± 4 (7) 40 ± 10 (11) 26 ± 13 (7) 27 ± 13 (11) 10 ± 12 (7) 13 ± 12 (11)
Padberg et al. ([2002]) 57 70% + N/A N/A + All (Tab one, Fig two) HAMD21 24 ± 6 (10) 24 ± 6 (10) 22 ± 6 (10) 17 ± 9 (10) 2 ± 6 (10) 7 ± 8 (10)
MADRS 30 ± 6 (10) 29 ± 6 (10) 29 ± 6 (10) 19 ± 9 (10) 1 ± 6 (10) 10 ± 8 (10)
Fitzgerald et al. ([2003]) 46 43% + + 10% N/A + All MADRS 36 ± 8 (20) 37 ± 8 (40) 35 ± 8 (20) 32 ± 8 (40) 1 ± 8 (20) 5 ± 8 (40)
BDI21 32 ± 9 (20) 34 ± 11 (40) 29 ± 9 (20) 27 ± 11 (40) 3 ± 9 (20) 7 ± 11 (40)
Tab two 10Hz MADRS 36 ± 8 (20) 36 ± 8 (20) 35 ± 8 (20) 31 ± 8 (20) 1 ± 8 (20) 5 ± 8 (20)
BDI21 32 ± 9 (20) 33 ± 12 (20) 29 ± 9 (20) 27 ± 12 (20) 3 ± 9 (20) 6 ± 12 (20)
Tab two 1Hz MADRS 36 ± 8 (20) 38 ± 8 (20) 35 ± 8 (20) 32 ± 9 (20) 1 ± 8 (20) 6 ± 8 (20)
BDI21 32 ± 9 (20) 35 ± 9 (20) 29 ± 9 (20) 27 ± 11 (20) 3 ± 9 (20) 8 ± 10 (20)
Höppner et al. ([2003]) 59 70% N/A + 3% - + Fig two 20Hz HAMD21 25 ± 8 (10) 22 ± 4 (10) 13 ± 8 (10) 14 ± 5 (10) 12 ± 8 (10) 8 ± 5 (10)
Fig one 20Hz BDI21 28 ± 8 (10) 26 ± 7 (10) 22 ± 11 (10) 18 ± 8 (10) 6 ± 10 (10) 8 ± 8 (10)
Loo et al. ([2003]) 52 79% some + 16% N/A + Authors HAMD17 20 ± 4 (10) 24 ± 5 (9) 16 ± 7 (10) 19 ± 8 (9) 4 ± 6 (10) 5 ± 7 (9)
MADRS 33 ± 5 (10) 38 ± 6 (9) 27 ± 10 (10) 31 ± 14 (9) 6 ± 9 (10) 7 ± 12 (9)
Nahas et al. ([2003]) 43 61% N/A + 100% N/A - Authors HAMD28 33 ± 8 (12) 32 ± 4 (11) 24 ± 12 (12) 24 ± 12 (11) 9 ± 11 (12) 8 ± 11 (11)
Buchholtz et al. ([2004]) 50 31% N/A + 23% N/A + Authors HAMD17 24 ± 5 (7) 26 ± 3 (6) 13 ± 10 (7) 16 ± 3 (6) 11 ± 9 (7) 10 ± 3 (6)
Hausmann et al. ([2004]) 47 61% N/A N/A - +D1 Tab two HAMD21 34 ± 4 (13) 32 ± 6 (25) 22 ± 8 (13) 18 ± 9 (25) 12 ± 7 (13) 14 ± 8 (25)
BDI13 31 ± 12 (13) 32 ± 10 (25) 21 ± 14 (13) 17 ± 12 (25) 10 ± 13 (13) 15 ± 11 (25)
Holtzheimer et al. ([2004]) 43 47% + - - - Tab two HAMD17 21 ± 6 (8) 23 ± 5 (7) 15 ± 3 (8) 15 ± 3 (7) 6 ± 5 (8) 8 ± 4 (7)
BDI21 28 ± 11 (8) 30 ± 10 (7) 22 ± 2 (8) 24 ± 3 (7) 6 ± 10 (8) 6 ± 9 (7)
Kauffmann et al. ([2004]) 52 92% + N/A N/A + Text HAMD21 18 ± 5 (5) 22 ± 6 (7) 12 ± 4 (5) 11 ± 8 (7) 6 ± 4 (5) 11 ± 7 (7)
Koerselman et al. ([2004]) 52 56% N/A N/A N/A + Tab four HAMD17 26 ± 6 (26) 26 ± 4 (26) 22 ± 7 (24) 21 ± 7 (25) 4 ± 7 (25) 5 ± 6 (26)
Mosimann et al. ([2004]) 62 42% + + 17% N/A + Tab three HAMD21 24 ± 7 (9) 28 ± 5 (15) 20 ± 7 (9) 23 ± 7 (15) 4 ± 7 (9) 5 ± 6 (15)
BDI21 28 ± 11 (9) 30 ± 9 (15) 23 ± 11 (9) 24 ± 13 (15) 5 ± 11 (9) 6 ± 12 (15)
Poulet et al. ([2004]) 43 47% N/A N/A N/A +D1 Authors MADRS 36 ± 7 (9) 33 ± 5 (10) 17 ± 9 (9) 16 ± 8 (10) 19 ± 8 (9) 17 ± 7 (10)
BDI13 18 ± 6 (9) 21 ± 8 (10) 11 ± 7 (9) 14 ± 7 (10) 7 ± 7 (9) 7 ± 8 (10)
Rossini et al. ([2005])a 47 80% - - - +D1 Tab two HAMD21      8 ± 7 (47) 13 ± 7 (49)
Rumi et al. ([2005]) 39 85% N/A N/A - + Fig two MADRS 39 ± 8 (24) 38 ± 8 (22) 28 ± 12 (24) 14 ± 11 (22) 11 ± 11 (24) 24 ± 10 (22)
Su et al. ([2005]) 43 73% + + 17% - + All (Tab two) HAMD21 23 ± 5 (10) 24 ± 7 (20) 19 ± 8 (10) 11 ± 7 (20) 4 ± 7 (10) 13 ± 7 (20)
BDI21 33 ± 10 (10) 31 ± 9 (20) 29 ± 15 (10) 16 ± 10 (20) 4 ± 13 (10) 15 ± 10 (20)
Avery et al. ([2006]) 44 54% + - - + Tab one, Text HAMD17 24 ± 3 (33) 24 ± 4 (35) 20 ± 6 (33) 16 ± 8 (35) 4 ± 5 (33) 8 ± 7 (35)
BDI21 28 ± 8 (33) 28 ± 9 (35) 24 ± 8 (33) 17 ± 13 (35) 4 ± 8 (33) 11 ± 12 (35)
Fitzgerald et al. ([2006]) 45 62% + + 16% - + Authors, Tab two HAMD17 20 ± 5 (22) 23 ± 7 (25) 17 ± 6 (22) 16 ± 7 (25) 3 ± 6 (22) 7 ± 7 (25)
BDI21 29 ± 10 (22) 29 ± 10 (25) 22 ± 14 (22) 18 ± 10 (25) 7 ± 12 (22) 11 ± 10 (25)
MADRS 34 ± 6 (22) 34 ± 6 (25) 31 ± 8 (22) 26 ± 10 (25) 3 ± 7 (22) 8 ± 9 (25)
Garcia-Toro et al. ([2006]) 48 55% + - - + Tab two HAMD21 25 ± 7 (10) 27 ± 5 (10) 24 ± 8 (10) 20 ± 8 (10) 1 ± 8 (10) 7 ± 7 (10)
Januel et al. ([2006]) 38 78% - - N/A - Tab one HAMD17 22 ± 3 (16) 22 ± 4 (11) 17 ± 5 (16) 10 ± 6 (11) 5 ± 4 (16) 12 ± 5 (11)
Anderson et al. ([2007]) 47 55% some N/A N/A + Tab one MADRS 28 ± 7 (14) 27 ± 4 (11) 23 ± 10 (14) 15 ± 10 (11) 5 ± 9 (14) 12 ± 9 (11)
Bortolomasi et al. ([2007]) 56 58% N/A + 16% N/A + Fig two HAMD24 22 ± 4 (7) 25 ± 8 (12) 18 ± 5 (7) 11 ± 10 (12) 4 ± 5 (7) 14 ± 9 (12)
Fig one BDI21 27 ± 5 (7) 26 ± 7 (12) 22 ± 6 (7) 12 ± 10 (12) 5 ± 6 (7) 14 ± 9 (12)
Herwig et al. ([2007]) 50 60% some + 6% N/A +D1 Tab one HAMD21 23 ± 5 (65) 25 ± 5 (62) 14 ± 8 (65) 14 ± 6 (62) 9 ± 7 (59) 11 ± 6 (57)
Tab two
BDI21 27 ± 10 (65) 27 ± 9 (62) 18 ± 10 (65) 16 ± 9 (62) 9 ± 10 (59) 11 ± 9 (57)
MADRS 27 ± 6 (65) 28 ± 7 (62) 16 ± 9 (65) 17 ± 8 (62) 11 ± 8 (59) 11 ± 8 (57)
Loo et al. ([2007]) 48 47% - + 11% - + Tab two HAMD17 21 ± 4 (19) 19 ± 4 (19) 15 ± 7 (19) 12 ± 6 (19) 6 ± 6 (19) 7 ± 5 (19)
BDI21 34 ± 8 (19) 27 ± 8 (19) 27 ± 10 (19) 18 ± 10 (19) 7 ± 9 (19) 9 ± 9 (19)
MADRS 33 ± 4 (19) 30 ± 4 (19) 27 ± 10 (19) 19 ± 8 (19) 6 ± 9 (19) 11 ± 7 (19)
O’Reardon et al. ([2007]) 48 53% some - - - Tab one HAMD17 23 ± 4 (146) 23 ± 3 (155) 19 ± 6 (146) 17 ± 6 (155) 4 ± 5 (146) 6 ± 5 (155)
MADRS 34 ± 6 (146) 33 ± 6 (155) 30 ± 10 (146) 27 ± 11 (155) 4 ± 9 (146) 6 ± 10 (155)
Stern et al. ([2007]) 53 - some - - - All (Tab three) HAMD21 27 ± 3 (15) 28 ± 4 (30) 27 ± 4 (14) 19 ± 8 (28) 0 ± 4 (14) 9 ± 7 (29)
10Hz 27 ± 3 (15) 28 ± 3 (10) 27 ± 4 (14) 15 ± 6 (10) 0 ± 4 (14) 13 ± 5 (10)
1Hz L 27 ± 3 (15) 28 ± 4 (10) 27 ± 4 (14) 28 ± 6 (8) 0 ± 4 (14) 0 ± 5 (9)
1Hz R 27 ± 3 (15) 28 ± 4 (10) 27 ± 4 (14) 16 ± 5 (10) 0 ± 4 (14) 12 ± 5 (10)
Bretlau et al. ([2008]) 55 62% some N/A - +D1 Tab two HAMD17 25 ± 3 (23) 25 ± 3 (22) 19 ± 5 (23) 16 ± 4 (22) 6 ± 4 (23) 9 ± 4 (22)
Mogg et al. ([2008]) 54 63% some + 2% N/A + Authors HAMD17 22 ± 5 (30) 21 ± 5 (29) 20 ± 8 (29) 16 ± 9 (28) 2 ± 7 (30) 5 ± 8 (28)
BDI-II21 36 ± 10 (30) 38 ± 11 (29) 31 ± 15 (26) 26 ± 15 (28) 5 ± 13 (28) 12 ± 14 (28)
  1. Notes: All studies included patients with a major depressive episode and/or disorder according to DSM-IV and/or ICD-10 criteria. The mean number of patients per group was used in the final calculations if patients dropped out throughout the study between baseline and final sessions. All values ending with exactly 0.5 were rounded as follows to reduce the rounding error: zero and uneven numbers upwards (1.5 = 2), even numbers downwards (2.5 = 2). Standard error of the mean (SEM) was converted to standard deviation (SD) using the formula: SD = SEM × √N (where N = sample size of sham or rTMS groups). ’All’ indicates that scores for all independent subgroups within studies were combined. AATreatment-resistance: + are studies in which all patients failed (or showed intolerance to) ≥2 antidepressant trials (of same or different class) of an adequate dose/length during current or lifetime episode; − are studies in which all patients failed ≤1 antidepressant trials; ‘some’ are studies in which patients failed ≥1 antidepressant trial (these studies were excluded from all analyses because this category overlapped with the + and – categories); BBipolar (%): + are studies including any proportion of patients with bipolar disorder at baseline; − means that all patients had unipolar depression (no history of bipolar disorder, mania, hypomania, Axis I disorders); CPsychotic (%): + are studies including any proportion of patients with psychotic features at baseline; − means that all patients had non-psychotic depression (no history of psychosis, Axis I disorders); DMedication = antidepressants (+means any proportion of patients/study received stable doses, +D1 means that antidepressants were started on day 1 concurrently with rTMS, − means that all patients were unmedicated but some might have received mood stabilizers); EIt was assumed that HAMD21 or BDI21 were used if no further information was provided.; F"Last session" refers to the last session of the double-blind phase of a study. aDepression scores were reported as change scores from baseline (baseline – final session). Abbreviations: BDI, Beck Depression Inventory; D1, antidepressants started on day 1 concurrently with rTMS; DLPFC, dorsolateral prefrontal cortex; DSM-IV, Diagnostic and Statistical Manual of Mental Disorders; Fig, Figure; HAMD, Hamilton Depression Rating Scale; ICD-10, International Statistical Classification of Diseases and Related Health Problems; L, left DLPFC; MADRS, Montgomery Åsberg Depression Rating Scale; N/A, not reported or inadequate information; R, right DLPFC; RCT, randomised-controlled trial; rTMS, repetitive transcranial magnetic stimulation; SD, standard deviation; Tab, Table.
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