Table 1.
Characteristics of the included studies.
| Authors | Active rTMS | Sham rTMS | Blinding | Cortical Target | Frequency (Hz) | Sessions | Total Pulses | Treatment Duration (Weeks) | Follow-Up (Weeks) | Sham Strategy | Treatment Resistant | Comorbid MDD | ||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| n | Age (Mean ± SD) | F/M | N | Age (Mean ± SD) | F/M | |||||||||||
| Alonso et al. (2001) [54] | 10 | 39.2 ± 13 | 8/2 | 8 | 30.3 ± 9.5 | 4/4 | double-blind | R-DLPFC | 1 (LF) | 18 | 21,600 | 6 | 10 | tilted coil | Yes | None |
| Prasko et al.(2006) [55] | 18 | 28.9 ± 7.7 | 5/13 | 12 | 33.4 ± 8.7 | 7/5 | double-blind | L-DLPFC | 1 (LF) | 10 | 18,000 | 2 | 2 | tilted coil | Yes | None |
| Sachdev et al. (2007) [56] | 10 | 29.5 ± 9.9 | 3/7 | 8 | 35.8 ± 8.2 | 5/3 | double-blind | L-DLPFC | 10 (HF) | 10 | 15,000 | 2 | N/A | Inactive coil | Yes | None |
| Ruffini et al. (2009) [57] | 16 | 41.5 ± 9.06 | 6/10 | 7 | 39.3 ± 9.55 | 3/4 | single-blind | L-OFC | 1 (LF) | 15 | 9000 | 3 | 12 | tilted coil | Yes | None |
| Kang et al. (2009) [58] | 10 | 28.6 ± 12.66 | 2/8 | 10 | 26.2 ± 10.52 | 1/9 | rater blinded | R-DLPFC and SMA | 1 (LF) | 10 | 12,000 | 2 | 2 | tilted coil | Yes | Yes |
| Sarkhel et al. (2010) [59] | 21 | 29.38 ± 6.55 | 11/10 | 21 | 31.95 ± 7.81 | 8/13 | single-blind | R-DLPFC | 10 (HF) | 10 | 8000 | 2 | 2 | tilted coil | N/A | Yes |
| Badawy et al. (2010) [60] | 20 | 26 ± 5.58 | 10/10 | 20 | 28.9 ± 5.7 | 13/7 | single-blind | L-DLPFC | 20 (HF) | 15 | 12,000 | 3 | N/A | tilted coil | Yes | None |
| Mantovani et al. (2009) [61] | 9 | 39.7 ± 8.6 | 4/5 | 9 | 39.4 ± 10.2 | 3/6 | double-blind | BL-pre-SMA | 1 (LF) | 20 | 24,000 | 4 | N/A | sham coil | Yes | Yes |
| Mansur et al. (2011) [62] | 13 | 42.1 ± 11.9 | 6/7 | 14 | 39.3 ± 13.9 | 8/6 | double-blind | R-DLPFC | 10 (HF) | 30 | 60,000 | 6 | 6 | Inactive coil | Yes | Yes |
| Gomes et al. (2012) [63] | 12 | 35.5 ± 7.5 | 8/4 | 10 | 37.5 ± 16 | 5/5 | double-blind | SMA | 1 (LF) | 10 | 12,000 | 2 | 12 | sham coil | Yes | Yes |
| Ma et al. (2014) [64] | 25 | 27.12 ± 8.97 | 8/17 | 21 | 29.86 ± 9.42 | 8/13 | double-blind | BL-DLPFC | 8–12 (HF) | 10 | 6480–8720 | 2 | 1 | sham coil | Yes | None |
| Nauczyciel et al. (2014) [65] | 9 | 40 | 7/2 | 10 | 39 | 8/2 | double-blind | OFC | 1 (LF) | 10 | 12,000 | 1 | 4 | tilted coil | Yes | Yes |
| Haghighi (2015) [66] | 10 | 34.9 ± 5.91 | 3/7 | 11 | 36.55 ± 3.95 | 6/5 | single-blind | BL-DLPFC | 20 (HF) | 20 | 7500 | 2 | 2 | tilted coil | Yes | None |
| Seo et al. (2016) [67] | 14 | 34.6 ± 9.8 | 6/8 | 13 | 36.3 ± 12.5 | 7/6 | single-blind | R-DLPFC | 1 (LF) | 15 | 18,000 | 3 | N/A | sham coil | Yes | Yes |
| Hawken et al. (2016) [68] | 10 | 33 ± 10 | 3/7 | 12 | 34 ± 14 | 8/4 | double-blind | BL-SMA | 1 (LF) | 25 | N/A | 6 | 6 | tilted coil | Yes | None |
| Jahangard et al. (2016) [69] | 5 | 32.40 ± 8.97 | 1/4 | 5 | 33.80 ± 5.81 | 2/3 | single-blind | BL-DLPFC | 20 (HF) | 20 | 7500 | 2 | 2 | tilted coil | Yes | None |
| Pelissolo et al. (2016) [70] | 20 | 39.1 ± 10.4 | 13/7 | 16 | 42.3 ± 10.6 | 9/7 | double-blind | pre-SMA | 1 (LF) | 20 | 30,000 | 4 | N/A | sham coil | Yes | Yes |
| Elbeh et al. (2016) 1 [71] | 15 | 26.8 ± 5.2 | 4/11 | 15 | 25.5 ± 4 | 5/10 | double-blind | R-DLPFC | 1 (LF) | 10 | 20,000 | 2 | 12 | tilted coil | Yes | None |
| Elbeh et al. (2016) 2 [71] | 15 | 28.9 ± 3.9 | 6/9 | 15 | 25.5 ± 4 | 5/10 | double-blind | R-DLPFC | 10 (HF) | 10 | 20,000 | 2 | 12 | tilted coil | Yes | None |
| Shayganfard et al. (2017) [72] | 5 | 33.8 ± 9.55 | 4/1 | 5 | 33.2 ± 7.86 | 2/3 | single-blind | BL-DLPFC | 20 (HF) | 10 | 7500 | 2 | 2 | tilted coil | Yes | None |
| Arumugham et al. (2018) [73] | 19 | 27.74 ± 7.88 | 3/16 | 17 | 30.71 ± 10.43 | 5/12 | double-blind | pre-SMA | 1 (LF) | 18 | 21,600 | 3 | N/A | sham coil | Yes | Yes |
| Zhang et al. (2019) [74] | 25 | 32.2 ± 13.25 | 10/15 | 24 | 39.38 ± 17.04 | 10/14 | double-blind | pre-SMA | 1 (LF) | 20 | 24,000 | 4 | 2 | sham coil | Yes | None |
| Ziblak et al. (2020) [75] | 19 | 41.47 ± 10.23 | 14/5 | 15 | 36.53 ± 13.69 | 9/6 | double-blind | R-OFC | 1 (LF) | 20 | 20,000 | 2 | 2 | tilted coil | Yes | None |
| Ji et al. (2021) [76] | 20 | 27.75 ± 1.58 | 5/15 | 17 | 27.65 ± 1.73 | 5/12 | double-blind | R-preSMA | 1 (LF) | 14 | 25,200 | 2 | N/A | sham coil | Yes | None |
| Meek et al. (2021) [77] | 10 | 45 ± 16.7 | 6/4 | 10 | 38.3 ± 11.5 | 4/6 | double-blind | dACC | 1 (LF) | 20 | 24,000 | 2 | N/A | sham coil | N/A | N/A |
| Joshi et al. (2022) [78] | 13 | 31.85 ± 7.56 | 7/6 | 11 | 25.36 ± 5.07 | 3/8 | double-blind | SMA | 1 (LF) | 20 | 32,000 | 3 | N/A | sham coil | No | Yes |
| Khedr et al. (2022) 1 [79] | 20 | 36.9 ± 11.5 | 11/9 | 20 | 35.35 ± 9.38 | 10/10 | double-blind | R-DLPFC | 1 (LF) | 10 | 15,000 | 2 | 12 | tilted coil | No | Yes |
| Khedr et al. (2022) 2 [79] | 20 | 34.05 ± 10.23 | 11/9 | 20 | 35.35 ± 9.38 | 10/10 | double-blind | R- OFC | 1 (LF) | 10 | 15,000 | 2 | 12 | tilted coil | No | Yes |
| Jahanbakhsh et al. (2023) [80] | 15 | 34.07 ± 8.34 | 9/6 | 15 | 34.53 ± 9.75 | 11/4 | double-blind | L-DLPFC | 1 (LF) | 15 | 18,000 | 3 | 12 | Inactive coil | Yes | None |
R-DLPFC: right dorsolateral prefrontal cortex, L-DLPFC: left dorsolateral prefrontal cortex, BL-DLPFC: bilateral dorsolateral prefrontal cortex, pre-SMA: pre-supplementary motor area, dACC: dorsal anterior cingulate cortex, OFC: orbitofrontal cortex, HF: high-frequency stimulation, LF: low-frequency stimulation, N/A: not applicable to studies without follow-up data.