BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) benefits adults with depression while its efficacy and safety in children and adolescents with major depressive disorder (MDD) remain unclear. We conducted a preliminary meta-analysis here to objectively appraise rTMS in the youth with MDD to inform future research and clinical practice.
METHODS: We searched Pubmed, Embase, Web of Science and the Cochrane Central Register of Controlled Trials from their inception to December 1, 2021. Studies with a control group or self-controlled designs and evaluating the Hamilton Depression Scale (HAM-D) or the Children's Depression Rating Scale-Revised (CDRS-R) at baseline and post-rTMS treatment were included. Two reviewers independently selected eligible studies, retrieved data in a structured fashion and assessed studies' quality. Hedges'g with 95% confidence intervals and withdrawal rate with 95% confidential intervals were separately used to evaluate the efficacy and safety of rTMS.
RESULTS: Thirteen studies with six datasets (165 patients, 61.8% female, age range from 10 to 25years old) were included and our meta-analysis found children and adolescents with MDD benefited from rTMS treatment (Hedges'g 1.37, 95% CI 0.85 to 1.90, P=0.001). In addition, 4% of patients (95% CI 0.02 to 0.09) withdrew during rTMS treatment for reasons including fear, mood swings, suicide ideation and adverse events.
LIMITATIONS: This conclusion is tempered by a small number of studies included and a potentially existing placebo effect.
CONCLUSIONS: Our findings suggest rTMS could benefit children and adolescents with MDD in a relatively safe manner, and this result may help guide clinical practice.
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