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

Table 3 Univariate random-effects subgroup analyses and meta-regressions in N = 32 HFL rTMS studies

Study subgroups^a	Nstudies (%)^b	d (95% CI)	p _two-tailed	Meta-regression predictors	Nstudies^b	Mode	Range	Regression line slopep _two-tailed
Treatment resistance	13			Patient characteristics
YES (all failed ≥2 AD trials)	10 (77%)	-.56 (−.81, −.32)	<.001*	Female patients (%)	32	47, 50	22-92	.003*
NO (all failed ≥1 AD trials)	3 (23%)	-.58 (−.90, −.26)	<.001*	Mean age (years)	32	43, 44	39-62	.194
Antidepressants	32			Bipolar patients (%)	24	0	0-100	.211
YES (any % of patients)	25 (78%)	-.51 (−.68, −.35)	<.001*	Psychotic patients (%)	14	0	0-8	.789
Stable dose	20 (80%)	-.54 (−.74, −.34)	<.001*	rTMS parameters
Started with rTMS	5 (20%)	-.43 (−.75, −.12)	.007*	Frequency (Hz)	32	10	5-20	.824
NO (all patients)	7 (22%)	-.33 (−.53, −.14)	.001*	Motor threshold (%)	32	80, 90, 110	80-120	.984
Bipolar depression	24			Total sessions	32	10	5-20	.813
YES (any % of patients)	16 (67%)	-.39 (−.62, −.16)	.001*	Stimuli/session	20	1600	250-3000	.021*^c
NO (all patients)	8 (33%)	-.45 (−.62, −.28)	<.001*	Total stimuli/study	20	16000	1250-60000	.124
Psychotic depression	14			Trains/session	28	20	5-100	.217
YES (any % of patients)	3 (21%)	-.73 (−1.78, .33)	.177	Inter-train interval (s)	31	30	8-60	.680
NO (all patients)	11 (79%)	-.59 (−.81, −.36)	<.001*
Coil-type	30
Figure-of-eight	28 (93%)	-.50 (−.66, −.34)	<.001*
Circular	2 (7%)	-.59 (−1.59, .42)	.254
Coil angle sham	32
0° (inactive coil)	2 (6%)	-.33 (−.85, .19)	.217
0° (sham coil)	5 (16%)	-.63 (−.98, −.28)	<.001*
45°	12 (38%)	-.27 (−.50, −.04)	.022*
90°	13 (41%)	-.61 (−.82, −.40)	<.001*

Notes: ^aThere were no statistically significant differences in effect sizes between subgroups. Subgroups were compared using the mixed-effect model (random-effects model was used to compute the overall mean weighted d in each subgroup, overall mean weighted d of subgroups were compared using the fixed-effect model because the number of subgroups was fixed). ^bNot all studies reported the characteristics investigated in this table. ^cUnlike % female patients, the slope of regression line of stimuli/session on weighted d was driven by the largest study in the current analysis ( O’Reardon et al. [2007]). After removal of this study the p-value of the slope of regression line was .061. Abbreviations: AD, antidepressant; d, weighted standardised mean difference (Cohen’s d); HFL, high-frequency left rTMS; rTMS, repetitive transcranial magnetic stimulation. *p < .05

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